Obtaining History with a Language Barrier in the Emergency Department: Perhaps not a Barrier After All

Abstract

IntroductionPatients with limited English proficiency may be at risk for incomplete history collection, potentially a patient safety issue. While federal law requires qualified medical interpreters be provided for these patients, little is known about the quality of information obtained in these encounters. Our study compared the medical histories obtained by physicians in the emergency department (ED) based on whether the patients primarily spoke English or Spanish.MethodsThis was a prospective, observational study conducted at a single, urban, academic ED during a six-month time period. Resident and faculty physicians caring for adult patients with a chief complaint of chest or abdominal pain were eligible for participation. Patient encounters were directly observed by medical students who had been trained using simulated encounters. Observers documented which key historical data points were obtained by providers, including descriptions of pain (location, quality, severity, radiation, alleviating/aggravating factors), past medical/family/surgical history, and social history, in addition to the patient’s language in providing history. Providers, interpreters, and observers were blinded to the nature of the study. We used chi-square analyses to examine differences in whether specific elements were collected based on the primary language of the patient.ResultsEncounters with 753 patients were observed: 105 Spanish speaking and 648 English speaking. Chi-square analyses found no statistically significant differences in any history questions between Spanish-speaking and English-speaking patients, with the exception that questions regarding alleviating factors were asked more often with Spanish-speaking patients (45%) than English-speaking patients (30%, p=.003). The average percentages of targeted history elements obtained in Spanish and English encounters were 60% and 57%, respectively.ConclusionIn this study at a large, urban, academic ED, the medical histories obtained by physicians were similar between English-speaking and Spanish-speaking patients. This suggests that the physicians sought to obtain medical histories at the same level of detail despite the language barrier. One limitation to consider is the Hawthorne effect; however, providers and observers were blinded to the nature of the study in an attempt to minimize the effect.

A Scoping Review of Current Social Emergency Medicine Research

“…We identified 32 relevant publications 411 – 442 ; 26 observational studies 411 – 436 ; three interventional studies 437 – 439 ; one review publication; and two commentary publications. The observational research spanned a broad range of topic areas covering many parts of ED care, including triage (8%), 419 , 438 history of present illness collection (4%), 416 management of care (4%), 411 interpreter utilization and need (12%), 415 , 428 , 429 ED resource utilization (15%), 423 , 424 , 431 , 433 length of stay (8%), 427 , 430 the discharge process (15%), 417 , 420 – 422 and follow-up care (8%). 432 , 435 Of the interventional studies, one examined the role of the patient’s preferred language in the success of a drinking intervention.…”

The Relationship Between Language Barrier in Non-Arabic Nurses and Anxiety in Cardiovascular Patients: A Cross-Sectional Descriptive Study

“…Furthermore, language barriers cause challenges in elder and end-of-life care and present risks to the health care providers, such as increased malpractice claims (8). There is no doubt that patients with LEP represent a vulnerable group because they cannot comprehend all the information given to them about their conditions, which limits their ability to make well-thought-out decisions freely (9).…”

History and Mental Status Examination in Primary Care in Saudi Arabia: A Review

“…In some cases, a question may need to be asked numerous times in order to obtain the relevant information [1,[16][17][18].…”