Rates and Predictors of Professional Interpreting Provision for Patients With Limited English Proficiency in the Emergency Department and Inpatient Ward

Interpretation Services in a Canadian Emergency Department: How Often Are They Utilized for Patients With Limited English Proficiency?

Introduction Patients with limited English proficiency (LEP) face barriers to communication leading to inferior health outcomes when compared with English-proficient patients. Professional interpretation services have been shown to improve healthcare outcomes for patients with LEP but are often underutilized. Methods We conducted a retrospective chart review of all patients who visited the Kingston Health Sciences Centre's ED and urgent care centre between July 2015 and August 2021 and identified as having a non-English preferred language. The demographic and visit information of LEP patients who used LanguageLine (Monterey, CA) were compared to LEP patients who did not use the service. Variables were analysed using t-tests and chi-squared tests. A survey distributed to ED physicians and residents collected perspectives on the facilitators/barriers to LanguageLine use. Results Of the 37,500 visits from LEP patients between 2015 and 2021, 118 (0.31%) used LanguageLine. LEP patients were more likely to access LanguageLine if they were younger (p < 0.001), had a more acute Canadian Triage Acuity Scale (CTAS) score (p < 0.001), and spoke Arabic (p<0.001). All 16 staff/residents who responded to the survey (30% response rate) had at least one LEP patient in the preceding month, and 3/16 (19%) accessed LanguageLine for these patients. Further, 5/16 (31%) reported never using the service, with 4/5 (80%) unaware the service existed. Among those aware of LanguageLine, 7/12 (58%) reported the availability of an ad-hoc interpreter as a reason for not accessing the service. Conclusion Interpretation services are underutilized for LEP patients in the ED, with less than 1% of these patients accessing LanguageLine. Patients were more likely to access LanguageLine if they were younger, spoke Arabic, and had a more acute triage score. Most ED physicians were either unaware of or not accessing LanguageLine despite seeing LEP patients. Future work should aim to improve the use of language services and patient-centred care for LEP patients in the ED.

Interpreter Use and Patient Satisfaction in the Otolaryngology Outpatient Clinic

Background

Communication between providers and patients is essential to patient care and to the patient-physician relationship. It plays a significant role in both measurable and perceived quality of care. This study explores the satisfaction of English-speaking and limited English proficiency (LEP) patients with English-speaking providers, focusing on the correlation between patients’ primary language and the use of interpreter services on patients’ visit satisfaction.

Methodology

This study was designed to have a sample size sufficient to detect a 10% difference in the primary outcome, overall visit satisfaction, between language-concordant patients and LEP patients in the interpreter and no interpreter groups, assuming a two-tailed alpha of 0.05 and power of 80%. All collected data were analyzed using the Statistical Package for the Social Sciences software, version 25 (IBM Corp, Armonk, NY, USA), and significance was determined if p <0.05.

Results

Of the total 209 patients, 65 utilized professional interpreter services, nine used an ad-hoc interpreter, and 135 did not require an interpreter. Patients who used an interpreter demonstrated lower visit satisfaction compared with patients who did not (p < 0.001). Patients expressed significantly greater preference for in-person interpreter (mean = 9.73) or a family member (mean = 9.44) compared to telephone services (mean = 8.50) (p = 0.002). The overall satisfaction scores did not significantly differ between different interpreter types (p = 0.157).

Conclusions

LEP patients experienced lower visit satisfaction compared to language-concordant patients. The data suggest that perceived quality of communication was a factor in these lower satisfaction reports. While LEP patients did prefer in-person interpreters, there was no significant difference in overall visit satisfaction between different types of interpreters.

Challenges and opportunities caring for neurology outpatients across language differences

BACKGROUND

With over 66 million Americans who speak over 350 languages other than English at home, we sought to examine attitudes and behaviors of neurology clinicians and staff when communicating across language differences.

METHODS

We conducted an electronic-enabled cross-sectional survey of clinicians and patient services coordinators working at an academic neurology outpatient clinic. Questions focused on professional medical interpreter (PMI) services usage, satisfaction, and perceived barriers to utilization.

RESULTS

A total of 82/235 (35%) neurology clinicians and 24/52 (46%) coordinators met the study eligibility criteria. Most clinicians (96%) reported seeing at least 1 non-English-speaking patient and using PMI services (85%) in the last month. Most commonly self-reported interpretation modalities were face-to-face PMI services (39%) and patients' family members or friends (28%). Perceived barriers to using PMI included time constraints (60%) and lack of available face-to-face PMI (51%). Among patient services coordinators, 33% reported consistently asking patients their preferred language and 50% if they needed a PMI for appointments. Most respondents (77% clinicians and 71% coordinators) were satisfied with PMI services. Recommendations included having more available face-to-face PMI, greater coordinated efforts to preschedule PMI, and more education on the effective use of PMI.

CONCLUSIONS

More than 70% of outpatient neurology clinicians and patient services coordinators were satisfied with PMI. However, their perceived barriers and reported practices suggest a need for updated policies and education to improve the use of PMI services.