Language Barriers among Patients in Boston Emergency Departments: Use of Medical Interpreters After Passage of Interpreter Legislation

Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA.
Journal of Immigrant and Minority Health (Impact Factor: 1.16). 09/2008; 11(6):527-30. DOI: 10.1007/s10903-008-9188-5
Source: PubMed


Since 2001, Massachusetts state law dictates that emergency department (ED) patients with limited English proficiency have the right to a professional interpreter.
One year later, for two 24-h periods, we interviewed adult patients presenting to four Boston EDs. We assessed language barriers and compared this need with the observed use and type of interpreter during the ED visit.
We interviewed 530 patients (70% of eligible) and estimated that an interpreter was needed for 60 (11%; 95% confidence interval, 7-12%) patients. The primary interpreter for these clinical encounters was a physician (30%), friend or family member age >or=18 years (22%), hospital interpreter services (15%), younger family member (11%), or other hospital staff (17%).
We found that 11% of ED patients had significant language barriers, but use of professional medical interpreters remained low. One year after passage of legislation mandating access, use of professional medical interpreters remained inadequate.

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    • "We chose these measures based on our hypotheses that when able to readily access interpreters to speak with LEP patients via the video-interpreting network, the ED clinicians would feel less need to rely on test ordering and time in the ED for diagnosis and evaluation and that admission to the hospital would be reduced as the physician would feel more comfortable that instructions and follow-up appointments would be understood by the patient upon discharge home. We chose the ED for this study, as it is known that interpreter services are in great demand in the ED setting and not always readily accessible, important outcomes can be measured for within the context of one visit, and the relationship between language barriers and increased diagnostic testing has been previously documented in the setting of the ED (Baker et al. 1996; Hampers et al. 1999; Hampers and McNulty 2002; Ramirez, Engel, and Tang 2008; Ginde, Clark, and Camargo 2009). METHODS Video-Interpreting Network We studied a large system of shared remote interpreter services organized in a collaborative network of 14 public and nonprofit hospitals in California with technical support from a private company, Paras and Associates. "
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    ABSTRACT: To measure the impact of a policy change from use of telephonic and face-to-face interpreting to use of a video-interpreting network on Emergency Department (ED) care. Observational study of ED care at two California hospitals. We compared tests ordered, time in the ED, and admission rates for English- and Spanish-speaking patients presenting with chest pain and abdominal pain before and after the policy change. Data were extracted from electronic medical and billing records. Mean time in the ED, mean number of laboratory tests, radiology services, electrocardiograms, and echocardiograms, and rates of hospital admission for both language groups at both hospitals went down in the post-video-interpreting network period compared with the pre-video-interpreting network period. The percentage of patients leaving the ED against medical advice (AMA) increased in one hospital for both language groups; this increase was statistically significantly smaller in the Spanish-language group compared with the English group (p = .04). The studied video-interpreting network had minimal impact on health care outcomes in the ED.
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    • "The appropriateness and effectiveness of a family interpreter in each context will be very different, while also depending on the individuals involved. Despite the acknowledged risks, many studies have found that family interpreters remain widely used in many situations (Auckland Area Health Board 1990; Chan et al. 1999; Gerrish 2001; Kuo et al. 2007; Atkin 2008; Garrett et al. 2008; Diamond et al. 2009; Ginde et al. 2009). Doctors often normalise the fact that trained interpreters are underused and often lack awareness of the difficulties and risks, learning of these only through experience (Diamond et al. 2009). "
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    • "These laws and recommendations typically apply to health care settings which receive public funding, and in theory should reduce or eliminate language barriers to care in settings such as hospital emergency departments. Yet professional interpreter services are underused in these settings, even when mandated by law, implying that limited-English patients continue to experience less than optimal access to and quality of care (Baker et al. 1996, Ginde et al. 2008). "
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