Large Municipal Hospital Research Articles

National-scale antimicrobial resistance surveillance in wastewater: A comparative analysis of HT qPCR and metagenomic approaches

Wastewater serves as an important reservoir of antimicrobial resistance (AMR), and its surveillance can provide insights into population-level trends in AMR to inform public health policy. This study compared two common high-throughput screening approaches, namely (i) high-throughput quantitative PCR (HT qPCR), targeting 73 antimicrobial resistance genes, and (ii) metagenomic sequencing. Weekly composite samples of wastewater influent were taken from 47 wastewater treatment plants (WWTPs) across Wales, as part of a national AMR surveillance programme, alongside 4 weeks of daily wastewater effluent samples from a large municipal hospital. Metagenomic analysis provided more comprehensive resistome coverage, detecting 545 genes compared to the targeted 73 genes by HT qPCR. It further provided contextual information critical to risk assessment (i.e. potential bacterial hosts). In contrast, HT qPCR exhibited higher sensitivity, quantifying all targeted genes including those of clinical relevance present at low abundance. When limited to the HT qPCR target genes, both methods were able to reflect the spatiotemporal dynamics of the complete metagenomic resistome, distinguishing that of the hospital and the WWTPs. Both approaches revealed correlations between resistome compositional shifts and environmental variables like ammonium wastewater concentration, though differed in their interpretation of some potential influencing factors. Overall, metagenomics provides more comprehensive resistome profiling, while qPCR permits sensitive quantification of genes significant to clinical resistance. We highlight the importance of selecting appropriate methodologies aligned to surveillance aims to guide the development of effective wastewater-based AMR monitoring programmes.

Selective microbial attachment to LDPE plastic beads during passage through the wastewater network

Urban wastewater treatment plants (WWTP) represent key point-source discharges of microplastics (MP) into the environment, however, little is known about the microbial carrying capacity of plastics travelling through them. The purpose of this study was to quantify the number of cells that become associated with MP at different locations within a WWTP, and to assess differences in microbiome communities. We conducted a field experiment incubating low density polyethylene (LDPE) MP beads in WWTP influent and effluent, as well as tracking free floating beads during passage in wastewater from a large municipal hospital to an urban WWTP, where they were subsequently recovered. Using two cell counting methods - automated flow cytometric true absolute cell counts and indirect cell quantification via protein content based on a model E. coli cell - we quantified cell attachment to LDPE beads. LDPE associated counts ranged from 350 × 103 cells cm−2 after incubation in wastewater effluent, and 990 × 103 cells cm−2 after incubation in wastewater influent. 16S rRNA gene amplicon sequencing was used to determine the bacterial community structure of the plastic-associated microbiomes. Our results showed that distinct bacterial communities developed on the LDPE MP following exposure to each wastewater type. Influent (untreated) wastewater LDPE-associated microbiomes were dominated by Bacillota whereas the microbes that attached in wastewater effluent (tertiary treated) were dominated by Pseudomonadota. In conclusion, this study provides clear evidence that microplastics migrating through the sewer network and WWTP rapidly accumulate microbiomes with unique microbial community structures varying from sewage influent to effluent. These findings demonstrate the differential microbiological risk from MP associated with routine wastewater discharges to those released from intermittent combined sewer overflows (CSOs) during storm events.

Epidemiology of Orbital Fractures in a Large Hospital in the Netherlands: Results of Implementation of a Multidisciplinary Orbital Trauma Team

Introduction: This study aims to describe the epidemiology, aetiology and therapy of orbital fractures in a large municipal hospital in The Hague, the Netherlands, and to demonstrate the effectiveness of an integrated approach of orbital trauma care with a team consisting of an ophthalmologist, an orthoptist and an oral and maxillofacial (OMF) surgeon. Methods: We obtained data from patients with an orbital fracture between June 2015 until July 2018. Primary outcomes were the classification of orbital fractures and treatment (conservative or surgical). Results: 182 patients were included in this study. The most common type of orbital fracture was an isolated orbital floor fracture (n=56, 30.8%). In most cases, therapy was conservative (69.2%). When surgical repair was indicated, a polydioxanone (PDS) plate was most commonly used (11.5%). The main cause of an orbital fracture was a fall accident (38.5%), followed by assault (32.4%). 32.4% of the patients were intoxicated with alcohol. Conclusion: In our study population, almost 70% (69.2%) of the patients were treated conservatively in our study. Compared to the international literature, this percentage is considerably higher than in other studies. In our opinion, our integrated approach to orbital trauma has led to a justifiable reduction of the proportion of cases receiving surgical intervention in orbital fractures. We would like to advocate the implementation of a similar team in other hospitals to improve the quality and cost-effectiveness of treatment in patients with orbital fractures.

