Use of Interpreters by Physicians for Hospitalized Limited English Proficient Patients and Its Impact on Patient Outcomes

López, Lenny; Rodríguez, Fátima; Huerta, Diego; Soukup, Jane; Hicks, LeRoi S.

doi:10.1007/s11606-015-3213-x

Cited by 90 publications

(72 citation statements)

References 27 publications

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“…17,18 While federal guidelines mandate the use of qualified interpreters for patients with LEP, 19 this is an unfunded mandate, and multiple studies have demonstrated low rates of professional interpreter utilization during hospital encounters, including during informed consent discussions. [20][21][22][23][24][25][26] Time constraints and lack of immediate availability have been implicated by clinicians as major barriers to use of professional interpreters in the hospital. 27 A recent study demonstrated that surgeons' decisions to use professional interpreters for informed consent discussions depended in large part on the rapid availability of interpreter services.…”

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confidence: 99%

Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency

et al. 2017

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BACKGROUND: Language barriers disrupt communication and impede informed consent for patients with limited English proficiency (LEP) undergoing healthcare procedures. Effective interventions for this disparity remain unclear. OBJECTIVE: Assess the impact of a bedside interpreter phone system intervention on informed consent for patients with LEP and compare outcomes to those of English speakers. DESIGN: Prospective, pre-post intervention implementation study using propensity analysis. SUBJECTS: Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors. INTERVENTION: Installation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters. MAIN MEASURES: Primary predictor: pre-vs. postimplementation group; secondary predictor: postimplementation patients with LEP vs. English speakers. Primary outcomes: three central informed consent elements, patient-reported understanding of the (1) reasons for and (2) risks of the procedure and (3) having had all questions answered. We considered consent adequately informed when all three elements were met. KEY RESULTS: We enrolled 152 Chinese-and Spanishspeaking patients with LEP (84 pre-and 68 postimplementation) and 86 English speakers. Postimplementation (vs. pre-implementation) patients with LEP were more likely to meet criteria for adequately informed consent (54% vs. 29%, p = 0.001) and, after propensity score adjustment, had significantly higher odds of adequately informed consent (AOR 2.56; 95% CI, 1.15-5.72) as well as of each consent element individually. However, compared to post-implementation English speakers, post-implementation patients with LEP had

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confidence: 99%

Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency

et al. 2017

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“…This was shown to be true in a similar study of hospitalized adults: NEPL patients with no in-person interpreter use had a shorter length of stay and NEPL patients with in-person interpreter use had a longer length of stay than English-speakers [23]. The authors concluded that increased clinical complexity, rather than in-person interpreter use, likely accounted for longer length of stay in these patients [23]. However, in our study, measures for clinical complexity were taken into account in all regressions and use of in-person interpreters continued to have an effect on length of stay.…”

Section: Discussionmentioning

confidence: 91%

“…Prior studies show that providers may use their own limited foreign-language skills or ad hoc interpreters for less clinically complex patients but opt for professional in-person interpreters for more complex patients [10,11]. This was shown to be true in a similar study of hospitalized adults: NEPL patients with no in-person interpreter use had a shorter length of stay and NEPL patients with in-person interpreter use had a longer length of stay than English-speakers [23]. The authors concluded that increased clinical complexity, rather than in-person interpreter use, likely accounted for longer length of stay in these patients [23].…”

Section: Discussionmentioning

confidence: 99%

In-Person Interpreter Use and Hospital Length of Stay among Infants with Low Birth Weight

Eneriz-Wiemer

Sanders

McIntyre

et al. 2018

IJERPH

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To ensure timely appropriate care for low-birth-weight (LBW) infants, healthcare providers must communicate effectively with parents, even when language barriers exist. We sought to evaluate whether non-English primary language (NEPL) and professional in-person interpreter use were associated with differential hospital length of stay for LBW infants, who may incur high healthcare costs. We analyzed data for 2047 infants born between 1 January 2008 and 30 April 2013 with weight <2500 g at one hospital with high NEPL prevalence. We evaluated relationships of NEPL and in-person interpreter use on length of stay, adjusting for medical severity. Overall, 396 (19%) had NEPL parents. Fifty-three percent of NEPL parents had documented interpreter use. Length of stay ranged from 1 to 195 days (median 11). Infants of NEPL parents with no interpreter use had a 49% shorter length of stay (adjusted incidence rate ratio (IRR) 0.51, 95% confidence interval (CI) 0.43–0.61) compared to English-speakers. Infants of parents with NEPL and low interpreter use (<25% of hospital days) had a 26% longer length of stay (adjusted IRR 1.26, 95% CI 1.06–1.51). NEPL and high interpreter use (>25% of hospital days) showed a trend for an even longer length of stay. Unmeasured clinical and social/cultural factors may contribute to differences in length of stay.

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“…1 Patient-provider communication during hospitalization and at the time of discharge is increasingly recognized as important to quality of care and safety for all patients. 2 This field of inquiry is of importance as the number of limited English proficiency (LEP) patients in our country grows, and as the authors document once again, interpreters are greatly underutilized in health care.…”

Section: Ear Editorsmentioning

confidence: 99%

Use of Interpreters by Physicians

2015

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D ear Editors,We read with interest Lopez et al.'s recent article. 1 Patient-provider communication during hospitalization and at the time of discharge is increasingly recognized as important to quality of care and safety for all patients. 2 This field of inquiry is of importance as the number of limited English proficiency (LEP) patients in our country grows, and as the authors document once again, interpreters are greatly underutilized in health care. The question asked by the authors is of great import-how does the use of an interpreter impact length of hospital stays (LOS) and post-discharge outcomes? However, we question the interpretation and importance of their findings, given the significant limitations of their measure of LEP, the fact that there is no measure of the providers' use of non-English language, and the very weak measure of interpreter use.The authors' measure of LEP was based on patients' documented language preference at the time of hospital admission. Karliner et al. document well that the optimal method of identifying LEP patients should be a two part process. Patients should be asked how well they can discuss their symptoms in English and this should be followed by a language preference question. 3 Lower specificity of the language preference question alone could lead to misclassification of some patients as LEP who are, in fact, able to effectively communicate in English with their physicians. Further, the authors did not consider the possibility that some of the patients in the study may have had physicians who spoke their language. This language-concordant care could have resulted in better communication and shorter length of stay. 4 There was also no documentation of the presence or absence of English proficient family members or use of phone interpretation. Finally, as we understand it, patients were included in the interpreter service utilized group if patients received interpreter services as little as one time. As LOS was, on average, more than 5 days, it would be highly unlikely that one-time use of an interpreter would have any impact on LOS or other outcomes.We recognize that many of these limitations were a consequence of conducting a retrospective study. These results should be interpreted within the context of these limitations and within the greater context of the existing literature, which overwhelmingly supports the use of professional interpreters as important to the quality of care delivered to LEP patients. 5

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Use of Interpreters by Physicians for Hospitalized Limited English Proficient Patients and Its Impact on Patient Outcomes

Cited by 90 publications

References 27 publications

Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency

Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency

In-Person Interpreter Use and Hospital Length of Stay among Infants with Low Birth Weight

Use of Interpreters by Physicians

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