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BACKGROUND

Transition from hospital to home is a particularly difficult stage in the care transitions continuum due to the likelihood of breakdowns in communication between providers and patients alike. Patients of ethnically diverse backgrounds are particularly vulnerable to breakdowns in the transition process due to language and cultural discordance, posing a significant challenge to the provision of quality healthcare.1,2

Language barriers contribute to health disparities among patients with limited English proficiency. Language discordant care between patients and their providers increases the risk for a variety of poor outcomes.3–7 The identification and resolution of this particular barrier can improve medication adherence, health education, patient satisfaction, and patient−provider relationships.

PATIENT PRESENTATION

Chief Complaint

Admitted for total knee arthroplasty (TKA)

History of Present Illness

Mariana is a 72-year-old female with a 3-year history of degenerative joint disease of the right knee with a profound exacerbation of her symptoms 2 months prior to admission. She was admitted 3 days ago for a TKA, which proceeded unremarkably. Postoperatively, she has been managed for VTE prophylaxis with enoxaparin and an intermittent pneumatic compression device. Her pain is well controlled with oxycodone via patient-controlled anesthesia (PCA) pump. Mild confusion noted on postoperative day 1 has mostly been resolved. She has a multi-year history of well-controlled hypertension and epilepsy, hypercholesterolemia of unknown duration, and chronic kidney disease (CKD) for the last 7 years. Based on the medication list, the patient was asked about coronary artery disease but she denies any history of heart disease. All history is per daughter translating at the bedside.

Past Medical History

Hypertension

Hypercholesterolemia

CKD Stage G3b

Epilepsy

Surgical History

Hysterectomy (unknown year)

Right TKA (3 days prior)

Family History

She is adopted and is not familiar with birth parents’ medical history

Social History

Relocated to the US 3 years ago from Ecuador. Speaks minimal English — preferred language is Spanish.

Married with two adult children; lives with spouse.

Denies alcohol, tobacco, or recreational/illicit drug use.

Immunization

Up to date

Insurance

Medicaid

Allergies

No known drug allergies

Home Medications

  • Hydrochlorothiazide 25 mg PO once daily

  • Losartan 50 mg PO once daily

  • Aspirin 81 mg PO once daily

  • Atorvastatin 40 mg PO once daily

  • Phenytoin 100 mg PO twice daily

Physical Examination

Vital Signs

Temp 98.7°F, ...

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