De-escalation of Antibiotics in Severe Sepsis and Septic Shock at a Large Municipal Hospital

Background: Early de-escalation of antibiotics in sepsis may be safe and effective. In our study, we performed a retrospective chart review of patients admitted to a large municipal hospital who were treated for severe sepsis or septic shock to compare outcomes in patients who experienced early de-escalation (DEG) with outcomes of those who did not (NDG).Methods: The observational study was conducted at Bellevue Hospital Center (an 850-bed municipal hospital affiliated with New York University School of Medicine, New York, NY). Patients admitted from January 1 to December 31, 2015, who were treated for severe sepsis or septic shock during any time of their hospital stay were reviewed for the study. De-escalation was defined as narrowing or discontinuation of 1 or more antimicrobial therapies < 3 days after sepsis onset. Results: Overall, 277 patients were included (DEG, 90 patients, 32%; NDG, 187 patients, 68%). The groups were similar in terms of sex, comorbidities, length of stay, and severity of illness: septic shock (47% DEG vs 49% NDG; P = .693) and ICU stay (27% DEG vs 32% NDG; P = .406). DEG patients were slightly older than NDG patients: (DEG age, 63+16 years vs NDE age, 58+16 years; P = .028). There was no difference in hospital mortality (8% DEG vs 12% NDE; P = .257). Nearly half of the patients in both groups (46% DEG and 47% NDG) had no causative microorganisms identified using conventional microbiology culture. The common sources of primary infection were respiratory, urinary tract, and gastrointestinal infections, and these were not different between groups. Also, 69% of DEG patients and 79% of NDG patients received antibiotics for >7 days (P = .002). Empiric intravenous vancomycin was initiated in 83% in DEG patients and 74% in NDG patients at sepsis diagnosis. Although organisms covered by intravenous vancomycin were isolated from only 17% of patients in DEG and 23% in NDG, vancomycin was continued for >5 days in 34% of DEG patients and 50.3% of NDG patients (P < .001). 60% of patients in DEG and 61% in NDG were seen by infectious diseases specialists (ID). Patients with infectious diseases consultations had significantly more comorbidities, were more frequently in the ICU, had higher MDRO isolation and longer hospital stays, but they were still de-escalated without a difference in mortality. Conclusions: Microbiology data did not contribute to early de-escalation of antibiotics in this study. This finding may be related to the high percentage of negative culture and unavailability of rapid molecular diagnostic tests. Shorter duration of antibiotics (including vancomycin) was not associated with worse outcome in these severely ill patients.Funding: NoneDisclosures: None

My first call on Covid duty.

The Covid-19 pandemic has meant that all available health workers have been summoned to serve the community. Here, I describe my first experience as a resident doctor of shift duty in the Covid ICU of a large municipal hospital in Mumbai, with its accompanying fears and discomforts, all contributing to learning painful but valuable lessons.. Keywords: Covid-19, ICU, pandemic, public health system, learning.

Evolution of transcatheter aortic valve implantation over 7 years: results of a prospective single-centre registry of 2000 patients in a large municipal hospital (TAVIK Registry)

ObjectivesUse of transcatheter aortic valve implantation (TAVI) to treat severe aortic stenosis (AS) has gained popularity, accompanied by an evolution of patient and clinical factors. We aimed to characterise changes...

Solving One of Graduate Medical Education's Problems: A Loss of Thoroughness

Solving One of Graduate Medical Education's Problems: A Loss of Thoroughness

Trans-sectoral care in patients with colorectal cancer: Protocol of the randomized controlled multi-center trial Supportive Cancer Care Networkers (SCAN).

