In-person Interpreters Research Articles

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults: Guideline V. Assessment of Cultural Factors.

(Excerpted from "The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition." Copyright © 2016, American Psychiatric Association. Reprinted with permission.).

Register-based study concerning the problematic situation of using interpreting service in a region in Sweden

BackgroundDue to increasing international migration, Sweden has become a multicultural and multilingual society, with about 19% of the population born abroad, which imposes high demands on the healthcare sector and interpreting services. The aim was to investigate problems in the use of interpreters as recorded by healthcare staff and the interpreter service in a region in Sweden.MethodsCross-sectional register-based study. The study focused on a geographically well-defined region in Sweden including (a) specialized care at three hospitals; (b) local healthcare, including out-patient clinics at hospital and emergency healthcare and primary healthcare; and (c) dental care. The study was based on 726 existing incident reports on the interpreting service and information from the interpreter agency from 2012 and the first quarter of 2016 during a period of a massive influx of refugees.ResultsThe highest number of adverse advents was reported in local healthcare and mainly concerned the absence of an interpreter at the appointed time. Non-authorized in-person interpreters performed most interpretation assignments and Arabic was the most requested language.ConclusionsThis study highlights the significance of good cooperation between healthcare and the interpreter service in order to guarantee safe and high-quality healthcare for patients in need of interpreters to be able to communicate in healthcare.

Spanish Interpreter Services for the Hospitalized Pediatric Patient: Provider and Interpreter Perceptions

BackgroundMany Americans have limited English proficiency (LEP) and difficulty communicating with health care providers, creating inequitable health care delivery. Despite widespread interpreter availability in hospitals, perceptions of interpreter services in the pediatric inpatient setting are largely unknown. ObjectiveTo investigate staff perspectives regarding: 1) roles of the interpreter and provider (attending, resident, and nurse) during an encounter, 2) modalities of interpretation, and 3) barriers to services. MethodsFocus groups were conducted with: 1) hospital-employed Spanish interpreters, 2) Pediatric Hospital Medicine attendings, 3) pediatric and internal medicine-pediatric residents, and 4) medical unit nurses. Sessions were audio-recorded and transcribed. Using Atlas.ti, 2 investigators created the coding scheme, independently coded the data, and achieved consensus. Qualitative methods were used for thematic analysis. ResultsFourteen groups (n = 59 participants) were held: 3 interpreter groups (n = 10), 3 attending groups (n = 14), 2 resident groups (n = 17), and 6 nurse groups (n = 18). Most believed the interpreter's role was to serve as a conduit (provide word-for-word interpretation), act as a cultural broker, and maintain transparency (not withhold information). All groups felt providers should interact with families as they would with English-speaking families. In-person interpreters were preferred over telephone and video for being more accurate, efficient, and personable. Barriers to accessing services included time needed for interpretation, overconfidence in language skills, variable family dynamics, and identification of LEP families. ConclusionsIn-person interpreters are highly valued, fulfilling complex roles. However, operational and human factors limit access to services in the hospital. These findings, along with family perspectives, can be used to optimize interpretation experiences.

Observational study to understand interpreter service use in emergency medicine: why the key may lie outside of the initial provider assessment

ObjectiveTo characterise the use of interpreter services and other strategies used to communicate with limited English proficient (LEP) patients throughout their emergency department visit.MethodsWe performed a process tracing study observing...

Enhancing Medical Student-Interpreter Collaboration in an Urban Free Clinic.

Cultural barriers and patient-provider language discordance exert deleterious effects on patient care. One solution has been the integration of medical interpreters into the care of patients with limited English proficiency. While medical schools and residency programs have started developing training programs on how to work with medical interpreters, no similar endeavor has been reported by student-run free clinics. Over 1 year, 76 third-year medical students (MS3s) were enrolled in control and intervention groups, and evaluated by in-person interpreters during interpreted real-patient encounters. MS3s in the intervention group received a lesson- and reminder-based training program on how to work with in-person interpreters. MS3s who received the intervention were more likely to ask the patient one question at a time (odds ratio [OR] 3.54, P=.0079), listen to the interpreter without unnecessary interruption (OR 3.30, P=.022), and speak in short, simple sentences with pauses for interpretation (OR 3.08, P=.017). Our lesson- and reminder-based training program on provider-interpreter collaboration can improve the performance of MS3s within a select skill set with minimal cost and time investment.

