Language assistance for limited English proficiency patients in a public ED: determining the unmet need

Many patients who present to public Emergency Departments (EDs) have Limited English Proficiency (LEP). LEP patients have worse understanding of their conditions and high rates of ED recidivism. LEP patients are entitled to language assistance under Title IV of the 1964 Civil Rights Act. The objective of this study is to characterize the unmet need for language assistance in a public ED.

Retrospective chart review of 48 h of successive patient encounters in a public ED. Registration workers asked each patient their preferred language and whether they would like an interpreter. On recent implementation of a new electronic health record (EHR), however, providers were unable to see the responses recorded. When discovered, this created a natural experiment to compare patient request for language assistance with documented practice of the providers who were unaware of the patient's stated preference at registration. The study was set in a public, urban ED, annual census of 50,000 visits, with language assistance services available 24/7 via video units and phone line. The subjects included all patients presenting to the ED for a 48-h period. Those with altered level of consciousness and those who left before being seen were excluded. Age, race, ethnicity, preferred language, preference for language assistance, status of the provider as certified bilingual, documentation of language assistance use, type of language assistance used (video, phone, bilingual staff or ad hoc) were captured. Descriptive statistics were used with proportions and 95% CIs to describe the unmet need.

In total, 253 encounters met inclusion criteria. Mean age was 41 years, 201/253 (79.5%) were Hispanic or Latino, and 134/253 (53%) preferred to use a language other than English (97% Spanish, 2% Armenian and 0.8% Tagalog). Of the 110/253 (43%) patients requesting an interpreter, 12/110 (10.9%) were seen by a certified bilingual provider and 5/110 (4.6%) had written documentation by the primary provider that language assistance was used. The calculated unmet need for spoken language assistance was 93/110 (84.5%) of patients requesting language assistance or 93/253 (36.8, 95%CI 31-42.9%) of total ED patients.

In this public ED, there is a large unmet need for language assistance for LEP patients.