P2B055: The Impact of Limited English Proficiency on Pediatric Emergency Department Length of Stay: A Single Center Experience

Background: Clear communication between healthcare providers and patients is vital in the Emergency Department (ED). A Limited English Proficiency (LEP) person, according to the US Census Bureau, refers to anyone age 5 and older who speaks English less than “very well”. In our Pediatric Emergency Department (PED), families identified as requiring interpreter services have been excluded from the “Fast Track” area due to limited resources. The objective of this study was to assess the impact on the patient experience, primarily length of stay (LOS) and number of tests performed.

Methods: We performed a retrospective chart review of patients 18 years of age or less, triaged as low acuity with an Emergency Severity Index (ESI) of 4 or 5, evaluated in the PED in August 2022. Subjects were excluded if they presented with a chief complaint not seen in our Fast Track such as injury or abuse, were evaluated at a satellite location without Fast Track, or arrived in the PED during times Fast Track was closed. We abstracted demographic information, use of interpreter services, time of ED arrival and discharge, time seen by provider, time of laboratory and/or imaging order, and any procedures performed. Patients identified with a primary language other than English were categorized as LEP patients. Categorical variables were compared by a Chi Square test and continuous variables were compared by a Mann-Whitney U test. The Institutional Review Board study number is 2022–1408.

Results: We analyzed 1153 patient charts including 50 LEP patients and 1103 primary English speakers (Table 1). The two groups did not differ by age (p=0.63) or gender (p=0.18). However, there were significant differences in the distribution of race and ethnicity (p < 0.001). LEP patients showed longer median lengths of stay (123 minutes vs. 105 minutes, p=0.028), slightly higher acuity (p=0.059), and more frequent admission (p=0.035). A univariate accelerated failure time model confirmed that LEP status was associated with longer stays (Time Ratio [TR]: 1.26, 95% CI: 1.02 – 1.57, p=0.032). However, in a covariate-adjusted model (Table 2), longer stays were associated with acuity (TR: 1.43, 95% CI: 1.30 - 1.58, p< 0.001) and admission (TR: 7.26, 95% CI: 4.83 – 10.9, p< 0.001), but not LEP status (TR: 1.14, 95% CI: 0.93 – 1.39, p=0.20).

Conclusion: LEP patients had a significantly longer LOS than primary English-speaking patients. We also found a slight difference in acuity and imaging studies. After adjusting for these variables, the use of an interpreter, but not English proficiency alone, predicted increased LOS. Limitations of the study include inconsistent documentation of preferred language and interpreter use in the medical record. Next steps include improving the identification and documentation of language preference as well as process changes to decrease the LOS for LEP families.