It's More Complicated Than Interpreter Use: Improving Care for Non-English-Speaking Families

Mateo is a 2-week-old male who presented for evaluation of neonatal fever and whose parents speak Spanish. Workup revealed pyelonephritis, underlying renal anomalies, and vesicoureteral reflux. A complex interplay of individual and contextual factors contributed to Mateo not receiving prophylactic antibiotics, which ultimately led to a potentially preventable subsequent admission for sepsis secondary to Escherichia coli pyelonephritis with bacteremia. Further history revealed additional communication breakdown; despite multiple appointments between hospitalizations, systems issues led to Mateo's primary care provider being unaware of Mateo's admissions or urologic diagnoses. This case demonstrates challenges facing health care providers as we strive to provide equitable care to families speaking languages other than English (LOE). Although an in-person interpreter was used throughout Mateo's hospitalization, there were still key areas of communication breakdown and opportunities for improvement. First, we describe characteristics of the growing population speaking LOE in the United States and discuss qualitative and quantitative disparities in health care encounters for this population. Through Mateo's experience, we highlight the transition of care at discharge as being highly vulnerable to communication breakdown, particularly for patients speaking LOE, and emphasize the additional impact of low health literacy on these challenges. Finally, we outline potential strategies to reduce disparities and improve outcomes for pediatric patients and families speaking LOE, focusing on (1) consistent and evidence-based interpreter use, (2) incorporation of health literacy-informed communication strategies in the discharge process, (3) reducing barriers to follow-up appointments or diagnostic testing, and (4) closed-loop communication with the patient's primary care provider.