Article: Plancarte, Carlos A., et al. “Association Between English Proficiency and Timing of Analgesia Administration After Surgery.” Hospital Pediatrics, vol. 11, no. 11, 2021, pp. 1199 -1204. DOI 10.1542/hpeds.2020-005766
Fellow: Danielle Smith, MD PGY 5 Cohen Children’s Medical Center
Summary: Both pediatric and adult studies have demonstrated disparities in health for racial and ethnic minority patients, specifically in relation to analgesia administration. This was a single-center, retrospective cohort study which hypothesized that there were disparities between English Proficient (EP) and Limited English Proficiency (LEP) families in analgesic administration in the postoperative period. Analgesia was defined as acetaminophen, non-steroidal anti inflammatories, or opiates. The study was conducted in a New York City borough in which only 41% of the population older than five speaks only English at home. Patients 1 to 18 year old and admitted to the general floor after surgical correction of a single limb fracture between July 2016 and July 2019 were included in the study. Limited English Proficiency was assigned to patients whose consent was in a non-English Language or for whom an interpreter was used. The authors found that within the first 12 hours post op, pediatric patients in LEP families received analgesia significantly less often (LEP 86.4% vs EP 96.8% P≤0.01) and also waited a significantly longer time to receive their first dose of medication. The authors noted a non-significant trend for LEP patients to be less likely to receive opiate medications and experience delays in time to first dose compared to EP patients. At 24 hours post op, there were no significant differences between EP and LEP families.
Key Strengths: This study explored an area, language disparities in hospitalized patients, that is not well studied in pediatrics.
Limitations/Flaws: The LEP group only consisted of 59 patients which is not a large number given the breakdown mentioned for the community. The process to determine LEP families for this paper allows for misclassification and it does not factor in the child’s own proficiency. The mean age of the patients in the study was nine, so it is possible that some of the children were able to interact with the medical team in English. Also this was a single center study which will affect its generalizability and observed differences may represent practice habits at a single center. The cohort of LEP families was small relative to EP families in this study as well.
Takeaway Message: Although we often feel that we are providing the same care to all our patients, multiple studies have found disparities in care based on social determinants of health. In this study, they demonstrated differences in the care being provided to the families of LEP patients. More research needs to be done to investigate these relationships and proposed changes so we can work towards equitable care.
Practice Impact: This article should impact our practice in several ways. The first is being mindful of our implicit bias and how it impacts the care we provide our patients. Secondly, by standardizing aspects of any process, in this case pain score assessment frequency and each medication being assigned a pain score range we could decrease the likelihood of any bias affecting care. Finally, patient assessments should occur in their primary language.
Fellow: Danielle Smith, MD PGY 5 Cohen Children’s Medical Center
Summary: Both pediatric and adult studies have demonstrated disparities in health for racial and ethnic minority patients, specifically in relation to analgesia administration. This was a single-center, retrospective cohort study which hypothesized that there were disparities between English Proficient (EP) and Limited English Proficiency (LEP) families in analgesic administration in the postoperative period. Analgesia was defined as acetaminophen, non-steroidal anti inflammatories, or opiates. The study was conducted in a New York City borough in which only 41% of the population older than five speaks only English at home. Patients 1 to 18 year old and admitted to the general floor after surgical correction of a single limb fracture between July 2016 and July 2019 were included in the study. Limited English Proficiency was assigned to patients whose consent was in a non-English Language or for whom an interpreter was used. The authors found that within the first 12 hours post op, pediatric patients in LEP families received analgesia significantly less often (LEP 86.4% vs EP 96.8% P≤0.01) and also waited a significantly longer time to receive their first dose of medication. The authors noted a non-significant trend for LEP patients to be less likely to receive opiate medications and experience delays in time to first dose compared to EP patients. At 24 hours post op, there were no significant differences between EP and LEP families.
Key Strengths: This study explored an area, language disparities in hospitalized patients, that is not well studied in pediatrics.
Limitations/Flaws: The LEP group only consisted of 59 patients which is not a large number given the breakdown mentioned for the community. The process to determine LEP families for this paper allows for misclassification and it does not factor in the child’s own proficiency. The mean age of the patients in the study was nine, so it is possible that some of the children were able to interact with the medical team in English. Also this was a single center study which will affect its generalizability and observed differences may represent practice habits at a single center. The cohort of LEP families was small relative to EP families in this study as well.
Takeaway Message: Although we often feel that we are providing the same care to all our patients, multiple studies have found disparities in care based on social determinants of health. In this study, they demonstrated differences in the care being provided to the families of LEP patients. More research needs to be done to investigate these relationships and proposed changes so we can work towards equitable care.
Practice Impact: This article should impact our practice in several ways. The first is being mindful of our implicit bias and how it impacts the care we provide our patients. Secondly, by standardizing aspects of any process, in this case pain score assessment frequency and each medication being assigned a pain score range we could decrease the likelihood of any bias affecting care. Finally, patient assessments should occur in their primary language.