Observational study to understand interpreter service use in emergency medicine: why the key may lie outside of the initial provider assessment

Abstract

ObjectiveTo characterise the use of interpreter services and other strategies used to communicate with limited English proficient (LEP) patients throughout their emergency department visit.MethodsWe performed a process tracing study observing LEP patients throughout their stay in the emergency department. A single observer completed 47 hours of observation of 103 communication episodes between staff and nine patients with LEP documenting the strategy used to communicate (eg, professional interpreter, family member, own language skills) and duration of conversations for each communicative encounter with hospital staff members. Data collection occurred in a single emergency department in the eastern USA between July 2017 and February 2018.ResultsThe most common strategy (per communicative encounter) was for the emergency department staff to communicate with the patient in English (observed in 29.1% of encounters). Total time spent in communicating was highest using telephone-based interpreters (32.9% of total time spent communicating) and in-person interpreters (29.2% of total time spent communicating). Communicative mechanism also varied by care task/phase of care with the most use of interpreter services or Spanish proficient staff (as primary communicator) occurring during triage (100%) and the initial provider assessment (100%) and the lowest interpreter service use during ongoing evaluation and treatment tasks (24.3%).ConclusionsEmergency department staff use various mechanisms to communicate with LEP patients throughout their length of stay. Utilisation of interpreter services was poorest during evaluation and treatment tasks, indicating that this area should be a focus for improving communication with LEP patients.

Breaking through barriers: the need for effective research to promote language‐concordant communication as a facilitator of equitable emergency care

“… 61 Interpreter use is highest during initial evaluation but less frequent for interactions with nurses and consultants and rare for reevaluation, procedures, and medication administration. 59 , 60 These interactions, though brief, are at high risk for serious safety events in which bidirectional communication opportunities with patients and families may be essential for prevention of harm. Remote interpretation may increase access to professional interpreters but requires reconnection at each communication encounter.…”

Enteropathy‐associated T‐cell lymphoma manifesting as non‐specific abdominal pain: A case report highlighting the dangers of relying on Google Translate for clinical history taking

“…Existing research concludes that patients who are not proficient in English are more likely to be misdiagnosed and to be dissatisfied with the care provided when compared with English-speaking patients. 8 The General Medical Council states that it is the duty of a doctor to "make sure that arrangements are made, wherever possible, to meet the patients' language and communication needs". 13 While the gold standard is an accredited in-person translator for scheduled appointments, this is frequently not possible in the ED setting.…”

“…7 Patients who are not proficient in English are twice as likely to revisit the ED within 72 h of discharge. 8 During discharge, providing safety-netting advice is a part of routine emergency medicine practice. Suboptimal clinician communication skills, such as failure to ensure that the patient understands the diagnosis and management plan, may contribute to non-English speaking patients revisiting the ED.…”

“…Patients who are not proficient in English are twice as likely to revisit the ED within 72 h of discharge 8 . During discharge, providing safety‐netting advice is a part of routine emergency medicine practice.…”

Beyond Interpretation: The Unmet Need for Linguistically and Culturally Competent Care for Latinx People Living with HIV in a Southern Region with a Low Density of Spanish Speakers

“…While access to interpreter services is mandated under law 31 for the 8.7% of the U.S. population who are LEP, 32 reimbursement for language services is variable 11 and language services remain underutilized. [33][34][35][36][37][38] LEP patients who receive care with professional interpreters have higher satisfaction with care, higher quality of care, and attend more visits than those using untrained interpreters, such as family members. 11,39 Yet, interpreters alone cannot overcome language barriers, 23 as seen in the underutilization and inadequate interpretation services experienced by our participants.…”