An Interview with Brent C. James

The aim of this study was to evaluate the process of implementing video remote interpreting (VRI) in a hospital already using in-person and over-the-phone interpreting (OPI), including the impact on utilization of language services, efficiency, and costs, as well as implementation challenges.A prospective program-evaluation design was used. From 2012 to 2017, 165 VRI carts and iPads were rolled out in clinics, inpatient wards, and the emergency department. Each area was supported for six weeks with training and problem-solving issues. Additional VRI rollouts occurred in groups, every two to four months. Outcomes were assessed using utilization and observation/interview data.Postimplementation, 50,611 VRI encounters occurred for a total of 556,938 interpretation minutes. OPI decreased by 37.5%. Mean wait time for language services fell from 60 to 5 minutes. Rapid VRI uptake (> 10,000 VRI minutes in Year 1) occurred in clinics previously lacking access to in-person interpreters. VRI was associated with in-person interpreters having more time for professional development activities and with five promotions. Implementation challenges included initial resistance to VRI use, device connectivity problems, and six months’ lead-in time to establish proper VRI use. Challenges were overcome through ongoing education, dialogue, and implementation rounds.After overcoming initial challenges, VRI implementation, as part of provision of comprehensive language services, can potentially yield several benefits, including immediate extensive use, decreased OPI, reduced wait times for language services, rapid uptake in clinics previously lacking in-person interpreter access, and increased average minutes per encounter by in-person interpreters.

Promoting Effective Communication with Limited English Proficient Families: Implementation of Video Remote Interpreting as Part of a Comprehensive Language Services Program in a Children’s Hospital

A prospective program-evaluation design was used. From 2012 to 2017, 165 VRI carts and iPads were rolled out in clinics, inpatient wards, and the emergency department. Each area was supported for six weeks with training and problem-solving issues. Additional VRI rollouts occurred in groups, every two to four months. Outcomes were assessed using utilization and observation/interview data. Postimplementation, 50,611 VRI encounters occurred for a total of 556,938 interpretation minutes. OPI decreased by 37.5%. Mean wait time for language services fell from 60 to 5 minutes. Rapid VRI uptake (> 10,000 VRI minutes in Year 1) occurred in clinics previously lacking access to in-person interpreters. VRI was associated with in-person interpreters having more time for professional development activities and with five promotions. Implementation challenges included initial resistance to VRI use, device connectivity problems, and six months' lead-in time to establish proper VRI use. Challenges were overcome through ongoing education, dialogue, and implementation rounds. After overcoming initial challenges, VRI implementation, as part of provision of comprehensive language services, can potentially yield several benefits, including immediate extensive use, decreased OPI, reduced wait times for language services, rapid uptake in clinics previously lacking in-person interpreter access, and increased average minutes per encounter by in-person interpreters.

Communicating with Patients with Disability: Perspectives of Practicing Physicians.

Patient-centered care for people with disability requires effective communication and compliance with the Americans with Disabilities Act (ADA). To understand physicians' perspectives on communication experiences with people with disability. Twenty semi-structured individual interviews. Interview recordings were transcribed verbatim for analysis. Massachusetts, October 2017-January 2018. Twenty physicians ranging from 8 to 51years in practice in primary care or 4 other specialties. Commonly expressed themes around communication with people with disability. Concerns coalesced around 4 broad categories: communication experiences with people who are deaf or hard of hearing, communication with people who are blind or have vision impairment, communication with people who have intellectual disability, and recommendations for improving communication. Although participants in this study reported various efforts to communicate effectively with patients with hearing or vision loss or intellectual disability, many gaps appear to remain, as well as instances where physicians' preferences run counter to patients' wishes and the ADA. Examples include physicians' preferences for remote, online sign language interpreters despite patients desiring in-person interpreters and suggesting that patients arrange for their own interpreters. Few educational materials are available in braille, and electronic medical records may not allow documents to be printed in large font for persons with low vision. Communicating with patients with intellectual disability raised particular concerns, with participants often preferring to interact with caregivers and minimal efforts to involve patients. Effective communication is necessary for ensuring the quality of health care for people with disability, and it is legally required under the ADA. Our results suggest that important gaps may remain in ensuring effective communication, and some practicing physicians could benefit from formal training in effective methods for communicating with patients with disability.

