Culturally and Linguistically Diverse patients in the Emergency Department: A clinical redesign initiative

Hannah Putland1, Angela Oliphant 2, Vikrant Kalke 3

1 Princess Alexandra Hospital Emergency Department and Metro South Health Equity and Access Unit , Woolloongabba, QLD 4102,
2 Logan Hospital Emergency Department and Metro South Health Equity and Access Unit, Meadowbrook, QLD, 4131,
3 Metro South Health Equity and Access Unit, Eight Mile plains, 4113,

Metro South Health is the most culturally diverse health service in Queensland, with an estimated 28% of the population in the region being born overseas and 41% have a first language other than English  (Queensland Government, 2016). The Metro South Health Equity and Access Unit (HEAU) identified that approximately 15.5% of patients that present to Metro South Emergency Departments (EDs) are patients from Culturally and Linguistically Diverse (CALD) backgrounds.

The HEAU partnered with a Metro South ED to initiate a four month project aimed at; identifying deficiencies in care for CALD patients within the ED. This project aimed to improve ED processes for CALD patients and remove barriers to patient centered care for CALD patients in this ED. Concepts derived from the project would then be evaluated and ones found to be effective would be implemented throughout Metro South’s ED’s.

Utilising a clinical redesign methodology the project team finalised planning, developed a steering committee of key stakeholders and began exploring the CALD patient journey. To understand the CALD patient journey, data was collected about the staff experience via a staff survey (52% response rate) and the patient perspective via patient interviews (67 patients participated). Additionally 19 patients’ journeys were mapped from triage to admission or discharge, attempting to identify key points such as; when to flag the need for interpreters, when should interpreters be utilised and the impact of interpreters on length of stay and re-presentation. Quantitative data was collected via the Emergency Department Information System (EDIS) and the Interpreter Services Information System (ISIS) mostly pertaining to patient demographics, interpreter provision, National Emergency Access Targets (NEAT) and length of stay.

Through the diagnostic phase of the project the multifaceted approach to collecting information allowed a comprehensive insight into the CALD patient journey. It was identified that approximately 1200 patients presented a month from CALD backgrounds and on average CALD patients spend 40 – 60 minutes longer in the ED. Furthermore it was identified that interpreter provision for patients that request interpreters at triage is around 25 %.

The solution implementation phase of the project was focused on ensuring the solutions would address the deficiencies identified in the diagnostic phase of the project. Initially the team developed and updated resources to aid in interpreter engagement and promotion, communication tools, the development of a protocol and centralising all resources for quick and easy access. Subsequently a large emphasise was placed on education for all ED staff both locally and across Metro South ED’s.

Project re-evaluation has been planned for early 2017, however 57% of ED staff received education from the ED CALD project team and since the project commencement Interpreter Provision has already increased by 6%.


Queensland Government. (2016, April 5). Culturally and Linguistically Diverse (CALD) people . Retrieved June 20, 2016 from Queensland Government Health Equity and Access:


Hannah Putland has spent the last 6 years working in a large tertiary Emergency Department in QLD. After completing her Masters in Emergency Nursing she focused her attention to the Patient Focus Working Group where she developed an interest in Quality projects.

Angela Oliphant started her nursing career in the vascular ward  at a large Queensland hospital. She has worked at the Logan Emergency Department for the last five years, assisting in the transition to a new department. Recently Angela has enjoyed working of quality projects.