Communication Access and Emergency Care for D/deaf People: A Reflexive Thematic Analysis of Patient Experiences.

AIM: To examine how D/deaf people experience communication access during emergency department visits and identify changes they consider most important for accessible and safe emergency care.

DESIGN

Interpretive qualitative survey study using reflexive thematic analysis.

METHODS

Written responses to open-ended questions in an accessible bilingual Auslan-English survey were analysed within a critical, system-oriented framework. Interpretation was informed by Deaf Elder and D/deaf advisory perspectives.

RESULTS

Accounts described widespread communication barriers, including absent or delayed interpreters, limitations of video remote interpreting and expectations to lip-read, write or rely on family members. These reflected hearing-centred emergency care that shifted communicative responsibility onto patients. Fear, confusion and frustration were particularly evident during urgent or painful presentations. Positive experiences were associated with early interpreter engagement, visual communication strategies and staff familiarity with sign language. Participants identified system-level changes, including on-call interpreter pathways, Deaf awareness training and improved visual and non-auditory communication systems.

CONCLUSION

Communication access was uncertain and inconsistently supported for D/deaf patients. Improving care requires organisational approaches that embed interpreter access, visual communication systems and Deaf-informed training within routine practice.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Communication access should be embedded within routine emergency care through reliable interpreter pathways, visual communication systems and Deaf-informed staff education.

IMPACT: This study identifies communication barriers that can affect safety, understanding and participation for D/deaf patients in emergency care and highlights the need for organisational approaches to communication access.

REPORTING METHOD: Reporting was guided by the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).

PATIENT OR PUBLIC CONTRIBUTION: D/deaf people contributed to study design, recruitment, analysis and interpretation. Survey items were refined with Deaf Elders and a D/deaf advisory team. A Deaf Elder co-author contributed to recruitment and manuscript development, while advisory input informed theme refinement and challenged hearing-centred interpretations.