Impact of language barriers and interpreter requirement on non-elective intensive care patient outcomes

Abstract

Background: In a multicultural society, limited data is available on the impact of language proficiency and utilisation of interpreters on critical care patient outcomes. Objective To investigate the relationship between hospital outcomes of non-elective intensive care unit (ICU) patients with language barriers and interpreter requirement. Methodology: Patients admitted to 23 adult public ICUs within the state of Victoria, Australia from July 2007 to June 2018, were extracted from The Australian New Zealand Intensive Care Society Adult Patient Database. De-identified patient data was matched using probabilistic methods and statistical linkage keys to the Victorian Admitted Episodes Database. Patients were classified into one of three groups; English as preferred language (EPL), English not-preferred language (ENPL), and English not-preferred language, interpreter required (ENPL-IR). Results: ICU admissions (n=126,891) were analysed of whom 6,355 (5%) were in the ENPL-IR group and 3,394 (3%) in the ENPL group. Compared to EPL, both groups of ENPL were older, had more co-morbidities and higher severity of illness scores. In-hospital mortality was 13.1% in EPL, 16.7% in the ENPL-IR group and 19.6% in the ENPL group. However, after adjusting for age, severity of illness and socio-economic status, the ENPL group remained with a higher risk adjusted mortality (OR 1.21, 95%CI 1.07-1.36, P = 0.002), whereas ENPL-IR group had a lower risk adjusted mortality (OR 0.81, 95%CI 0.74-0.89, P<0.001). Conclusion: The requirement for an interpreter is strongly associated with improved hospital outcomes for non-elective ICU patients with English as a non-preferred language. In view of these results, it is recommended that patients, family members and clinicians utilise interpreter services when English is not the preferred language of an ICU patient.