Visual inspection and dermoscopy, alone or in combination, for diagnosing keratinocyte skin cancers in adults.

Visual inspection and dermoscopy, alone or in combination, for diagnosing keratinocyte skin cancers in adults.

Visual inspection for diagnosing cutaneous melanoma in adults.

Melanoma has one of the fastest rising incidence rates of any cancer. It accounts for a small percentage of skin cancer cases but is responsible for the majority of skin cancer deaths. History-taking and visual inspection of a suspicious lesion by a clinician is usually the first in a series of 'tests' to diagnose skin cancer. Establishing the accuracy of visual inspection alone is critical to understating the potential contribution of additional tests to assist in the diagnosis of melanoma. To determine the diagnostic accuracy of visual inspection for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in adults with limited prior testing and in those referred for further evaluation of a suspicious lesion. Studies were separated according to whether the diagnosis was recorded face-to-face (in-person) or based on remote (image-based) assessment. We undertook a comprehensive search of the following databases from inception up to August 2016: CENTRAL; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. Test accuracy studies of any design that evaluated visual inspection in adults with lesions suspicious for melanoma, compared with a reference standard of either histological confirmation or clinical follow-up. We excluded studies reporting data for 'clinical diagnosis' where dermoscopy may or may not have been used. Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where information related to the target condition or diagnostic threshold were missing. We estimated summary sensitivities and specificities per algorithm and threshold using the bivariate hierarchical model. We investigated the impact of: in-person test interpretation; use of a purposely developed algorithm to assist diagnosis; and observer expertise. We included 49 publications reporting on a total of 51 study cohorts with 34,351 lesions (including 2499 cases), providing 134 datasets for visual inspection. Across almost all study quality domains, the majority of study reports provided insufficient information to allow us to judge the risk of bias, while in three of four domains that we assessed we scored concerns regarding applicability of study findings as 'high'. Selective participant recruitment, lack of detail regarding the threshold for deciding on a positive test result, and lack of detail on observer expertise were particularly problematic.Attempts to analyse studies by degree of prior testing were hampered by a lack of relevant information and by the restricted inclusion of lesions selected for biopsy or excision. Accuracy was generally much higher for in-person diagnosis compared to image-based evaluations (relative diagnostic odds ratio of 8.54, 95% CI 2.89 to 25.3, P < 0.001). Meta-analysis of in-person evaluations that could be clearly placed on the clinical pathway showed a general trade-off between sensitivity and specificity, with the highest sensitivity (92.4%, 95% CI 26.2% to 99.8%) and lowest specificity (79.7%, 95% CI 73.7% to 84.7%) observed in participants with limited prior testing (n = 3 datasets). Summary sensitivities were lower for those referred for specialist assessment but with much higher specificities (e.g. sensitivity 76.7%, 95% CI 61.7% to 87.1%) and specificity 95.7%, 95% CI 89.7% to 98.3%) for lesions selected for excision, n = 8 datasets). These differences may be related to differences in the spectrum of included lesions, differences in the definition of a positive test result, or to variations in observer expertise. We did not find clear evidence that accuracy is improved by the use of any algorithm to assist diagnosis in all settings. Attempts to examine the effect of observer expertise in melanoma diagnosis were hindered due to poor reporting. Visual inspection is a fundamental component of the assessment of a suspicious skin lesion; however, the evidence suggests that melanomas will be missed if visual inspection is used on its own. The evidence to support its accuracy in the range of settings in which it is used is flawed and very poorly reported. Although published algorithms do not appear to improve accuracy, there is insufficient evidence to suggest that the 'no algorithm' approach should be preferred in all settings. Despite the volume of research evaluating visual inspection, further prospective evaluation of the potential added value of using established algorithms according to the prior testing or diagnostic difficulty of lesions may be warranted.

Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults.

Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults.

Identifying and Addressing Language Needs in Primary Care: a Pilot Implementation Study.

