Language Is a Factor in Readmission Risk

Language Is a Factor in Readmission Risk

A recent study in the International Journal of Nursing Studies shows a direct correlation between a patient’s language preference and the risk of being readmitted to the hospital from a home health care environment.

Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: A retrospective analysis shows that when a patient in a predominantly English-speaking hospital or healthcare facility had a language preference that differs from English, the risk for being readmitted within a 30-day period increased. Although the reasons behind the finding are varied, the overall study offers a warning about language barriers being an additional risk factor for poorer health outcomes.

“Part of the issue with readmission is that it is always complicated,” says Allison Squires, PhD, RN, FAAN, associate professor at NYU Rory Meyers College of Nursing and the study’s lead author. Often, the outcome comes down to how well the language barrier was handled in a healthcare encounter, she says. If the patient has complex health issues or is sent home too early, language barriers will only make things more difficult.

When patients don’t have a needed interpreter, they likely won’t have a good enough explanation of services. “First and foremost, is there proper implementation by language services,” says Squires. Nurses must also be given the proper time to work with a patient, especially if extra time is needed for an interpreter’s services. “If you have to be in the hospital these days, you have to be pretty sick in general,” she says. “A language barrier makes it even trickier.”

Squires says that while many in the medical community have known about this problem for a long time, this is the first study to actually show the direct link. The best way to help take steps to lessen this effect is for healthcare workers to ensure a patient’s language preference is accurate and listed in the medical records and that interpreter’s services are available.

For instance, if a patient visits a primary care physician and speaks a little English, they might be listed as an English speaker, even if they don’t speak it well. Without the accurate language preference on record, it might look like the patient doesn’t need an interpreter when in fact they do, says Squires.

Attentive nurses can change that when they first encounter a patient (although in an emergency situation, that might not be possible) so they can record the patient’s language preference with accuracy. They can also document every time an interpreter is used–whether by phone, video or in person. It’s important to also note when an interpreter was expected but didn’t show up when they were supposed to. This isn’t to get anyone in trouble, but shows that a discharge might have been delayed because of that and nurses didn’t want to rush the process.

The potential for language misunderstandings is profound. Patients could have difficulty communicating when they are hungry or in pain or even if they need to use the bathroom. A patchwork of hand gestures is also difficult to interpret and could open the door for some serious cultural miscommunication, says Squires.

And the stopgap method of pulling in a nurse who speaks the patient’s language isn’t the best practice. The nurse might speak the language, but that doesn’t mean they can read or write it fluently enough to give the patient accurate medical information. And the practice isn’t helpful for the patient’s transition to home care.

Healthcare organizations are moving to correct this issue, says Squires, and it takes a comprehensive effort. Sending care instructions home in the patient’s language and in their caregiver’s (both a home health care provider and a family member) language is necessary to prevent any mix ups. And ensuring the patient has access to an interpreter or a care provider who speaks the same language is important for accurate care and for positive outcomes.

Although Squires says the study’s findings weren’t unexpected, there was a finding that surprised her. “Russian speaking patients have the second-highest risk for readmission,” she says, blasting the stereotype that only people of color speak a different language and need interpreters. The more it is recognized and mitigated, that patient is less likely to return to the hospital with an often-preventable readmission. “A language barrier is a language barrier,” Squires notes, “and it ups your risk of readmission.”