Impact of language barriers on patient satisfaction in an emergency department
To examine patient satisfaction and willingness to return to an emergency department (ED) among non-English speakers.
Cross-sectional survey and follow-up interviews 10 days after ED visit.
Five urban teaching hospital EDs in the Northeastern United States.
We surveyed 2,333 patients who presented to the ED with one of six chief complaints.
Measurements and main results
Patient satisfaction, willingness to return to the same ED if emergency care was needed, and patient-reported problems with care were measured. Three hundred fifty-four (15%) of the patients reported English was not their primary language. Using an overall measure of patient satisfaction, only 52% of non-English-speaking patients were satisfied as compared with 71% of English speakers (p<.01). Among non-English speakers, 14% said they would not return to the same ED if they had another problem requiring emergency care as compared with 9.5% of English speakers (p<.05). In multivariate analysis adjusting for hospital site, age, gender, race/ethnicity, education, income, chief complaint, urgency, insurance status. Medicaid status, ED as the patient’s principal source of care, and presence of a regular provider of care, non-English speakers were significantly less likely to be satisfied (odds ratio [OR] 0.59; 95% confidence interval [CI] 0.39, 0.90) and significantly less willing to return to the same ED (OR 0.57; 95% CI 0.34, 0.95). Non-English speakers also were significantly more likely to report overall problems with care (OR 1.70; 95% CI 1.05, 2.74), communication (OR 1.71; 95% CI 1.18, 2.47), and testing (OR 1.77; 95% CI 1.19, 2.64).
Non-English speakers were less satisfied with their care in the ED, less willing to return to the same ED if they had a problem they felt required emergency care, and reported more problems with emergency care. Strategies to improve satisfaction among this group of patients may include appropriate use of professional interpreters and increasing the language concordance between patients and providers.
Key wordspatient satisfaction communication barriers language Hispanic Americans
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- 1.Statistical Abstract of the US 1990 Census, 113th ed. Washington, DC: US Bureau of the Census; 1993.Google Scholar
- 3.Chang PH, Fortier JP. Language barriers to health care: an overview. J Health Care Poor Underserved. 1998;9(suppl 1):S5–19.Google Scholar
- 4.Torres RE. The pervading role of language on health. J Health Care Poor Underserved. 1998;9(suppl 1):S21–5.Google Scholar
- 7.Meridith LS, Siu AL. Variation and quality of self-report health data—Asians and Pacific Islanders compared with other ethnic groups. Med Care. 1995;33:1120–31.Google Scholar
- 21.Riddick SH. Improving access for limited English-speaking consumers: a review of strategies in health care settings. J Health Care Poor Underserved. 1998;9(suppl 1):S40–61.Google Scholar
- 24.Vasquez C, Javier RA. The problem with interpreters: communicating with Spanish speaking patients. Hosp Commun Psychiatry. 1991;42:163–5.Google Scholar
- 29.National Committee for Quality Assurance: Health Plan Employers Data and Information Set (HEDIS) 3.0 Washington, DC: NCQA: 1998.Google Scholar