Association Between Parent Comfort With English and Adverse Events Among Hospitalized Children

Key PointsQuestionDo hospitalized children of parents expressing limited comfort with English (LCE) have higher odds of adverse events than children of parents expressing comfort with English? FindingsIn this cohort study of 1666 parents of hospitalized children, 147 parents (8.8%) expressed LCE. Using systematic safety surveillance (medical record review, clinician reports, hospital incident reports, and family safety reporting), children of parents expressing LCE had 2.1 higher odds of adverse events than children of parents who expressed comfort with English, after controlling for other factors. MeaningHospitalized children of parents expressing LCE were at higher risk for adverse events; dedicated interventions to improve communication and safety in this vulnerable population are needed. This study examines the association between parents' limited comfort with English (LCE) and adverse events in a cohort of hospitalized children. ImportanceChildren of parents expressing limited comfort with English (LCE) or limited English proficiency may be at increased risk of adverse events (harms due to medical care). No prior studies have examined, in a multicenter fashion, the association between language comfort or language proficiency and systematically, actively collected adverse events that include family safety reporting. ObjectiveTo examine the association between parent LCE and adverse events in a cohort of hospitalized children. Design, Setting, and ParticipantsThis multicenter prospective cohort study was conducted from December 2014 to January 2017, concurrent with data collection from the Patient and Family Centered I-PASS Study, a clinician-family communication and patient safety intervention study. The study included 1666 Arabic-, Chinese-, English-, and Spanish-speaking parents of general pediatric and subspecialty patients 17 years and younger in the pediatric units of 7 North American hospitals. Data were analyzed from January 2018 to May 2020. ExposuresLanguage-comfort data were collected through parent self-reporting. LCE was defined as reporting any language besides English as the language in which parents were most comfortable speaking to physicians or nurses. Main Outcomes and MeasuresThe primary outcome was adverse events; the secondary outcome was preventable adverse events. Adverse events were collected using a systematic 2-step methodology. First, clinician abstractors reviewed patient medical records, solicited clinician reports, hospital incident reports, and family safety interviews. Then, review and consensus classification were completed by physician pairs. To examine the association of LCE with adverse events, a multivariable logistic regression was conducted with random intercepts to adjust for clustering by site. ResultsOf 1666 parents providing language-comfort data, 1341 (80.5%) were female, and the mean (SD) age of parents was 35.4 (10.0) years. A total of 147 parents (8.8%) expressed LCE, most of whom (105 [71.4%]) preferred Spanish. Children of parents who expressed LCE had higher odds of having 1 or more adverse events compared with children whose parents expressed comfort with English (26 of 147 [17.7%] vs 146 of 1519 [9.6%]; adjusted odds ratio, 2.1; 95% CI, 1.2-3.7), after adjustment for parent race and education, complex chronic conditions, length of stay, site, and the intervention period. Similarly, children whose parents expressed LCE were more likely to experience 1 or more preventable adverse events (adjusted odds ratio, 2.3; 95% CI, 1.2-4.2). Conclusions and RelevanceHospitalized children of parents expressing LCE were twice as likely to experience harms due to medical care. Targeted strategies are needed to improve communication and safety for this vulnerable group of children.