• Lauren Raff, Andrew G Blank, Ricardo Crespo Regalado, Emily Bulik-Sullivan, Lindsey Phillips, Carlton Moore, Lilia Galvan Miranda, and Evan Raff.
• Department of Surgery, Division of Trauma and Acute Care Surgery, University of North Carolina School of Medicine, 4008 Burnett-Womack Building, Campus Box 70, Chapel Hill, NC, 27599, USA.
• J Gen Intern Med. 2024 May 1; 39 (7): 110311111103-1111.

BackgroundRecognition of clinically deteriorating hospitalized patients with activation of rapid response (RR) systems can prevent patient harm. Patients with limited English proficiency (LEP), however, experience less benefit from RR systems than do their English-speaking counterparts.ObjectiveTo improve outcomes among hospitalized LEP patients experiencing clinical deteriorations.DesignQuasi-experimental pre-post design using quality improvement (QI) statistics.ParticipantsAll adult hospitalized non-intensive care patients with LEP who were admitted to a large academic medical center from May 2021 through March 2023 and experienced RR system activation were included in the evaluation. All patients included after May 2022 were exposed to the intervention.InterventionsImplementation of a modified RR system for LEP patients in May 2022 that included electronic dashboard monitoring of early warning scores (EWSs) based on electronic medical record data; RR nurse initiation of consults or full RR system activation; and systematic engagement of interpreters.Main MeasuresProcess of care measures included monthly rates of RR system activation, critical response nurse consultations, and disease severity scores prior to activation. Main outcomes included average post-RR system activation length of stay, escalation of care, and in-hospital mortality. Analyses used QI statistics to identify special cause variation in pre-post control charts based on monthly data aggregates.Key ResultsIn total, 222 patients experienced at least one RR system activation during the study period. We saw no special cause variation for process measures, or for length of hospitalization or escalation of care. There was, however, special cause variation in mortality rates with an overall pre-post decrease in average monthly mortality from 7.42% (n = 8/107) to 6.09% (n = 7/115).ConclusionsIn this pilot study, prioritized tracking, utilization of EWS-triggered evaluations, and interpreter integration into the RR system for LEP patients were feasible to implement and showed promise for reducing post-RR system activation mortality.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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