Emergency department (ED) clinicians used professional interpreters inconsistently during pediatric visits, although use of video interpretation versus telephone led to greater use among providers but not nurses, researchers reported.
Out of 312 communication events from 50 ED visits, professional interpretation for Spanish-speaking families was used for 36% of communications overall, most often for detailed histories (89%) and least often for procedures (11%) and medication administrations (8%), according to K. Casey Lion, MD, MPH, of the Center for Child Health, Behavior and Development, at Seattle Children’s Research Institute and University of Washington Seattle, and co-authors.
Additionally, speaker type, communication content, and duration were all significantly tied to professional interpreter use, and assignment to video interpretation (n=22/312) was linked with significantly increased use of professional interpretation for communication with providers (adjusted odds ratio 2.7, 95% CI 1.1 to 7.0) versus telephone communication (n=28), they reported in Pediatrics.
Lion’s group noted that “providers whose patients were assigned to video interpretation had an almost threefold increased odds of using professional interpretation for any communication compared with patients who were assigned to telephone. There was no association between assigned interpreter modality and interpreter use among nurses or in the overall sample, including medical communication by nurses, providers, and other staff.” The latter finding was in line with previous data on the less frequent use of interpreters by nurses.
While the authors stressed that 96% of the families with limited-English proficiency (LEP) in the study received some professional interpretation, more than half of medical communication still took place without professional interpretation despite ready access to those services.
Lion and co-authors highlighted that the healthcare providers knew they were being video recorded for the study on interpreter use, “so typical use may be even lower than what we found,” and that interpreter use may still be counted if it was used at any time in the patient encounter, even if it did not take place during “substantial medical communication.”
In a commentary accompanying the study, Mindy Ju, MD, MA, University of California San Francisco, noted that “The study reveals how dichotomous terms, such as ’interpreter used’ and ’interpreter not used,’ do not accurately encapsulate interpreter use and frequently overestimate time spent with an interpreter. As a result, the benefits of professional interpretation may be even larger than reported because many events are measured as ’interpreted,’ when, in reality, they are not or not to the extent desirable to achieve the full benefit.”
Ju acknowledged that time constraints on physician-patient interaction are an issue, and families may often prefer that a relative serve as the interpreter, but she offered some solutions. The former can be addressed through “adequate training for interpreters and education for providers on how to use interpreters appropriately and effectively.”
As for the latter, Ju said the healthcare community needs to look at the bigger picture — “we must also look at the diversity of our own health care workforce to address these issues.” She pointed out that research has shown better outcomes when the patient and the physician are fluent in the same language. Previous reports have put the number of physicians (both native and foreign graduates) who speak a non-English language at around 40%.
“Increasing outreach to underrepresented-in-medicine students, dismantling systemic bias in recruitment, valuing multilingual skills, and developing inclusive work environments can improve the diversity of our workforce,” Ju stated. For instance, according to a 2019 report from the Association of American Medical Colleges (AAMC), about 6% of active physicians in 2018 identified as Hispanic, but more than 18% of the U.S. population identified as Hispanics/Latinx in 2019. More recent AAMC data shows that the number of minority students enrolled in medical school is on the rise.
The current study was part of a larger trial by Lion’s group on observed communication behavior with Spanish-speaking LEP families in a pediatric ED. They author videoed ED visits for 20% of the total trial participants. 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 assessed with multivariate random-effects logistic regression, clustered on the patient,” they explained.
Of those whose events were recorded, the majority of the patients were boys with a mean age of 5.9 years. The vast majority (87%) of their parents were born in Mexico with a mean of 11.2 years in the U.S. A little over 40% of the parents had an education level below or including eighth grade and more than half had income levels between $15,000 and $30,000 annually.
Among the providers, 47% of attending, 41% of consultant, and 57% of residents or nurse practitioners used professional interpretation, as did 16% of nurses. The association between interpreter use and speaker role is a novel finding,” the authors stated. “Potential explanations include less familiarity with interpreter access in the ED or lower importance being placed on information exchange by those individuals.”
The authors looked at interpretation initiation delay, which was “defined as the time from when a health care professional started the process to connect to a telephone or video interpreter (eg, by dialing the phone number or tapping the video icon). They found that the delay was more than twice as long for telephone versus video interpretation for a mean of 2.1 minutes for the former versus 1 minute for the latter (P<0.001).
Lion’s group stated that “among provider-led communication events, assignment to video interpretation was associated with a 2.7-fold increased odds of professional interpreter use, after controlling for communication content, duration, and provider role.”
“Health care professionals and LEP parents have been found to prefer video over telephone interpretation,” they added. “Given that health care professionals are deciding whether to use interpretation before every communication event, even small additional barriers can amount to important decreases in use.”
Study limitations included the fact that it was done at a single center with “excellent interpreter services,” enrollment was low in the broader trial, and provider awareness of the video recording may have led to greater interpreter use.
During the pandemic, medical interpreters have seen some gains with the general increase in the use of telehealth, although some telemedicine-specific platforms still do not meet federally mandated language access services.
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Professional interpreter use for patients and families with limited English profiency was inconsistent over the course of an emergency department visit, with particularly low use for high-risk activities like medication administration.
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Assignment to video versus telephone interpretation led to greater professional interpreter use among physicians and nurse practitioners, but not nurses.
Shalmali Pal, Contributing Writer, BreakingMED™
The study was funded by the Center for Child Health, Behavior, and Development at the Seattle Children’s Research Institute and the Center for Diversity and Health Equity at Seattle Children’s Hospital, as well as supported by the Seattle Children’s Hospital Department of Interpreter Services and the Emergency Department research team.
Lion reported support from the National Institute of Child Health.
Ju reported no relationships relevant to the contents of this paper to disclose.
Cat ID: 138
Topic ID: 85,138,254,730,138,192,925
