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An Implementation Science Approach Improves Language Access in the Emergency Department

  • Original Paper
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Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

Background

The underuse of interpreters for limited English proficiency (LEP) patient encounters is pervasive, particularly in the emergency department (ED).

Objective

To measure the outcome of strategies to improve the use of interpreters by ED providers.

Methods

Pre- and post- intervention evaluation of the unmet need for language assistance (LA) in a public ED. Informed by the Behavior Change Wheel (BCW), strategies included: education, training, technology-based facilitators, local champions and environmental cues.

Results

Pre-intervention, of the 110 patient charts with interpreter requests, 17 (15.5%) had documentation of an interpreter-mediated encounter or were seen by a certified bilingual provider (unmet need = 84.5%). Post intervention, of the 159 patient charts with interpreter requests, 47 (29.6%) had documentation of an interpreter-mediated encounter or were seen by a certified bilingual provider (unmet need = 70.4%), difference + 0.14 (95% CI = 0.03-0.23).

Conclusion

In this pilot study, we found a statistically significant increase in the met need for language assistance.

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References

  1. Ryan C. Language use in the United States: 2011. In: Bureau USC, editor. 2013

  2. Chen AH, Youdelman MK, Brooks J. The legal framework for language access in healthcare settings: title VI and beyond. J Gen Intern Med. 2007;22(Suppl 2):362–7.

    Article  Google Scholar 

  3. Diamond LC, Schenker Y, Curry L, Bradley EH, Fernandez A. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med. 2009;24(2):256–62.

    Article  Google Scholar 

  4. 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 

  5. Lee KC, Winickoff JP, Kim MK, Campbell EG, Betancourt JR, Park ER, et al. Resident physicians’ use of professional and nonprofessional interpreters: a national survey. Jama. 2006;296(9):1050–3.

    Article  CAS  Google Scholar 

  6. Lindholm M, Hargraves JL, Ferguson WJ, Reed G. Professional language interpretation and inpatient length of stay and readmission rates. J Gen Intern Med. 2012;27(10):1294–9.

    Article  Google Scholar 

  7. Ngai KM, Grudzen CR, Lee R, Tong VY, Richardson LD, Fernandez A. 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 

  8. Samuels-Kalow ME, Stack AM, Porter SC. Parental language and dosing errors after discharge from the pediatric emergency department. Pediatr Emerg Care. 2013;29(9):982–7.

    Article  Google Scholar 

  9. Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727–54.

    Article  Google Scholar 

  10. 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 

  11. The Joint Commission. Advancing effective communication, cultural competence, and patient- and family-centered care: a roadmap. Oakbrook Terrace: The Joint Commission; 2010.

    Google Scholar 

  12. Betancourt JRRM, Green AR, et al. Improving patient safety systems for patients with limited English proficiency: a guide for hospitals. Rockville: Agency for Healthcare Research and Quality; 2012. Contract No.: AHRQ No. 12-0041

    Google Scholar 

  13. Section 1557: ensuring meaningful access for individuals with limited English proficiency: health and human services; 2010. Available from: https://www.hhs.gov/sites/default/files/1557-fs-lep-508.pdf

  14. Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. Jama. 1996;275(10):783–8.

    Article  CAS  Google Scholar 

  15. Taira BR, Kim K, Mody N. Hospital and health system-level interventions to improve care for limited English proficiency patients: a systematic review; 2018

  16. 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 

  17. Kwoh S. LA speaks: language diversity and English proficiency by Los Angeles County service planning area

  18. Handley MA, Gorukanti A, Cattamanchi A. Strategies for implementing implementation science: a methodological overview. Emerg Med J. 2016;33(9):660–4.

    Article  Google Scholar 

  19. Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health. 2010;31:399–418.

    Article  Google Scholar 

  20. Taira BR, Torres J, Nguyen A, Guo R, Samra S. Language assistance for the care of Limited English Proficiency (LEP) patients in the emergency department: a survey of providers and staff. J Immigr Minor Health. 2020;22(3):439–47.

    Article  Google Scholar 

  21. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.

    Article  Google Scholar 

  22. Taira BR. Language. http://www.idheal-ucla.org/2017. Available from: http://www.idheal-ucla.org/page-45/page-12/page-17/

  23. Tang AS, Kruger JF, Quan J, Fernandez A. From admission to discharge: patterns of interpreter use among resident physicians caring for hospitalized patients with limited English proficiency. J Health Care Poor Underserved. 2014;25(4):1784–98.

    Article  Google Scholar 

  24. Ginde AA, Sullivan AF, Corel B, Caceres JA, Camargo CA Jr. Reevaluation of the effect of mandatory interpreter legislation on use of professional interpreters for ED patients with language barriers. Patient Educ Couns. 2010;81(2):204–6.

    Article  Google Scholar 

  25. Yawman D, McIntosh S, Fernandez D, Auinger P, Allan M, Weitzman M. The use of Spanish by medical students and residents at one university hospital. Acad Med. 2006;81(5):468–73.

    Article  Google Scholar 

  26. Detailed languages spoken at home and ability to speak English for the population 5 years and over: 2009–2013: United States Census Bureau; 2015. Available from: https://www.census.gov/data/tables/2013/demo/2009-2013-lang-tables.html

  27. Taira BR, Kim K, Mody N. Hospital and health system-level interventions to improve care for limited English proficiency patients: a systematic review. Jt Comm J Qual Patient Saf. 2019;45(6):446–58.

    PubMed  Google Scholar 

  28. Smedley BD, Stith AY, Nelson AR. In: Medicine Io, editor. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press; 2003.

    Google Scholar 

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Acknowledgements

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

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Authors and Affiliations

  1. Department of Emergency Medicine, Olive View-UCLA Medical Center, 14445 Olive View Drive, North Annex, Sylmar, CA, 91342, USA

    Breena R. Taira, Catherine Yaggi, Aristides Orue & Hyung Kim

  2. Department of Language Services, Olive View-UCLA Medical Center, 14445 Olive View Drive, North Annex, Sylmar, CA, 91342, USA

    Laura Onofre

  3. Department of Pediatrics, Olive View-UCLA Medical Center, 14445 Olive View Drive, North Annex, Sylmar, CA, 91342, USA

    Shannon Thyne

Authors
  1. Breena R. Taira
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  2. Laura Onofre
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  3. Catherine Yaggi
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  4. Aristides Orue
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  5. Shannon Thyne
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  6. Hyung Kim
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Correspondence to Breena R. Taira.

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The authors have no conflicts of interest to disclose.

Informed Consent

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

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Taira, B.R., Onofre, L., Yaggi, C. et al. An Implementation Science Approach Improves Language Access in the Emergency Department. J Immigrant Minority Health 23, 1214–1222 (2021). https://doi.org/10.1007/s10903-020-01127-x

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  • DOI: https://doi.org/10.1007/s10903-020-01127-x

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