Medical interpreters improve care for patients with Limited English Proficiency but are underused. Protocols to improve interpreter use in primary care are needed. Medical Assistants (MAs) screened patients for language needs and arranged for telephone interpreters during rooming in two pilot clinics (PCs). We interviewed MAs and providers and analyzed interviews using modified grounded theory, linking themes to the Promoting Action on Research Implementation in Health Services (PARiHS) framework categories of Context, Evidence, and Facilitation. Providers in PCs and four comparison clinics were surveyed. Context themes included issues with the telephone interpreter vendor; having established teams, roles and workflows; and difficulty incorporating time-sensitive tasks. Evidence themes included engagement in language screening; preferring in-person interpreters; improving the patient experience; and having mixed responses to the protocol. Facilitation themes included MAs needing more support. PC providers were more satisfied with care (OR = 12.7) and communication (OR = 7.6) than comparison clinic providers. The protocol may improve patient care and communication, but implementation was inconsistent. Language screening is a complex process and further research is needed to improve screening questions and procedures. Future interventions should capitalize on team members' drives to improve patient care and control costs but also need to consider the impacts of health system changes, and to consider the culture, training needs, roles, and relationships of team members.

Evaluating the Feasibility of Incorporating In-Person Interpreters on Family-Centered Rounds: A QI Initiative.

No best practice has been defined for incorporating in-person interpreters into family-centered rounds (FCRs) for patients with limited English proficiency (LEP). We hypothesized that addressing barriers to scheduling in-person interpreters would make FCR encounters more likely, and thus ensure more equitable care for LEP patients. A quality improvement initiative was conducted from October 2014 to March 2016 to arrange in-person interpreters for LEP patients during FCRs on the inpatient pediatric service of a large, urban, tertiary care center in Boston. Main interventions included establishing a protocol for scheduling interpreters for rounds and the implementation of a form to track process adherence. Our primary outcome was the percentage of FCR encounters with LEP patients with an interpreter present. Our balancing measures were patient satisfaction, which was assessed using validated surveys administered weekly by nonphysician team members through convenience sampling of families present on the wards, and rounds duration. There were 614 encounters with LEP patients during the intervention, 367 of which included in-person interpreters. The percentage of encounters with LEP patients involving interpreters increased from 0% to 63%. Form completion, our primary process measure, reached 87% in the most recent phase. English-proficient and LEP patients reported similar satisfaction with their rounding experience amid a modest increase in rounds duration (preintervention, 105 minutes; postintervention, 130 minutes; P = .056). Using quality improvement as a framework to address key barriers, we successfully implemented a process that increased the participation of in-person interpreters on FCRs on a busy pediatric service.

In-Person Interpreter Use and Hospital Length of Stay among Infants with Low Birth Weight.

To ensure timely appropriate care for low-birth-weight (LBW) infants, healthcare providers must communicate effectively with parents, even when language barriers exist. We sought to evaluate whether non-English primary language (NEPL) and professional in-person interpreter use were associated with differential hospital length of stay for LBW infants, who may incur high healthcare costs. We analyzed data for 2047 infants born between 1 January 2008 and 30 April 2013 with weight <2500 g at one hospital with high NEPL prevalence. We evaluated relationships of NEPL and in-person interpreter use on length of stay, adjusting for medical severity. Overall, 396 (19%) had NEPL parents. Fifty-three percent of NEPL parents had documented interpreter use. Length of stay ranged from 1 to 195 days (median 11). Infants of NEPL parents with no interpreter use had a 49% shorter length of stay (adjusted incidence rate ratio (IRR) 0.51, 95% confidence interval (CI) 0.43–0.61) compared to English-speakers. Infants of parents with NEPL and low interpreter use (<25% of hospital days) had a 26% longer length of stay (adjusted IRR 1.26, 95% CI 1.06–1.51). NEPL and high interpreter use (>25% of hospital days) showed a trend for an even longer length of stay. Unmeasured clinical and social/cultural factors may contribute to differences in length of stay.

Medical Interpreters in Outpatient Practice.

