Evaluating a Post-Discharge Callback Program to Improve Emergency Department Transitions of Care Among Older Adults with Limited English Proficiency

Background: Emergency department (ED) discharge instructions are often complex and result in poor follow-up and ED revisits, particularly in older adults with limited English proficiency (LEP).This quality improvement initiative evaluated the impact of a callback program on ED revisits and admissions within 30 days. Approach:We included patients 65 years, who preferred languages other than English or required an interpreter, discharged from a single urban ED from June 1, 2024-May 31, 2025.Physician Associates called patients within 24 hours of discharge using standardized scripts and certified interpreters to address unmet needs.Call attempt and success rates (patient or caregiver reached), reported barriers, demographics, and ED revisit and admission rates were recorded. Results:The call attempt rate increased from 34% in June to 94% in December 2024 and remained above 93% through May 2025.Call success averaged 55% and was highest among female (n = 642, 65%), "other" race (n = 758, 77%), and Medicare Managed Care patients (n = 713, 73%).Success was lowest among male (n = 339, 35%), Black (n = 24, 2%), and statesponsored Medicaid (n = 28, 3%) patients.Language was the most reported barrier (97%).Of patients reporting post-discharge barriers (n = 91), 88% cited care coordination.Among reached patients, 16% revisited the ED and 7% were admitted within 30 days, compared to 25% and 16% respectively, among those not reached. Conclusion:ED callbacks identified barriers to care and may reduce 30-day revisits and admissions for older adults with LEP.Social vulnerability index should be assessed to inform increased outreach to male, Black, and Medicaid patients.