BackgroundManaging therapy-related side-effects and improving health-related quality of life in patients with colorectal cancer is still challenging. The need for an effective management of adverse events and unmet supportive care needs have been widely discussed. In the past decade, interventions by nursing staff gained more and more importance. Evidence suggests that a majority of patients even in early stages of the disease experience substantial impairments potentially resulting in diminished therapy adherence as well as impaired quality of life. However, evidence for the effectiveness of nurse-led interventions on symptom management and quality of life is still very limited. This especially applies to care transitions between different inpatient and outpatient health care providers throughout the course of treatment and aftercare.Methods/DesignSupportive Cancer Care Networkers (SCAN) is a prospective randomized controlled trial conducted in eight large and middle-sized German cancer centers and municipal hospitals. The target population is adults with colorectal cancer UICC I-III after initial R-0 resection scheduled for adjuvant chemotherapy or guideline-based aftercare only. 370 patients will be randomly assigned to either intervention or control group. Patients in the intervention group will receive an additional support by specialized oncology nurses for eight weeks after discharge from hospital by telephone, consisting of symptom monitoring, counselling on self-assessment and self-management and dealing with individual resources for coping and psychosocial well-being. The primary endpoint will be health-related quality of life (HRQoL) at eight weeks after discharge from the initial treating hospital.DiscussionThe presented SCAN trial is to provide information that will be useful to advance our understanding of complex interdependencies between symptom severity, supportive care needs, functioning and the risk for diminished HRQoL. Most importantly, these patient-reported outcomes are not fully implemented in today’s clinical routine practice potentially resulting in therapy cessations and lower chemotherapy treatment rates for colorectal cancer especially in older patients.Trial registrationClinicalTrials.gov Identifier NCT01651832.

Trends in cesarean delivery: rate and indications.

To compare the cesarean delivery rates over the last decade and to examine the indications contributing to changed trends, if any. To compare the rate and indications of cesarean delivery over the last decade, the data were collected in a retrospective manner from all the deliveries that occurred between January 1 and December 31 in 2001, 2006, and 2011, in the department of obstetrics and gynecology, Seth G.S. Medical College and K.E.M. Hospital, a large tertiary care municipal hospital in Western India. A cohort of 20853 delivered women was studied. The rates and indications of primary and repeat cesarean sections were analyzed among the live births to estimate the relative contribution of each indication to the overall increase in rate. The cesarean delivery rate increased from 171.70 to 289.30 per 1,000 live births, with an increase in primary cesarean delivery rate from 118.53 (69.03%) in 2001 to 210.09 (72.62%) in 2011 per 1,000 live births. Fetal distress, arrest of descent, multiple gestations, and fetal indications contributed to this increase. There is a significant increase in the total cesarean rate with primary cesarean accounting for most of the increase.

Indexing Severity of Diabetic Foot Infection With 99mTc-WBC SPECT/CT Hybrid Imaging

OBJECTIVEManagement of diabetic foot infection (DFI) has been hampered by limited means of accurately classifying disease severity. New hybrid nuclear/computed tomography (CT) imaging techniques elucidate a combination of wound infection parameters not previously evaluated as outcome prognosticators. Our aim is to determine if a novel standardized hybrid image–based scoring system, Composite Severity Index (CSI), has prognostic value in DFI.RESEARCH DESIGN AND METHODSMasked retrospective 99mTc-white blood cell (WBC) single photon emission CT (SPECT)/CT image interpretation and independent chart review of 77 patients (101 feet) suspected of DFI-associated osteomyelitis at a large municipal hospital between January 2007 and July 2009. CSI scores were correlated with probability of favorable outcome (no subsequent amputation/readmission after therapeutic intervention) during median 342-day follow-up.RESULTSCSI ranged from 0–13. Receiver operating characteristic accuracy for predicting favorable outcome was 0.79 (optimal cutoff CSI, ≤2; odds ratio of therapeutic failure for CSI >2, 15.1 [95% CI 4.4–51.5]). CSI of 0 had a 92% chance of favorable outcome, which fell progressively to 25% as indices rose to ≥7. Image-based osteomyelitis versus no osteomyelitis assessment was less accurate than CSI at predicting outcome (P = 0.016). In patients with intermediate severity (CSI 3–6), treatment failure decreased from 68 to 36% when antibiotic duration was extended to ≥42 days (P = 0.026).CONCLUSIONS99mTc-WBC SPECT/CT hybrid image–derived wound infection parameters incorporated into a standardized scoring system, CSI, has prognostic value in DFI.

Die Herausforderung der sachgerechten Vergütung von Schwerverletzten im deutschen DRG-System