This article provides an overview of the federal requirements related to providing interpreter services for non-English-speaking patients in outpatient practice. Antidiscrimination provisions in federal law require health programs and clinicians receiving federal financial assistance to take reasonable steps to provide meaningful access to individuals with limited English proficiency who are eligible for or likely to be encountered in their health programs or activities. Federal financial assistance includes grants, contracts, loans, tax credits and subsidies, as well as payments through Medicaid, the Children's Health Insurance Program, and most Medicare programs. The only exception is providers whose only federal assistance is through Medicare Part B, an exception that applies to a very small percentage of practicing physicians. All required language assistance services must be free and provided by qualified translators and interpreters. Interpreters must meet specified qualifications and ideally be certified. Although the cost of interpreter services can be considerable, ranging from $45-$150/hour for in-person interpreters, to $1.25-$3.00/minute for telephone interpreters, and $1.95-$3.49/minute for video remote interpreting, it may be reimbursed or covered by a patient's Medicaid or other federally funded medical insurance. Failure to use qualified interpreters can have serious negative consequences for both practitioners and patients. In one study, 1 of every 40 malpractice claims were related, all or in part, to failure to provide appropriate interpreter services. Most importantly, however, the use of qualified interpreters results in better and more efficient patient care.

Community perspectives on substance use among Bhutanese and Iraqi refugees resettled in the United States

ABSTRACTPremigration trauma and postmigration stressors put refugees at high risk for mental health concerns, including substance use. However, there is limited systematic research on substance use in refugee communities exists. We conducted exploratory qualitative research to examine Bhutanese and Iraqi refugee perspectives related to the use of recreational substances after resettlement in the United States. Data were collected through separate focus groups with 28 Bhutanese and 22 Iraqi adult men. Focus groups were facilitated by an experienced clinician with an in-person interpreter, audiorecorded, and transcribed. Transcripts were checked for accurate translation and then analyzed using a conventional content analysis approach. Findings revealed similarities and differences between the two refugee groups with regard to recognizing excessive use, triggers for use, and preferred modes of outreach and intervention. Findings also revealed postmigration changes in substance use behaviors stemming from issues related to access, cost, and perceived legal ramifications.

The Importance of Medical Interpreters

Back to table of contents Previous article Next article Arts and CultureNo AccessThe Importance of Medical InterpretersEmily Tonkin, D.O.Emily TonkinSearch for more papers by this author, D.O.Published Online:1 Aug 2017https://doi.org/10.1176/appi.ajp-rj.2017.120806AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail While working on the psychiatry consultation-liaison service at a children’s hospital, I was asked to see a 12-year-old girl with lymphoma, multiple medical comorbidities, and limited English proficiency. The primary hematology-oncology team was concerned about oppositional and aggressive behaviors interfering with necessary medical care. Upon reviewing the case and doing a behavioral analysis on several major incidents in which the patient became aggressive or otherwise out of control, it was discovered that often staff was not using medical interpreter services. For example, a phlebotomist was witnessed entering the patient’s room and attempting to draw blood without speaking a word to the patient. After implementing a behavioral plan and increasing the use of medical interpreters, the patient’s behaviors improved.Executive order 13166 was enacted in April 2000 to improve access to services for people with limited English proficiency in accordance with Title VI of the Civil Rights Act, which prohibits discrimination on the basis of national origin. As such, health care agencies must provide interpreter services to limited English proficiency patients. Data show that professional medical interpreters are underutilized in the health care setting, and multiple barriers to appropriate use have been identified, including limited time and limited access to interpreters (1). Additionally, alternatives to on-site interpreters, including telephone and video interpreters, have demonstrated some deficiencies (e.g., lack of non-verbal communication, less attention to cultural differences) (1).As demonstrated by the opening anecdote, communication barriers can lead to a variety of problems, including aggression, hindrance of care, lack of informed consent, and avoidance of the health care system, among other negative outcomes. Conversely, it has been shown that use of an interpreter increases patient satisfaction, decreases adverse outcomes, and improves adherence and positive outcomes (2). Patients with limited English proficiency have expressed preference for professional interpreters over their bilingual family members and friends (3). In addition to providing accurate and informed language interpretation, interpreters often serve as cultural liaisons between patients and medical staff (2). Nevertheless, there are limitations to interpreter services, including variability in skill level, as there is no standardized certification for medical interpreters (4). Further limitations include delays in assessment (e.g., pain level) while waiting for an interpreter (1).Despite these limitations, it is of the utmost importance to utilize medical interpreters in order to provide the same quality of care to all patients regardless of their preferred language. Medical providers have a professional and ethical obligation to treat all patients according to a standard of care determined by their field. This obligation cannot be fulfilled with regard to limited English proficiency individuals without the use of medical interpreters. Future efforts to improve interpreter services could focus on implementation of a standardized certification process and recruitment to increase the number of available in-person interpreters in the health care system.At the time this article was accepted for publication, Dr. Tonkin was a fifth-year resident in the Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans.

