Interpreter Services in Emergency Medicine

Abstract

Emergency physicians are routinely confronted with problems associated with language barriers. It is important for emergency health care providers and the health system to strive for cultural competency when communicating with members of an increasingly diverse society. Possible solutions that can be implemented include appropriate staffing, use of new technology, and efforts to develop new kinds of ties to the community served. Linguistically specific solutions include professional interpretation, telephone interpretation, the use of multilingual staff members, the use of ad hoc interpreters, and, more recently, the use of mobile computer technology at the bedside. Each of these methods carries a specific set of advantages and disadvantages. Although professionally trained medical interpreters offer improved communication, improved patient satisfaction, and overall cost savings, they are often underutilized due to their perceived inefficiency and the inconclusive results of their effect on patient care outcomes. Ultimately, the best solution for each emergency department will vary depending on the population served and available resources. Access to the multiple interpretation options outlined above and solid support and commitment from hospital institutions are necessary to provide proper and culturally competent care for patients. Appropriate communications inclusive of interpreter services are essential for culturally and linguistically competent provider/health systems and overall improved patient care and satisfaction.

Introduction

The Institute of Medicine defines optimal primary care as including “an understanding of the cultural systems of patients and communities that may assist or hinder effective health care delivery” (1). With the swelling cultural, ethnic, and racial diversity of the United States, health care providers face increased challenges in achieving what has been termed “cultural competence” in their clinical practice. Cultural competence has been described as the skillful negotiation of cultural diversity in all its manifestations, an important aspect of which is adequate communication with patients regardless of a language barrier (2).

Techniques that may be employed while striving towards general cultural competence include recruiting and working to retain staff members who reflect the cultural diversity of the community served, use of interpreter services or multilingual providers for clients with limited English proficiency, multilevel staff cultural competency training, use of linguistically and culturally appropriate health education materials, coordinating care with traditional healers, including family/community members, and establishing culturally specific health care settings (3). Language interpretation does not solve all of the problems associated with achieving cultural competency, but it is a critical aspect of providing care that has many possible solutions.

The most recent national census in 2000 revealed that one in five Americans speaks a language other than English at home, and 8% report that they speak English less than “very well” (4). Unfortunately, miscommunication between patients and health care providers is a common occurrence in emergency medicine (EM) and has been identified in over 70% of malpractice depositions (5). Although emergency physicians (EPs) must be comfortable making critical decisions, often based on incomplete information, the ability to communicate well with patients is nevertheless an important goal to achieve.

The service provided by interpreters is a significant component of providing culturally competent care. There is sufficient evidence to support the importance and effectiveness of interpreter services if appropriately used. It is an important adjunct to the care of the emergency patient and should be available in all emergency departments (EDs) and health systems. Effective communication can exert a positive influence on symptom resolution in addition to the emotional health of the patient. Effective use of interpreter services by EPs has been shown to improve patient satisfaction, decrease patient time spent in EDs, and decrease superfluous resource utilization such as over-utilization of diagnostic testing when compared to similar English-speaking patients (6, 7, 8).

The various methods used to overcome language barriers in the ED, such as ad hoc interpreters (for example, family members or local staff), telephone interpreter services, use of bilingual staff members, professional interpreters, and mobile computer technology at the bedside each have unique benefits and deficits. There is a paucity of data formally evaluating and validating these methods, but those that do exist seem to be counterintuitive. Lack of uniform availability of interpretation options seems to be the greatest barrier to adequate translation. Perhaps it is time to discuss a standard or goal regarding this aspect of providing care. This article will present a review of the various techniques used to overcome language barriers in the ED and a brief discussion of the advantages and drawbacks of each in an effort to determine the preeminent method.