Interpreter Services in Emergency Medicine

Abstract

Emergency Department (ED) physicians are routinely confronted with problems associated with language barriers. It is important for emergency health care providers and the health system to strive for cultural competency when communicating with members of an increasingly diverse society. Solutions include professional interpretation, telephone interpretation, the use of bilingual staff members, the use of ad hoc interpreters, and more recently the use of mobile computer technology at the bedside. Each method carries a specific set of advantages and disadvantages. Although professionally-trained medical interpreters offer improved communication, better patient care, and overall cost savings, they are underutilized due to their perceived inefficiency. Ultimately, the solution will vary for every Emergency Department (ED) depending on the population served and available resources. Accessibility of the multiple interpretation options outlined above and solid support and commitment from hospital institutions are necessary to provide proper and culturally competent care for patients. Appropriate communications inclusive of interpreter services are essential for culturally competent provider/health systems and overall improved patient care.

Shrinking the language accessibility gap: a mixed methods evaluation of telephone interpretation services in a large, diverse urban health care system

“…OPI offers an interesting mix of benefits and challenges. Its impersonal quality enables confidential communication about sensitive or emotionally disturbing information [ 25 , 20 ], but the loss of nonverbal input can also be a barrier to an optimal exchange [ 2 , 26 , 27 , 6 , 25 , 28 ]. Providers also cite inconvenience and the extra time it requires as disadvantages of OPI [ 23 , 26 ], and suggest its utility may be limited to certain types of provider-patient interactions, such as direct information exchange [ 29 , 20 ].…”

“…One review found just 18 % of hospitals in the United Kingdom used a formal interpreter agency [ 15 ]; and a review of pediatricians found low use in all states in the United States, regardless of demographics – a pattern which has improved only modestly since 2004 [ 16 , 17 ]. The most commonly cited reasons for low uptake of these services include cost issues - such as lack of reimbursement mechanisms - and timeliness of access [ 18 , 2 , 19 , 20 , 6 , 21 , 17 , 22 ]. Other noted barriers include presence of bilingual staff [ 23 ] and providers’ belief that patients prefer using their relatives over professional interpreters [ 24 , 14 ], though some studies with patients have disputed the latter [ 5 , 12 ].…”

Clinician Ratings of Interpreter Mediated Visits in Underserved Primary Care Settings with Ad hoc, In-person Professional, and Video Conferencing Modes

“…11, 13 Finally, LEP patients tend to rely more heavily on emergency departments, and are less likely to use preventive and primary care services compared to language concordant or English speaking-patients. 2, 10, 14 …”

“…29 Thus, there is a paucity of data on which to base decisions about funding and implementation of language assistance services. 14 Video conferencing medical interpretation is a new modality that uses video conferencing technology ( via mobile, closed-circuit televisions) to interpret in real time from a remote location while maintaining three-way non-verbal communication among the patient, interpreter, and clinician. Through centralization of shared language services, video conferencing interpretation offers great potential for increasing language access and reducing costs across health care sites and systems.…”

Rates and Predictors of Professional Interpreting Provision for Patients With Limited English Proficiency in the Emergency Department and Inpatient Ward

“… 26 The availability of family members to interpret in the context of a hectic and chaotic setting where time pressures are high and the engagement of ad hoc interpreters is the norm appears to be an even greater obstacle to professional interpreter engagement in the ED. 24 , 26 Older Greek, Italian, or Spanish patients may be more likely to be accompanied by adult children to the ED who may be more willing to interpret. Our finding that older people speaking European languages such as Italian, Greek, and Spanish are significantly less likely to be provided with a professional interpreter through their hospital journey is consistent with availability and willingness of family members to interpret, which can influence clinician decision making more than cost.…”