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St. Luke's Nurse Works to Assist Patients with Language Barriers


Bonnie Lunsford, RN, BSN, is a nurse in the UnityPoint Health – St. Luke’s Hospital Emergency Department (ED) and is scheduled to graduate with her Master’s in Community and Public Health at Allen College in Waterloo this May. For her graduate project, Bonnie completed a project in support of the vulnerable Limited English Proficient population (LEP).

“The problem I identified was care coordination does not consistently occur for the LEP population who present as patients to the ED,” said Lunsford. “Our ED practice did not automatically provide care coordination for LEP patients which, if done consistently, could assist with resource provision, referrals and prescriptions assistance, as well as a better understanding of health disposition.”

Other things Bonnie identified as potential obstacles for the LEP population included the patients not being established with a UnityPoint Clinic primary care provider, or even if they are, not having the means to get to the clinic for follow-up care or a pharmacy for medications. All these issues, commonly addressed through care coordination, were addressed through Lunsford’s project, which helped establish a standardized process of care coordination referrals for the LEP population, from the bedside staff to ED social workers or nurse case managers.

“The exciting part was the significant increase we saw in referrals, as well as the increase in resources our care coordination team was able to provide,” said Lunsford. “There was a 32 percent increase in referrals per number of LEP patient arrivals and a 250 percent increase in resource provision. More than 50 percent of referrals were to assist LEP patients to get established with a primary care provider and receive follow-up care.”

PODCAST EPISODE: Medicine: Color, Culture and Equity Pt. 4
Bonnie Lunsford, RN, BSN, St. Luke's Emergency Department, joins Dr. Arnold to discuss her recent graduate project which identified and looked to improve inconsistencies in care for limited English speaking populations.

“The ED social workers and nurse case managers were instrumental in achieving these results,” said Lunsford. “Social workers Sarah Hefflefinger, Marilyn Gerhold, Trent Fekkers and Brittany Schiltz, and nurse case managers Tina Rice and Kelsi Taggart, were huge champions of this project.”

Another benefit of Bonnie’s project was the tracking of the most common languages spoken by LEP patients in the ED. The most common was Swahili, followed by Spanish, French and Kinyarwanda/Kirundi. Swahili, Kinyarwanda/Kirundi and French are often spoken by patients from Africa, showing there has been a shift in prominent ethnicities in our community from Spanish to African. Yet there are no bilingual discharge instructions in two of the three commonly spoken African languages, an issue Bonnie would like to see change to help those populations.

“One study I found while doing my research showed patients with limited English proficiency and low health literacy experience poor health outcomes twice as often as those with neither, which is not a surprise,” said Lunsford. “Poor outcomes were experienced 45 percent of the time for LEP patients with low health literacy, compared to 18 percent experienced by English speakers with adequate health literacy.”

Thanks to Bonnie’s project, these health disparities have come to light and St. Luke’s Hospital is leading the effort for better health outcomes for the LEP population in Cedar Rapids.