Inconsistent Use Of Professional Interpretation In Pediatric EDs

Families with limited English proficiency lack consistent access to professional interpreters in pediatric emergency departments, a new U.S. study suggests.

Researchers analyzed video recordings of 312 medical communication events that occurred during 50 pediatric emergency department (ED) visits. All participants in the study were part of a larger trial examining telephone versus video interpretation services for Spanish-speaking families with limited English Proficiency.

Overall, professional interpretation was used for just 36% of medical communication events in the study, researchers report in Pediatrics. Professional interpretation was most common for taking detailed medical histories (89%) and least often utilized for procedures (11%) and medication administration (8%).

"Part of the variability in interpreter use has to do with whether we think communication is the point of the interaction or not; if not, then its use is much less likely," said lead study author Dr. Casey Lion, an assistant professor of pediatrics at the University of Washington School of Medicine and investigator at the Center for Child Health, Behavior and Development at Seattle Children's Research Institute.

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"This is problematic, though, because all of these additional contacts with staff provide English-speaking families with really important opportunities to ask new questions, get updates, and share additional information, which families who don't speak English proficiently are denied if no interpreter is used when providers go in the room," Dr. Lion said by email.

Over the course of a visit, these brief interactions add up to a big difference in how much communication a family receives, Dr. Lion added.

Participants in the study who had been randomly assigned to receive video interpretation services were significantly more likely to have access to a professional interpreter during medical communication events than the participants who had been randomized to receive telephone interpretation services.

Compared with telephone interpretation services, video interpretation was associated with a significantly greater chance of access to a professional interpreter during communications with providers (odds ratio 2.7).

The provider type also impacted use of professional interpreters. For example, compared with ED attendings, consulting doctors (OR 0.19) and nurses (OR 0.28) were significantly less likely to use professional interpreters.

One limitation of the study is that it enrolled families at a single medical center with excellent interpreter services, so it's possible the results might not be generalizable to other settings, the authors note.

In addition, more families randomized to video interpretation in the larger clinical trial agreed to enroll in the current study than families randomized to telephone interpretation.

Video interpretation may be more intuitive and quicker to start than using telephone interpretation services, which may require longer hold times to access help, said Dr. Mindy Ju, an assistant clinical professor of pediatric critical care medicine at the University of California San Francisco who authored a commentary accompanying the study.

On the individual provider level, this study should bring awareness to the lack of interpreter use and should motivate individuals to use them more frequently, Dr. Ju said by email.

"At a higher level, for me the take-home message is that we continue to work within our clinical settings to advocate for more interpreter support, focusing on in-person and video interpretation, as video interpretation is associated with high utilization rates," Dr. Ju added. "It also highlights a need for creating systems to increase use of interpreters for high risk situations, such as medication administration and procedures."

—Lisa Rapaport

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