Comparison of Throughput Times for Limited English Proficiency Patient Visits in the Emergency Department Between Different Interpreter Modalities

Friday, October 16, 2009: 5:30 PM
207A (Washington Convention Center)
Amy Grover, MD, Genie Roosevelt, MD, MPH, Sara Deakyne, Lalit Bajaj, MD, MPH and Lou Hampers, MD, MBA, Pediatrics, Section of Emergency Medicine, The Children's Hospital, University of Colorado Denver and Health Sciences Center, Aurora, CO

Purpose: The rising number of LEP (limited English proficiency) patients seeking health care within the US system has led to increased awareness of the legal and socioeconomic pitfalls associated with failure to provide appropriate interpretive services to these patients and their families. However, there has been little guidance provided to hospital and practice administrators in comparing different interpreter modalities. The purpose of this study was to compare throughput times for ED visits involving patients and caretakers with LEP based on the type of language service provided: on site professional interpreters, remote telephonic interpreters or bilingual providers.

Methods: This is a secondary data analysis of a large randomized trial of different interpreter modalities in which 1198 Spanish-speaking families were enrolled: 405 randomized to telephonic interpretation; 376 to on-site interpretation; 417 interviewed by a bilingual physician.  For this analysis, we queried the electronic medical record for process and resource utilization data regarding the visit including event time stamps, clinical factors, lab and radiology utilization and disposition. Chi square tests were used for categorical variables.  Continuous variables, age and time, were analyzed with the Kruskal-Wallis test as the distributions were not normal.  

Results: The cohorts (telephonic, on-site interpretation, bilingual physician) did not differ with respect to patient age or sex, or the parent’s country of origin.  The patients in the on-site interpretation cohort (median 116 minutes) had a significantly shorter total throughput time than both telephonic (median 141 minutes) and bilingual provider (153 minutes) cohorts.(p<.0001).  There was no difference in the cohorts between arrival time to triage and triage time to time seen by a physician.  Time to see a physician until disposition was significantly shorter in the on-site interpretation cohort (median 52 minutes) as compared to telephonic (72 minutes) and bilingual providers (81 minutes).(p<.0001)  There was no difference between the cohorts on laboratory (p=0.28) or radiology utilization (p=.73).  However, there was a lower admission rate in the on-site cohort (3.5%) as compared to both telephonic (9.4%) and bilingual provider (8.6%) cohorts.(p=.02)

Conclusions:  On-site interpretation significantly decreased ED throughput times for LEP patients by decreasing the time between physician evaluation and disposition.  This may have varying implications for Hospital and ED administrators depending on the volume of LEP patients as well as the resources available.