421 Patterns of Non-English Language Use for Patient Care in a Public Emergency Department

Abstract

In public emergency departments (ED), many patients have limited English proficiency (LEP). Many EDs, however, report persistently low rates of language assistance use in the setting of a high volume of LEP patients. One possible explanation is that ED employees use their own non-English language (NEL) skills to supplement formal language assistance.The objective of this study is to describe employee use of NELs for patient care in a public ED. Study Design: Prospective, anonymous survey questionnaire of ED employees. Setting: A public emergency department with an estimated 50,000 visits per year where the majority of patients are LEP and language assistance is available via videoconference and phone 24/7. Subjects: All ED staff with substantial patient contact including MDs, NPs, RNs, NAs, research assistants, radiology techs, registration workers and respiratory therapists. Measures and outcomes: ED role, native language, languages spoken with patients, comfort level and frequency of NEL use, formal coursework in the NEL, bilingual certification, frequency of interpreting for others and comfort with medical terminology in the NEL. Prior formal training in interpretation (assistance with spoken language) and translation (assistance with written language) was also considered. Analysis: Descriptive statistics were used for analysis. Of the 354 total ED employees, 261 were approached and 259 agreed to participate, which represents a 73% response rate (259/354). MDs comprised 88/259 (33.9%) of participants. The native language of employees was 161/259 (62%) English, followed by Spanish 50/259 (19%), Tagalog 23/259 (8.9%) and Armenian 14/259 (5.4%). When communicating with patients, 24/259 (9.2%) of employees speak only English, 194/259 (75%) use one non-English language (NEL) and 41/259 (15.8%) use two NELs. Frequency of NEL use was categorized as often to every day for 205/233 (88%) of participants. Only 49/233 (21%), however, were certified by the hospital system to use their NEL with patients. Of those using NELs, 151/234 (64.5%) had past formal coursework and 81/233 (34.8%) were uncomfortable with medical terminology. Although 196/235 (83.4%) of participants stated they speak Spanish with patients, only 133/235 (56.6%) stated they feel comfortable doing so. Further, only 7/228 (3%) had prior training in how to interpret and 5/229 (2%) had training in how to translate. In this public ED, providers use their own NEL skills frequently in patient care, but without certification. Very few have training on how to interpret or translate. If the NEL skills of employees are to comprise part of the institutional plan for language assistance for LEP patients, certification and training must be implemented to assure that LEP patients receive the same high quality care as their English-speaking counterparts.