Critically injured patients are a very heterogeneous group, medically and economically. Their treatment is a major challenge for both the medical care and the appropriate financial reimbursement. Systematic underfunding can have a significant impact on the quality of patient care. In 2009 the German Trauma Society and the DRG-Research Group of the University Hospital Muenster initialised a DRG evaluation project to analyse the validity of case allocation of critically injured patients within the German DRG system versions 2008 and 2011 with additional consideration of clinical data from the trauma registry of the German Trauma Society. Severe deficits within the G-DRG structure were identified and specific solutions were designed and realised. A retrospective analysis was undertaken of standardised G-DRG data (§ 21 KHEntgG) including case-related cost data from 3 362 critically injured patients in the periods 2007 and 2008 from 10 university hospitals and 7 large municipal hospitals. For 1 241 cases of the sample, complementary detailed information was available from the trauma registry of the German Trauma Society to monitor the case allocation of critically injured patients within the G-DRG system. Analyses of coding and grouping, performance of case allocation, and the homogeneity of costs in the G-DRG versions 2008 and 2011 were done. The following situations were found: (i) systematic underfunding of trauma patients in the G-DRG-Version 2008, especially trauma patients with acute paraplegia; (ii) participation in the official G-DRG development for 2011 with 13 proposals which were largely realised; (ii) the majority of cases with cost-covering in the G-DRG version 2011; (iv) significant improvements in the quality of statistical criteria; (v) overfunded trauma patients with high intensive care costs; (vi) underfunding for clinically relevant critically injured patients not identified in the G-DRG system. The quality of the G-DRG system is measured by the ability to obtain adequate case allocations for highly complex and heterogeneous cases. Specific modifications of the G-DRG structures could increase the appropriateness of case allocation of critically injured patients. Additional consideration of the ISS clinical data must be further evaluated. Data-based analysis is an essential prerequisite for a constructive development of the G-DRG system and a necessary tool for the active participation of medical societies in this process.

Characteristics of Smoking Cessation Program Participants in a Large Municipal Hospital During the Last Two Years of the Greek Smoking Ban

PURPOSE: Among European countries, Greece ranks first in cigarette consumption per person, with the smoking prevalence rising above 40%. The purpose of this study is to highlight special characteristics of smokers referring to a smoking cessation clinic of a large municipal hospital, in relation to the smoking ban implemented in Greece during the last two years.

Organization of Specialized Medical Care to Patients with Urgent Surgical Pathology of the Spine

Objective. Scientific-practical and economical substantiation of the expedience of urgent spine surgery centre organization in megalopolises for the admittance of patients not only with acute spine and spinal cord trauma, but also with other urgent spinal pathologies. Material and Methods. Authors performed retrospective analysis of work of neurosurgical departments in large municipal hospitals of St. Petersburg during the last two years. Results. It was found out that almost all neurosurgical departments in municipal multi-field hospitals, except for the St. Petersburg Research Institute of the First Aid n.a. I.I. Dzhanelidze, do not provide a modern level of specialized medical care to patients with urgent surgical pathology of the spine. Conclusion. Working experience of the Centre for Urgent Spine Surgery created on the base of St. Petersburg Research Institute of the First Aid n.a. I.I. Dzhanelidze demonstrated that such organizational pattern allows for improving the quality of specialized medical care and more effective municipal healthcare utilization.

Head and neck radiotherapy compliance in an underserved patient population

Compliance to intensive multiweek radiation therapy (RT) regimens in head and neck cancer (HNC) patients is challenging, particularly among medically underserved patients with fewer financial and social resources. Treatment prolongation reduces local control and overall survival rates, making adherence to treatment a key factor in optimal outcome. We evaluated factors affecting compliance in medically underserved patients who received RT for HNC in a large municipal hospital setting in New York City. Retrospective review. Treatment records of patients treated between July 2004 and August 2008 were reviewed. Number of and reasons for missed treatments were identified. Several demographic, toxicity, and treatment variables were analyzed for impact on compliance. Eighty consecutive HNC patients who underwent RT with a 5- to 7-week regimen were identified. Thirty-two patients (40%) missed no treatments, 36 (45%) missed one to six treatments, six (8%) missed seven to 14 treatments, two (3%) missed more than 14 treatments, and four (5%) did not complete treatment. Reasons for missed treatments were hospitalization (31% of events) and toxicity (20%). Patients with percutaneous endoscopic gastrostomy tube were more likely to miss treatments (P = .01, chi(2) test). No other variable showed a significant association with missed treatments (chi(2) test). Intensive RT for HNC can be delivered with very good adherence within a medically underserved population. Eighty-five percent of patients completed treatment with 0 to 6 days of interruption. Efforts to further improve adherence in this population are ongoing.

