Journal of General Internal Medicine

, Volume 14, Issue 2, pp 82–87 | Cite as

Impact of language barriers on patient satisfaction in an emergency department

  • Olveen Carrasquillo
  • E. John Orav
  • Troyen A. Brennan
  • Helen R. Burstin
Original Articles



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 words

patient satisfaction communication barriers language Hispanic Americans 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Statistical Abstract of the US 1990 Census, 113th ed. Washington, DC: US Bureau of the Census; 1993.Google Scholar
  2. 2.
    Woloshin S, Bickell NA, Schwartz LM, Francesca G, Welch G. Language barriers in medicine. JAMA. 1995;273:724–8.PubMedCrossRefGoogle Scholar
  3. 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. 4.
    Torres RE. The pervading role of language on health. J Health Care Poor Underserved. 1998;9(suppl 1):S21–5.Google Scholar
  5. 5.
    Kirkmann-Liff B, Mondragon D. Language of interview: relevance for research of southwest Hispanics. Am J Public Health. 1991;81:1399–404.CrossRefGoogle Scholar
  6. 6.
    Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275:783–8.PubMedCrossRefGoogle Scholar
  7. 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
  8. 8.
    Harpole LH, Orav EJ, Hickey M, Posther KE, Brennan TA. Patient satisfaction in the ambulatory setting—influence of data collection methods and sociodemographic factors. J Gen Intern Med. 1996;11:431–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Grumback K, Keane D, Bindman A. Primary care and public emergency department overcrowding. Am J Public Health. 1993; 83:372–8.CrossRefGoogle Scholar
  10. 10.
    Baker DW, Stevens CD, Brook RH. Determinants of emergency department use by ambulatory patients at an urban hospital. Ann Emerg Med. 1995;25:311–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Baker DW, Stevens CD, Brook RH. Regular source of ambulatory care and medical care utilization by patients presenting to a public hospital emergency department. JAMA. 1994;271:1909–12.PubMedCrossRefGoogle Scholar
  12. 12.
    Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334.CrossRefGoogle Scholar
  13. 13.
    Cleary PD, Edgman-Levitan S, Roberts M, et al. Patients evaluate their health care: a national survey. Health Aff (Millwood). 1991;10:254–67.CrossRefGoogle Scholar
  14. 14.
    Baker DW, Stevens CD, Brook RH. Patients who leave a public hospital emergency department without being seen by a physician: causes and consequences. JAMA. 1991;266:1085–90.PubMedCrossRefGoogle Scholar
  15. 15.
    Tumulty P. What is a clinician and what does he do? N Engl J Med. 1970;283:20–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Hulka BS, Kupper LL, Daly MB, Cassel JC, Schoen F. Correlates of satisfaction and dissatisfaction with medical care: a community perspective. Med Care. 1975;13:648–58.PubMedCrossRefGoogle Scholar
  17. 17.
    Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care. 1988;26:1119–28.PubMedCrossRefGoogle Scholar
  18. 18.
    Todd KH, Samaroo N, Hoffman JR. Ethnicity as a risk factor for inadequate emergency department analgesia. JAMA. 1993;269:1537–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Perez-Stable EJ, Napoles-Springer A, Miramontes JM. The effects of ethnicity and language on medical outcomes of patients with hypertension or diabetes. Med Care. 1997;35:1212–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Seijo R, Gomez H, Freidenberg J. Language as a communication barrier in medical care for Latino patients. Hisp J Behav Sci. 1991;13:363–76.CrossRefGoogle Scholar
  21. 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
  22. 22.
    Perez-Stable EJ. Issues in Latino health care. West J Med. 1987; 146:213–8.PubMedGoogle Scholar
  23. 23.
    Putsch RW. Cross-cultural communication—the special case of interpreters in health care. JAMA. 1985;254:3344–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Vasquez C, Javier RA. The problem with interpreters: communicating with Spanish speaking patients. Hosp Commun Psychiatry. 1991;42:163–5.Google Scholar
  25. 25.
    Hornberger JC, Gibson CD, Wood W, et al. Eliminating language barriers for Non-English speaking patients. Med Care. 1996;34:845–56.PubMedCrossRefGoogle Scholar
  26. 26.
    Osmond DH, Vranizan K, Schillinger D, Stewart AL, Bindman AB. Measuring the need for medical care in an ethnically diverse population. Health Serv Res. 1996;31:551–71.PubMedGoogle Scholar
  27. 27.
    Williams MV, Parker RM, Baker DW, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995;274:1677–82.PubMedCrossRefGoogle Scholar
  28. 28.
    Blumenthal D. Quality of care—what is it? N Engl J Med. 1996; 335:891–4.PubMedCrossRefGoogle Scholar
  29. 29.
    National Committee for Quality Assurance: Health Plan Employers Data and Information Set (HEDIS) 3.0 Washington, DC: NCQA: 1998.Google Scholar

Copyright information

© Society of General Internal Medicine 1999

Authors and Affiliations

  • Olveen Carrasquillo
    • 1
  • E. John Orav
    • 3
  • Troyen A. Brennan
    • 2
    • 3
  • Helen R. Burstin
    • 2
  1. 1.Department of MedicineCambridge HospitalCambridge
  2. 2.Division of General Medicine, Department of MedicineBrigham and Women’s HospitalBoston
  3. 3.Harvard School of Public HealthBoston

Personalised recommendations