Patterns and Predictors of Professional Interpreter Use in the Pediatric Emergency Department

Abstract

BACKGROUND AND OBJECTIVES: Professional interpretation for patients with limited English proficiency remains underused. Understanding predictors of use is crucial for intervention. We sought to identify factors associated with professional interpreter use during pediatric emergency department (ED) visits. METHODS:We video recorded ED visits for a subset of participants (n = 50; 20% of the total sample) in a randomized trial of telephone versus video interpretation for Spanish-speaking limited English proficiency families. Medical communication events were coded for duration, health professional type, interpreter (none, ad hoc, or professional), and content. With communication event as the unit of analysis, associations between professional interpreter use and assigned interpreter modality, health professional type, and communication content were assessed with multivariate random-effects logistic regression, clustered on the patient. RESULTS:We analyzed 312 communication events from 50 ED visits (28 telephone arm, 22 video arm). Professional interpretation was used for 36% of communications overall, most often for detailed histories (89%) and least often for procedures (11%) and medication administrations (8%). Speaker type, communication content, and duration were all significantly associated with professional interpreter use. Assignment to video interpretation was associated with significantly increased use of professional interpretation for communication with providers (adjusted odds ratio 2.7; 95% confidence interval: 1.1-7.0).CONCLUSIONS: Professional interpreter use was inconsistent over the course of an ED visit, even for patients enrolled in an interpretation study. Assignment to video rather than telephone interpretation led to greater use of professional interpretation among physicians and nurse practitioners but not nurses and other staff. WHAT'S KNOWN ON THIS SUBJECT: Professional interpreter use improves safety and quality of care for individuals with limited English proficiency, but use remains low in clinical settings. A better understanding of predictors of use is essential for crafting successful interventions.WHAT THIS STUDY ADDS: Interpreter use was associated with speaker type, longer communications, and communication content, with particularly low use for high-risk activities like medication administration. Assignment to video rather than telephone interpretation led to greater professional interpreter use among providers but not nurses.

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.…”

“…58 Even when readily available, professional interpretation is not consistently used throughout the ED visit. 59,60 ED physicians acknowl- edge frequent lapses in use even when professional interpretation is readily available. 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.…”

Association Between Language Use and ICU Transfer and Serious Adverse Events in Hospitalized Pediatric Patients Who Experience Rapid Response Activation

“…Future work should explore reasons for low interpretation use, and factors associated with increased interpreter use, to inform interventions. Potential interventions include increasing access to interpretation resources, ( 5 , 11 ) process changes to identify patients who may benefit from interpretation and communicate interpretation need and use, ( 8 , 12 ) education of providers and nurses, ( 1 ) standardized and protocolized processes for clinical team communications during RRTs, and changes to clinical workflow such as adjusting nursing assignments and rounding schedules to make use of interpretation less of a barrier. It is important that future work includes perspectives of families who use LOE, with the ultimate goal to address their communication needs and barriers.…”

“…Among patients who use LOE, increased rates of interpretation use by provider teams are associated with improved outcomes, improved quality of care, and better patient satisfaction among adult and pediatric patients ( 5 , 8 , 10 , 11 ). Despite this, interpretation is underutilized, with rates reported at 39–45% of conversations with patients and families who use LOE ( 8 , 12 ).…”

Promoting true meaningful access and equity for patients and clinicians through the use of certified interpreters in hospitals

“…Given that communication is a root cause of safety events, interpreters play a critical role in ensuring safe and high‐quality care for patients with LEP. However, certified interpreters are used in under half of clinical interactions, including high‐risk interactions like medication administration and procedures 2 . Consequently, patients and clinicians often take shortcuts to work around limited access to certified interpreters.…”