Quality of Care and Communication With Limited English Proficiency (LEP) Obstetric Patients [37J]

Abstract

INTRODUCTION: Hospital guidelines and standards recommend the routine use of professional interpreters for patients with Limited English Proficiency (LEP). There is no preexisting data on LEP obstetrics patients and their communications with physicians and nurses. Our objective was to review English LEP patients’ communication with physicians and nurses during their delivery hospitalization, including the use of interpreters and language proficient providers, as well as its association with patient satisfaction. METHODS: Cross-sectional study with in-person survey methodology and retrospective chart review of patients admitted to our postpartum service after delivery at our institution. IRB exempt. RESULTS: 148 postpartum patients were screened. After applying inclusion and exclusion criteria, 20 patients participated in the survey. 70% of these patients were admitted by non-language proficient provider. Of these, only 36% documented use of interpreter during admission. 2 of the 3 patients who underwent cesarean section reported that the reason for cesarean was explained to them in English without the use of interpreter. Despite this, there was reported 100% satisfaction with overall physician care, physician communication with respect to medical condition, and physician respect for culture and language. CONCLUSION: We hypothesized that the rate of use of interpreters and language-proficient providers would be poor, and this proved to be correct in our internal review. The high reported rates of patient satisfaction with both physician and nursing care, communication, and perception of respect for culture and language was a seemingly discordant finding that warrants further exploration. Patient satisfaction drivers may be somewhat different for obstetric populations. This warrants further investigation.

Transcending Language Barriers in Obstetrics and Gynecology

“…A cross-sectional study of communication practices during childbirth hospitalization showed that only 36% of clinicians appropriately collaborated with interpreters. 8 Clinical care teams may have limited access to all modalities of interpreters based on the time of day and institutional contracts. In-person interpretation is typically preferred, especially for admission and confirmation of code status, assessment of trauma history, second stage of labor, procedures, acute events, delivery of bad news, and medication and care summary review at discharge.…”

“…[1][2][3][4][5] Patients with language barriers also experience intersectionality with xenophobia, racism, and other systems of oppression that drive inequities in obstetrics and gynecology, such as lower rates of gynecologic cancer screening, higher rates of unscheduled cesarean birth and forced sterilization, and more experiences of obstetric trauma and mistreatment in childbirth, among minoritized individuals. [6][7][8][9][10][11] Despite this evidence base, there is limited guidance on best practices for advancing equitable care for patients who have language barriers within obstetrics and gynecology.…”

Disparities in Comprehension of the Obstetric Consent According to Language Preference Among Hispanic/Latinx Pregnant Patients

“…The availability of interpreters and language-concordant providers is often insufficient, and studies outside of obstetrics have demonstrated that patients with LEP are less likely to have fully documented informed consent and more likely to experience worse care outcomes overall [6][7][8][9][10]. No prior studies have investigated differences in understanding of the obstetric consent form between patients with English and Spanish preference.…”