An Implementation Science Approach Improves Language Access in the Emergency Department.

Area of Science:

• Healthcare accessibility
• Medical communication
• Health services research

Background:

• Limited English proficiency (LEP) patients frequently face underuse of interpreters in emergency departments (EDs).
• Effective language assistance (LA) is crucial for equitable healthcare delivery.
• Addressing the unmet need for interpreters is a key challenge in diverse patient populations.

Purpose of the Study:

• To evaluate the impact of multifaceted strategies on improving interpreter utilization by ED providers.
• To measure the change in unmet need for language assistance among LEP patients.
• To assess the effectiveness of interventions informed by the Behavior Change Wheel.

Main Methods:

• A pre- and post-intervention study design was employed in a public emergency department.
• Intervention strategies included education, training, technology, local champions, and environmental cues, guided by the Behavior Change Wheel (BCW).
• The unmet need for language assistance was evaluated by analyzing patient chart documentation of interpreter use or certified bilingual provider encounters.

Main Results:

• The proportion of documented interpreter-mediated encounters or certified bilingual provider use increased from 15.5% to 29.6%.
• The unmet need for language assistance decreased from 84.5% to 70.4% post-intervention.
• This represented a statistically significant improvement in met need for language assistance (difference +0.14, 95% CI = 0.03-0.23).

Conclusions:

• Multifaceted strategies led to a significant increase in met language assistance needs for LEP patients in the ED.
• The findings suggest that a combination of interventions can effectively improve interpreter use.
• This pilot study demonstrates a successful approach to enhancing communication and care for diverse patient populations.