Investigation on quality of spirometry in 36 large hospitals in China

To assess the current status of quality control of spirometry reports in China. Spirometry case reports from January 2008 to October 2008 were collected from pulmonary function testing laboratories in 36 large hospitals (provincial or municipal) in China. The quality analysis was performed according to ATS/ERS standardization for measurement of spirometry. The number of reports that met the criteria for quality control was expressed as percentages. A total of 345 spirometry test reports were collected. 82.5% (282/342) met the start-of-test criteria for quality control. 333 reports could be analyzed for free of artifacts, of which 65.8% (219/333) were consistent with the criteria of smooth expiration; the remaining reports (114) failed to meet the criteria, for reasons including cough (29/333, 8.7%), premature glottis closure (8/333, 2.4%), gas leakage (29/333, 8.7%), early termination of expiration (26/333, 7.8%), mouthpiece obstruction (6/333, 1.8%), and incomplete exertion of efforts (49/333, 14.7%). 235 reports were analyzed for end-of-test criteria, with 50.6% (119/235) complying to criteria. 22.6% (78/345) of the reports were tested for more than 3 times, among which 65 reports with the data of each manoeuvre could be analyzed for repeatability. 95.4% (62/65) of the reports met the repeatability criteria, which accounted for 18.0%(62/345)of the total reports collected. The rate of the 2 highest FVC (forced vital capacity) and FEV(1) (forced expiratory volume in one second) of less than 150 ml was 95.4% (62/65) and 100.0% (65/65), respectively. The rate of the 2 highest FVC and FEV(1) of less than 100 ml was 92.3% (60/65) and 87.7% (57/65), respectively. Only 7.2% of the reports (25/345) met all of the 4 criteria listed above. The quality of spirometry tests in large (provincial or municipal) hospitals in China needs to be improved in the future.

Missed Opportunities for Colorectal Cancer Screening

Our goal was to examine colorectal cancer (CRC) screening, referral, and follow-up practices in a population of Chinese and Latino immigrant patients. We conducted a nested cohort study within a larger randomized trial in a primary care clinic of a large municipal hospital. Participants were patients born in China and Latin America, new to the clinic and eligible for screening colonoscopy. The main outcome measures were physician referral for screening colonoscopy and patients’ adherence to referral. One hundred and forty-six (146) patients met inclusion criteria; 92 were born in Latin America and 54 in China. Of those born in Latin America, 27% received a referral for screening colonoscopy and 80% adhered to the provider referral. Of those born in China, 24% received a referral for colonoscopy and 92% of those adhered to it. No significant associations were found between patient characteristics, referral for colonoscopy and completion of screening. Rates of CRC screening among Chinese and Latino patients in primary care remain low. The rate-limiting factor appears to be provider referral; language and other patient barriers play a relatively minor role.

Reducing blood transfusion requirements in preterm infants by a new device: a pilot study

To test a new device designed to salvage red blood cells (RBCs) from blood samples drawn from preterm infants, with the intent of decreasing blood loss and lowering the requirements for RBC transfusions. A case-controlled pilot study was conducted in two Israeli neonatal intensive care units in large municipal hospitals. Twenty low-birthweight preterm infants were randomly and equally divided into the ErythroSave group or a control group. All blood tests in the study group (except for complete blood count and coagulation parameters) were obtained during the first week of life by the new device in the study group and by ordinary syringes in the control group. The main outcome measure was the total number of units of blood needed. The average volume of blood obtained for laboratory analyses from each infant was 27 mL in the ErythroSave group and 24 mL in controls (not significant). The average volume of transfused packed cells was 6.4 mL for the ErythroSave group and 21.3 mL for the controls (p = 0.008). The use of ErythroSave for sampling blood significantly reduced blood transfusion requirements in premature infants compared to sampling by conventional syringes.

