Improving care equity for hard-of-hearing veterans through implementation of a hearing assistive device in the emergency department: A pre-post observational study.

BACKGROUND: In the high-noise environment of emergency departments (EDs), Veterans who are deaf and hard-of-hearing (HOH) often face communication barriers that can compromise care. To address this, we piloted and scaled up a program providing a personal voice amplification device ("device") to Veterans who are HOH. OBJECTIVE: To evaluate feasibility, early acceptability, and ED operational outcomes after scale-up of device use for HOH Veterans to all ED staff. METHODS: Following a 6-month pilot (4/2024-10/2024) involving clinical champions, the program was implemented department-wide at the Greater Los Angeles Veterans Affairs ED (11/2024-6/2025). Data sources included the ED tracking system, electronic health record, and patient and staff surveys. We compared pilot and scale-up periods using bivariate and multivariate analyses on time to disposition, admission rate and 3-day revisit rate. RESULTS: During the pilot, 2.3% (387/16,449) of visits were for Veterans who are HOH, compared with 1.8% (347/19,111) during scale-up. Of scale-up visits, 36% resulted in admission, 64% in discharge, and 4% in 3-day revisits (versus, 33%, 67%, and 6% during the pilot). In adjusted analyses, time to disposition was longer during the scale-up, with mean time 48 min longer (95% CI, 15-80, p = 0.004). Among 79 encounters where staff completed the surveys, the device was used in 81% (64/79) and of those, 84% (54/64) of staff responses rated it as very helpful. Of 18 surveyed Veterans who used the device, 89% (16/18) reported the device was helpful. Notably, 26% of Veterans who are HOH identified during scale-up had no prior hearing loss diagnosis. CONCLUSIONS: Implementation of an assistive hearing device in the emergency department was feasible and well accepted by staff and Veterans who used it. The initiative also highlighted the ED's potential role in identifying previously unrecognized hearing loss. Future work should focus on sustaining and streamlining device use.