SGEM#383: Tommy Can You Hear Me – Deaf and Hard-of-Hearing (DHH) Patients in the ED

Date: November 26th, 2022 Reference: James et al. Emergency Department Condition Acuity, Length of Stay, and Revisits Among Deaf and Hard-of-Hearing Patients: A Retrospective Chart Review. AEM November 2022 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Click on the LINK for a transcript of the podcast Case: One night you grab the next patient on the board, and upon entering the room introduce yourself as you normally would. The patient waves at you and gestures to a friend in the room, who explains that the patient is deaf and needs a sign language interpreter. You know from your brief look at the triage report that the patient’s vitals are stable and their chief complaint isn’t likely to be immediately life threatening, so you politely explain you’ll be back, and go find the charge nurse to obtain interpreter services. Background: The emergency department sees anyone at anytime for anything. This includes some patients who have difficulty accessing the healthcare system due to social determinants of health, race, gender, mental health, substance use disorder, and physical difficulties. Deaf and hard-of-hearing (DHH) experience disparities in social outcomes as well as health inequities (1), likely due to audism, which creates privilege for non-DHH people in our society (2). DHH patients are more likely to use the ED than non-DHH patients, but little research has been done to compare ED-focused outcomes for these groups of patients (1, 3-4). DHH patients are heterogenous, with adult-onset DHH patients being less likely to use American Sign Language (ASL) with proficiency (5). DHH ASL users may have delays due to interpreter availability, potentially resulting in care discrepancies (1, 6). Clinical Question: How do deaf and hard-of-hearing (DHH) American Sign Language speakers and DHH English speakers utilize the ED, specifically regarding acuity of complaints and pain, what is their ED length of stay and what is the prevalence of acute revisits? Reference: James et al. Emergency Department Condition Acuity, Length of Stay, and Revisits Among Deaf and Hard-of-Hearing Patients: A Retrospective Chart Review, AEM November 2022 Population: All DHH-American Sign Language, DHH-English speakers, non-DHH English speakers users who had used a single academic center for care Excluded: Patients who had not had an ED visit during the time period Intervention: None Comparison: Non-DHH English speakers were compared to DHH ASL-users and DHH English speakers Outcomes: Primary Outcome: Emergency Severity Index (ESI), triage pain score, ED length of stay (LOS), and acute ED revisit (defined as within 9 days) Type of Study: Retrospective chart review of a single health care system Dr. Tyler James This is an SGEMHOP episode which means we have the lead author on the show Dr. Tyler James. Dr. James is a Postdoctoral Research Fellow in the Department of Family Medicine at the University of Michigan Medical School. His research focuses on healthcare access, utilization, and delivery for people with disabilities, with specific interest in working with people with sensory disabilities. He is also a mixed methods research methodologist, and serves as Associate Editor for Media Reviews of the Journal of Mixed Methods Research. Authors’ Conclusions: Our study identified that DHH ASL-users have longer ED LOS than non-DHH English-speakers. Additional research is needed to further explain the association between DHH status and ED care outcomes (including ED LOS, and acute revisit), which may be used to identify intervention targets to improve health equity. Quality Checklist for Observational Study: Did the study address a clearly focused issue? Yes Did the authors use an appropriate method to answer their question? Yes Was the cohort recruited in an acceptable way?...