Closing the Gap in Language With Audio Instructions: An Exploratory Pilot Study

Significance: Not all patients can read discharge instructions even when the documentation is provided in their preferred language. Our emergency department strives to provide language-concordant discharge instructions to all patients; however, we do not have access to written instructions in Haitian creole, K'iche, or other less commonly spoken languages. Providers often give these patients discharge instructions in English, or the next closest language, such as French for our Haitian creole speaking patients, or Spanish for K'iche speaking patients. Discharge instructions are also provided verbally using a language-concordant phone interpreter. However, connectivity issues and interpreter access often pose challenges to effective communication and verbal instructions are often an overwhelming amount of information to process and remember. At Women and Infants Hospital, the most vulnerable populations are Haitian Creole and K'iche, but those of Spanish speaking descent are also at risk.

Hypothesis/Outcomes: For patients who cannot read in their preferred language, if they are provided audio instructions in their preferred language, these instructions will be acceptable, feasible, and useful to patients.

Procedures:

1. Establish Degree of the Problem

2. Administer initial exploratory survey (part of the post-intervention survey) to:

   • Determine literacy
   • Preferred mode of instructions: written vs audio vs video
   • Satisfaction of discharge instructions from previous experiences

3. Provide Intervention

   • Work with interpreter services to interpret audio instructions in Spanish, Haitian Creole and K'iche for the following complaints: Labor/Preterm Labor, Vaginal Bleeding in Pregnancy (2TM/3TM and threatened miscarriage), Fetal Kick Counts
   • Store Audio Instructions on an online database with associated QR code.

4. Post-Intervention Survey

   • Medical student will verbally go through the post-intervention survey with patients
   • To be provided within 48-72 hours post-discharge
   • Medical student to confirm telephone number and good time to call.
   • Will include an extra question concerning how many times they listened to the audio recording VS having the QR code record the number of listens.

Post-Intervention Survey Questions

1. Patient identification question:

   • Name
   • DOB
   • MRN
2. What is your preferred language?
3. Are you able to understand written text? Y N
4. Have you ever been asked if you understand written text in the healthcare setting?
5. If you have received written instructions from any hospital prior, what was your satisfaction with them?
6. On a scale of 0-10, how helpful were the audio discharge instructions?
7. Did you feel confident in the instructions you received? Y N
8. How many times did you or your family members listen to the audio recording?
9. Would you use the audio discharge tool in the future?
10. Would you recommend the audio discharge tool to others?
11. In your own words, can you describe how the audio discharge tool helped you understand your medical care?
12. Can you tell us one thing you learned from the instructions?
13. Is there another form of instructions you prefer: Written, Audio only, Video with Audio