Organization of laboratory analytics into centers – meaningful or not? 1

Abstract Specialists working in the field of in-vitro diagnostics increasingly make use of similar methods. This applies to laboratory medicine, microbiology and virology, pathology, hygiene, environmental medicine, and, in part, transfusion medicine and human genetics. Although the diagnostic issues and/or the specimens differ in most cases, the molecular, cellular, immunologic, mass-spectrometric and other separation and detection procedures are based on identical principles and technologies. With some of these procedures costly multiple investments are unavoidable, since several specialties make use of them. Furthermore, an increasing degree of mechanization and the need for modern IT-based process controls in all specialty fields tie up additional resources. On the other hand, it is exactly these specialty fields in German hospitals that find themselves under considerable cost pressure, intensified by the competition with private large-scale laboratories and laboratory chains. Hospitals that still run their own laboratories and institutes in these specialties are considering either partnerships with such laboratories or outsourcing. Such changes, however, go hand in hand with the curtailment of each hospital's decision and development autonomy. For this reason many hospitals are seeking autonomous solutions. As yet no university medical center in Germany has decided on permanent outsourcing. To increase their economic efficiency on their own, hospitals have attempted to develop rationalization programs and to achieve qualitative added value by establishing laboratory centers. Large municipal hospitals had earlier already pursued this approach, some university clinics adopted it some years ago. They created competence and organizational centers like “diagnostic centers”, “centers for clinical pathology”, etc. with the objective of utilizing the technical and organizational synergies of the specialty fields mentioned above. In particular, the focus here is on joint methodological competencies, identical or similar instrumentation, similar requirements for IT-based process controls as well as overlapping qualifications of medical and technical personnel. These primarily specialized aspects unfold their potential for cost savings only when they are organized appropriately. Hence the key to success for the creation of a center is to change a specialty-centered organization into an organization that spans multiple specialties and is aligned along synergies. In view of the importance of technical decisions this challenge can be met only with expert leadership. Therefore successful concepts always envision such centers to be under the direction of a physician, regardless of their varying designs. In competition with large-scale laboratories and laboratory chains, large centers at this time can still frequently capitalize on their technical breadth as a unique selling proposition in their respective areas. So far private large-scale laboratories are active primarily in the areas of laboratory medicine, microbiology and virology and less frequently also in the area of human genetics, but only rarely in the areas of transfusion medicine and pathology. In comparison, the centers of large hospitals with greater technical breadth cannot only make even wider use of synergies, but can also bring to bear their comprehensive technical competence. Hence, the formation of centers can be a path to economic efficiency and to a strengthening of the competitive position above all for large hospitals.

The timing of surgery for cholecystitis: a review of 202 consecutive patients at a large municipal hospital

Background Traditionally, cholecystectomy for cholecystitis is performed within 3 days of the onset of symptoms or after 5 weeks, allowing for resolution of the inflammatory response. This study reviewed the outcomes of cholecystectomy performed for patients with gallstone disease in the acute (n = 45), intermediate (n = 55), and delayed (n = 102) periods after the onset of symptoms. Methods The medical records of 202 patients who underwent laparoscopic cholecystectomy at a large municipal hospital were reviewed retrospectively. The primary outcomes studied were length of hospital stay, conversion to open cholecystectomy, and complications. Results There was no significant difference in the conversion rate (acute [18%] vs intermediate [20%] vs delayed [11%]) or complication rate (acute [16%] vs intermediate [9%] vs delayed [7%]) among the 3 groups. The delayed group had a significantly shorter length of hospital stay than the intermediate or acute group (3.1 ± 3.8 vs 4.3 ± 3.8 vs 1.7 ± 2.1, respectively, P < .001). Conclusions Patients who present with acute symptoms of cholecystitis should undergo surgery during the same admission, regardless of the duration of symptoms.

Patient Satisfaction with Different Interpreting Methods: A Randomized Controlled Trial

BackgroundGrowth of the foreign-born population in the U.S. has led to increasing numbers of limited-English-proficient (LEP) patients. Innovative medical interpreting strategies, including remote simultaneous medical interpreting (RSMI), have arisen to address the language barrier. This study evaluates the impact of interpreting method on patient satisfaction.Methods1,276 English-, Spanish-, Mandarin-, and Cantonese-speaking patients attending the primary care clinic and emergency department of a large New York City municipal hospital were screened for enrollment in a randomized controlled trial. Language-discordant patients were randomized to RSMI or usual and customary (U&C) interpreting. Patients with language-concordant providers received usual care. Demographic and patient satisfaction questionnaires were administered to all participants.Results541 patients were language-concordant with their providers and not randomized; 371 were randomized to RSMI, 167 of whom were exposed to RSMI; and 364 were randomized to U&C, 198 of whom were exposed to U&C. Patients randomized to RSMI were more likely than those with U&C to think doctors treated them with respect (RSMI 71%, U&C 64%, p < 0.05), but they did not differ in other measures of physician communication/care. In a linear regression analysis, exposure to RSMI was significantly associated with an increase in overall satisfaction with physician communication/care (β 0.10, 95% CI 0.02–0.18, scale 0–1.0). Patients randomized to RSMI were more likely to think the interpreting method protected their privacy (RSMI 51%, U&C 38%, p < 0.05). Patients randomized to either arm of interpretation reported less comprehension and satisfaction than patients in language-concordant encounters.ConclusionsWhile not a substitute for language-concordant providers, RSMI can improve patient satisfaction and privacy among LEP patients. Implementing RSMI should be considered an important component of a multipronged approach to addressing language barriers in health care.