Interpretation Modalities Used on Family-Centered Rounds: Perspectives of Spanish-Speaking Families.

Limited-English-proficient (LEP) patients and families are at risk for worse hospital outcomes due to impaired communication. Family-centered rounds (FCR) have become the preferred format for information sharing among providers and families at pediatric institutions. However, there are limited data on FCR among LEP families, particularly regarding interpretation type. We sought to examine the relationships between interpretation type and FCR satisfaction and efficacy among Spanish-speaking families, the fastest growing LEP population in pediatric hospitals. Spanish speakers admitted to general pediatrics units over a period of 16 months were identified on admission. A bilingual research assistant observed FCR and completed an observation tool, including interpreter type. After FCR, the research assistant interviewed families, collecting parent demographics, FCR experience, and interpreter satisfaction. Associations between interpretation type and satisfaction as well as interpretation type and understanding were tested by using χ2 analyses. We studied 124 families over 16 months. Most respondents were patients' mothers (84%), born in Mexico (76%), had grade school education (56%), and spoke limited English (96%). Overall, 83 (73%) reported the interpreter services improved their understanding of their child's medical condition. Interpreter type was significantly associated with family satisfaction with FCR; specifically, an in-person hospital interpreter or video interpreter was associated with complete caregiver satisfaction (P = .005). Spanish speakers report higher satisfaction with face-to-face interpreters during FCR, including in-person and video, compared with telephonic interpreters. Video interpretation via iPad during FCR may be a valuable and accessible approach to improve communication in the care of hospitalized children.

Hospital discharge preparedness for patients with limited English proficiency: A mixed methods study of bedside interpreter-phones

ObjectiveAssess effects of a bedside interpreter-phone intervention on hospital discharge preparedness among patients with limited English proficiency (LEP). MethodsMixed-methods study compared patient-reported discharge preparedness and knowledge of medications and follow-up appointments among 189 Chinese- and Spanish-speakers before (n=94) and after (n=95) bedside interpreter-phone implementation, and examined nurse and resident-physician interpreter-phone utilization through focus groups. ResultsPre-post discharge preparedness (Care Transitions Measure mean 77.2 vs. 78.5; p=0.62) and patient-reported knowledge of follow-up appointments, discharge medication administration and side effects did not differ significantly. Pre-post knowledge of medication purpose increased in bivariate (88% vs. 97%, p=0.02) and propensity score adjusted analyses [aOR (adjusted odds ratio), 4.49; 95% CI, 1.09–18.4]. Nurses and physicians reported using interpreter-phones infrequently for discharge communication, preferring in-person interpreters for complex discharges and direct communication with family for routine discharges. Post-implementation patients reported continued use of ad-hoc family interpreters (43%) or no interpretation at all (22%). ConclusionImplementation of a bedside interpreter-phone systems intervention did not consistently improve patient-reported measures of discharge preparedness, possibly due to limited uptake during discharges. Practice implicationsHospital systems must better understand clinician preferences for discharge communication to successfully increase professional interpretation and shift culture away from using family members as interpreters.

Assessment of the efficiency of language interpreter services in a busy surgical and procedural practice

BackgroundSurgical and procedural patient care settings require efficient patient flow. The primary goal of this study was to assess use and efficiency of language services for our limited English proficiency (LEP) patients undergoing surgical and outpatient procedures.MethodsPatient language services needs were recorded from our operating room and procedural locations over a two and a half month period in 2016. Time from in-person interpreter request to arrival was recorded. Frequency of language service modality used and reason for telephone and professional video remote interpreting (VRI) rather than in person professional services was queried.ResultsMean time from in-person interpreter request until arrival was 19 min. Variation was high. No cases were cancelled due to lack of available interpretive services and no LEP patient underwent a procedure without requested interpretative service assistance.ConclusionsTime for in person professional interpreter assistance was short but highly variable. Access to telephone interpretive services and VRI services ensured assistance when in person interpreters were immediately unavailable.With the numbers of LEP patients increasing over time along with any new mandates for providing language assistance, the stress on hospital patient service units and the financial implications for many health care facilities will likely continue as challenges.