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Language Assistance for the Care of Limited English Proficiency (LEP) Patients in the Emergency Department: A Survey of Providers and Staff

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Abstract

Many ED patients have limited English proficiency (LEP). Under Title VI of the 1964 Civil Rights Act, LEP patients are entitled to language assistance, however, multiple studies demonstrate that language assistance is underutilized. We aimed to characterize the knowledge, practice patterns, and preferences of ED providers and staff regarding language assistance for LEP patients. We performed a self-administered, anonymous questionnaire in an urban, public ED where most patients have LEP. Subjects included all ED providers and staff with substantial patient contact. We recorded ED role, knowledge of language assistance policy, prior training on working with interpreters, non-English language skills and bilingual certification. Outcomes included frequency of and comfort level with respondent’s own non-English language (NEL) use in the ED, and the preferred and most frequently used modalities of language assistance. Of the 354 total ED employees, 261 were approached and 259 agreed to participate, which represents a 73% response rate (259/354). Respondents were 37% MD/NPs, 34% RNs and 29% other ED staff. Only 50/259 (19%) had prior training on working with interpreters. 171/257 (67%) were “unsure” if the hospital had a policy on language assistance. The most frequent modalities accessed for spoken language assistance were “Other ED staff” 106/259 (41%) or “ad hoc interpreter” 62/259 (24%). Although 227/274 (83%) use a non-English language with patients regularly, comfort levels in using their NEL for clinical care were variable. Most ED providers and staff had little training in the use of language assistance and were unaware of hospital policy. Use of NEL skills by providers for clinical care is common. Dissemination of best practices for the provision of language assistance and the clinical use of NEL skills has the potential to improve communication with LEP patients.

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References

  1. Ramirez D, Engel KG, Tang TS. Language interpreter utilization in the emergency department setting: a clinical review. J Health Care Poor Underserved. 2008;19(2):352–62.

    Article  Google Scholar 

  2. Youdelman MK. The medical tongue: US laws and policies on language access. Health Aff (Millwood). 2008;27(2):424–33.

    Article  Google Scholar 

  3. Baker DW, et al. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275(10):783–8.

    Article  CAS  Google Scholar 

  4. Taira BR, Orue A. Language assistance for limited English proficiency patients in a public ED: determining the unmet need. BMC Health Serv Res. 2019;19(1):56.

    Article  Google Scholar 

  5. Ginde AA, et al. (2010) Reevaluation of the effect of mandatory interpreter legislation on use of professional interpreters for ED patients with language barriers. Patient Educ Couns 81(2), 204–206.

    Article  Google Scholar 

  6. Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255–99.

    Article  Google Scholar 

  7. Betancourt JR, Renfrew M, Green AR, et al. Improving patient safety systems for patients with limited English proficiency: a guide for hospitals. Rockville, MD: AHRQ Publication; 2012.

    Google Scholar 

  8. Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press; 2003.

    Google Scholar 

  9. Diamond LC, et al. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med. 2009;24(2):256–62.

    Article  Google Scholar 

  10. Kwoh S, Speaks LA. Language diversity and English proficiency by Los Angeles County service planning area.

  11. Harris PA, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  Google Scholar 

  12. Ngai KM, et al. The association between limited English proficiency and unplanned emergency department revisit within 72 hours. Ann Emerg Med. 2016;68(2):213–21.

    Article  Google Scholar 

  13. Chan YF, et al. Interpreter services in emergency medicine. J Emerg Med. 2010;38(2):133–9.

    Article  Google Scholar 

  14. Section 1557: ensuring meaningful access for individuals with limited English proficiency. Affordable Care Act 2010. https://www.hhs.gov/sites/default/files/1557-fs-lep-508.pdf. Accessed 5 Dec 2018

  15. Parker MM, et al. Association of patient-physician language concordance and glycemic control for limited-English proficiency Latinos with type 2 diabetes. JAMA Intern Med. 2017;177(3):380–7.

    Article  Google Scholar 

  16. Diamond LC, Jacobs EA. Let's not contribute to disparities: the best methods for teaching clinicians how to overcome language barriers to health care. J Gen Intern Med. 2010;25(Suppl 2):S189–S193193.

    Article  Google Scholar 

  17. Diamond LC, Reuland DS. Describing physician language fluency: deconstructing medical Spanish. JAMA. 2009;301(4):426–8.

    Article  CAS  Google Scholar 

  18. Prince D, Nelson M. Teaching Spanish to emergency medicine residents. Acad Emerg Med. 1995;2(1):32–6 (discussion 36–7)

    Article  CAS  Google Scholar 

  19. Ryan C. Language use in the United States: 2011. U.S.C. Bureau, Editor; 2013.

  20. Regenstein M, Andres E, Wynia MK. Appropriate use of non-English-language skills in clinical care. JAMA. 2013;309(2):145–6.

    Article  CAS  Google Scholar 

  21. Diamond L, et al. Non-English-language proficiency of applicants to US residency programs. JAMA. 2014;312(22):2405–7.

    Article  Google Scholar 

Download references

Acknowledgement

Redcap access was supported by NIH/National Center for Advancing Translational Science (NCATS) UCLA CTSI Grant Number UL1TR000124.

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Correspondence to Breena R. Taira.

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This study was approved by the Olive View-UCLA IRB prior and granted a waiver of written informed consent.

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Taira, B.R., Torres, J., Nguyen, A. et al. Language Assistance for the Care of Limited English Proficiency (LEP) Patients in the Emergency Department: A Survey of Providers and Staff. J Immigrant Minority Health 22, 439–447 (2020). https://doi.org/10.1007/s10903-019-00964-9

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