Impact of an Easy-Access Telephonic Interpreter Program in the Acute Care Setting: An Evaluation of a Quality Improvement Intervention

Abstract

Language barriers render interaction with the health care system difficult and lead to health disparities for patients with limited English proficiency (LEP). Despite a long-standing legal obligation for large health care organizations in the United States to try to provide free language access services for patients with LEP, professional interpretation is not always widely accessible, and even when it is, its use is often suboptimal. A dual-handset phone with 24-hour access to professional telephonic interpretation was placed at the bedside of all patients admitted to the general medicine floor of a tertiary care academic hospital. Nurses and physicians were surveyed before and after the easy-access interpretation program's implementation. Distribution of pre- and postimplementation surveys to 127 and 122 nurses, respectively, yielded a total of 163 completed surveys (overall participation rate, 65%). Distribution of surveys to 96 and 78 physicians, respectively, yielded 116 completed surveys (overall participation rate, 67%). After implementation, use of professional telephonic interpreters for communication with LEP patients increased fourfold, without a decrease in use of professional in-person interpreters. There were significant increases in professional interpreter use during brief communications with high error potential, including medication administration (odds ratio [OR] = 1.9, 95% confidence interval [CI] 1.1-3.2) and pre-rounding (OR = 3.4, 95% CI 1.2-9.8). Increasing ease of access to dual-handset interpreter telephones promotes use of professional interpreters in the acute care setting. Future hospital policy should focus on further integrating language services into the hospital environment, accompanied by an educational program to assist in shifting professional norms toward use of professional interpreters.