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Association of language concordance and restraint use in adults receiving mechanical ventilation

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Abstract

Purpose

Clinician–patient language concordance improves patient outcomes in non-intensive care unit (ICU) settings. We sought to assess the association of ICU nurse–patient language concordance with delirium-related outcomes.

Methods

We conducted a retrospective cohort study of adult English- or Spanish-speaking mechanically ventilated ICU patients admitted to ICUs at the University of Miami Hospital and Clinics (January 2021–September 2022). Our primary exposure was nurse–patient language concordance on each shift. We used mixed-effects multivariable regression to evaluate the association of language concordance with the primary outcome of restraint use, and secondary outcomes of agitation and identification of delirium, during each shift (with patient as a random effect).

Results

Our cohort included 4326 shifts (3380 [78.1%] with language concordance) from 548 patients and 157 nurses. Spanish language was preferred by 269 (49.1%) of patients. English-speaking patients tended to be younger (65 [53, 75] vs 73 [61, 83], p < 0.001) and of non-Hispanic ethnicity (55.5% vs 7.1%, p < 0.001). English-speakers had restraints ordered on fewer of their included shifts (0 [0, 3] vs 1 [0, 3], p = 0.005). After adjustment, the odds of restraint use on shifts with language concordance was significantly lower (odds ratio [OR, 95% confidence interval [CI]]: 0.50 [0.39–0.63], p < 0.001). Agitation (18.6% vs 25.2%; OR [95% CI]: 0.71 [0.55–0.92], p = 0.009) and delirium identification (34.5% vs 41.3%; OR [95% CI]: 0.54 [0.34–0.88], p = 0.014) were also less common.

Conclusions

We identified a twofold reduction in the odds of restraint use among mechanically ventilated patients for language concordant nurse–patient dyads. Ensuring nurse–patient language concordance may improve ICU delirium, agitation, and restraint use.

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Data availability

Data contain personal health information and are, therefore, not sharable without a Data Usage Agreement with the University of Miami.

Code availability

Code is available and can be provided by contacting the corresponding author.

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Acknowledgements

The authors would like to thank critical care nurse managers Brittany L. McClure, MBA, BSN, RN, Octavio Jimenez, BSN, RN, and Maria Lawton, BSN, RN for their help in assigning nurse Spanish fluency.

Funding

HBG, SP, MAS, DJP, and TF were supported by the University of Miami Hospital and Clinics Data Analytics Research Team (UHealth-DART) of which all are a part. CMM received funding from the US Centers for Disease Control and Prevention (CDC) and medical/legal consulting.

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Design of work: HBG, SP, CMM; data acquisition and analysis: HBG, SP; data interpretation: all authors; drafting: HBG; revising manuscript: all authors; final approval: all authors.

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Correspondence to Hayley B. Gershengorn.

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The authors report no conflicts directly related to this work. HBG received funds from Gilead Sciences, Inc. to serve as a scientific advisor regarding COVID-19 therapeutics and is currently Editor-in-Chief of CHEST Critical Care.

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Gershengorn, H.B., Patel, S., Mallow, C.M. et al. Association of language concordance and restraint use in adults receiving mechanical ventilation. Intensive Care Med 49, 1489–1498 (2023). https://doi.org/10.1007/s00134-023-07243-0

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