Case

You enter the room to see the next case and find two people. One is the patient and the other is a friend. Before you can introduce yourself, the friend interrupts you to let you know the patient is hard of hearing and needs a sign language interpreter. The patient is stable, so you acknowledge the situation and excuse yourself to arrange interpreter services.

Clinical Question

What is the Emergency Severity Index (ESI), triage pain score, emergency department (ED) length of stay (LOS), and acute ED revisit rate in deaf and hard-of-hearing (DHH) American Sign Language speakers and DHH English speakers who utilize the ED?

Background

DHH patients experience disparities in social outcomes as well as health inequities.¹ This is likely due to audism, which creates privilege for non-DHH people in our society.²

It has been reported that DHH patients are more likely to use the ED than non-DHH patients. However, little research has been done to compare ED-focused outcomes for these two 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 also have delays due to interpreter availability, potentially resulting in care discrepancies.^1,6

Reference: James TG, et al. Emergency department condition acuity, length of stay, and revisits among deaf and hard-of-hearing patients: A retrospective chart review. Acad Emerg Med. 2022;29(11):1290-1300.

• Population: Patients presenting to a single academic center for care between June 2011 and April 2020
• Excluded: Patients who had not had an ED visit during that time or who were non-English-speaking
• Intervention: None
• Comparison: Non-DHH English speakers were compared to DHH ASL users and DHH English speakers
• Outcomes: 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

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.”

Results

This study included 100 percent of DHH-ASL people (n=277) and compared them to 1,000 randomly sampled DHH English speakers and 1,000 randomly sampled non-DHH English speakers. During the time frame, 39 percent, 36 percent, and 30 percent, respectively, had an ED visit that could be analyzed. The mean age of the cohort was mid to late 40s, just over half were women, and about two-thirds identified as white.