Imagine you develop food poisoning while traveling in the Philippines. You receive discharge instructions that say:

“Mangyaring manatiling hydrated sa pamamagitan ng pag-inom ng likido na may electrolytes. Gamitin ang Zofran ayon sa reseta kung kinakailangan para sa pagduduwal o pagsusuka. Bumalik sa emergency department kung lumala ang pananakit ng tiyan, magkaroon ng lagnat o anumang iba pang nakakabahalang sintomas.”

Would you know what to do next?

This is what so many patients with limited English proficiency in the US face every day when they encounter the medical system. They receive discharge instructions only in English, many times not in their native language.

Discharge notes and patient instructions are essential after every medical encounter. They help patients understand what happened during the encounter, which medications to take, and the necessary next steps.

Challenges Faced by LEP Patients

One study¹ found that significant disparities exist in patient-reported post-discharge issues. The results indicate a need for better discharge processes that focus on communication quality and health equity.

Patients with LEP were more likely to report problems with all measured post-discharge issues. A greater number of LEP patients had questions regarding the information in their discharge instructions compared to patients with English proficiency (EP). More LEP patients needed help getting their prescriptions filled and had concerns about their medications. After discharge, LEP patients were more likely to have questions about follow-up care. They were also more likely to experience new or worsening symptoms and have other clinical questions for nurses.

Another study² suggests that only 12% of patients reported having access to professional interpreters when discharge instructions were provided. Additionally, a different study³ found that LEP patients' understanding was generally low regarding follow-up appointment types and medication outcomes.

Health Workflows

While many health institutions have policies for translating general documents (such as consent forms), one study⁴ found that only 76% of providers reported translating discharge instructions. The barriers to effective translation include uncommon languages, mismatched discharge and translation timeframes, and inconsistent use of translation services by clinical staff.

Some providers resort to using tools like Google Translate to translate discharge notes. However, Google Translate is not HIPAA-compliant, has privacy issues, and should not be used with PHI. Studies⁵ also suggest that its accuracy can be inconsistent.

Why Current Discharge Notes May Not Be Effective for LEP Patients

Possible reasons include:

• No translation or inaccurate translation of discharge notes
• A mismatch between the patient’s literacy level and the provider’s notes
• Workflow issues, such as not carefully reviewing the discharge note with the patient to ensure understanding

How Can We Improve?

There is a need for new processes, technology, and workflows to achieve better outcomes by:

• Generating highly accurate translations of discharge notes to all LEP encounters
• Making them simple enough to understand by patients
• Delivering them quickly and efficiently, so providers will utilize them at scale

One way to meet these demands is by harnessing the latest technology to generate accurate translations on the spot, making the workflow faster for providers.

In summary: Creating clear and simple discharge notes for patients with limited English proficiency is essential in healthcare. Existing processes should support the need for accurate translations and clear workflows within the often stressful healthcare environment. New AI technology should be considered to support these objectives.


Resources

1. Disparities After Discharge: The Association of Limited English Proficiency and Post-Discharge Patient Reported Issues - link
2. Caregiving for Older Adults with Limited English Proficiency: Transitioning from Hospital to Home - link
3. Language Barriers and Understanding of Hospital Discharge Instructions - link‍
4. Translating Discharge Instructions for Limited English–Proficient Families: Strategies and Barriers - link‍
5. A Pragmatic Assessment of Google Translate for Emergency Department Instructions - link

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