title: Unscheduled return visits to the emergency department: the impact of language.
abstract: BACKGROUND
  Return visits to the emergency department (ED) resulting in admission are an important marker of quality of care. Patients and families with limited English proficiency (LEP) are at risk for suboptimal care related to imprecise communication.
  
  
  OBJECTIVE
  The objective of this study was to compare the rate of return visits resulting in admission in LEP patients to the rate in the English-speaking patients.
  
  
  METHODS
  We assembled a retrospective cohort of patients cared for in a pediatric, tertiary ED. Eligible patients included those who were discharged on the first encounter, and those who returned and were admitted to the hospital within 72 hours of ED discharge were identified. A logistic regression was performed comparing the rate of return visits resulting in admission in the LEP and non-LEP populations adjusting for emergency severity index and time of day at ED visit.
  
  
  RESULTS
  A total of 119,782 patients were discharged from the ED during a 32-month study period. Of these patients, 11.7% (14,053) identified a language other than English as their primary language. The rate of return visits resulting in admission was 1.2% (1279/105,729) among English speakers and 1.6% (220/14,053) in the LEP population. Patients with LEP were more likely to return to the ED for admission (odds ratio, 1.30; 95% confidence interval, 1.12-1.50; P < 0.001) The increased risk of a return visit for LEP patients remained significant after controlling for age, emergency severity index, and time of day (adjusted odds ratio, 1.43; 95% confidence interval, 1.23-1.66; P < 0.001).
  
  
  CONCLUSIONS
  Patients with LEP are at higher risk of return visit for admission.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Children's Hospital Boston, Boston, MA, USA. Rachel.gallagher@childrens.harvard.edu
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Gallagher
authors.forename: Stephen
authors.initials: S
authors.lastname: Porter
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stack
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003144:Communication Barriers; D032882:Comprehension; D003695:Delivery of Health Care; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007802:Language; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data; D010351:Patient Discharge; D010359:Patient Readmission; D019984:Quality Indicators, Health Care; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014175:Translating