Impact of COVID-19 on Patients with a Preferred Language Other than English in the Emergency Department

The COVID-19 pandemic had a disproportionate impact on minority communities, including patients who identify as having a preferred language other than English (PLOE). Our primary goal in this study was to evaluate the effect of the COVID-19 pandemic on patients with a PLOE in the emergency department (ED), and the use of interpreter services. Secondary outcomes evaluated were measures of patient care, including length of stay, number of studies performed, and unplanned return visits to the ED.

We performed an interrupted time series study of prospectively collected electronic health record (EHR) adult ED and language services data from an urban, safety-net hospital.

The total number of patients presenting to the ED went down in the early peak of the pandemic; however, the percentage of patients with a PLOE went up compared with previous years (19% vs 16%) and, despite making up only 19% of total patients, comprised 44% of total COVID-19 positive patients. In-person interpreter use decreased (prevalence ratio 0.49, 95% confidence Interval [CI] 0.43-0.56) while telephonic and video interpretation increased (prevalence ratio 3.97, 95% CI 3.56-4.43). Baseline testing was unchanged. All groups experienced a decrease in median LOS in 2020, but this was only found to be significant for patients who speak a language other than English or Spanish (P<0.001). None of the patient groups experienced a significant increase in unscheduled returns in 2020.

Our data confirms that COVID-19 disproportionately affected patients with a PLOE, with patients with a PLOE 2.9 times more likely to test positive for COVID-19 than their English-speaking counterparts. Efforts should be made to mitigate this effect via language-concordant care, professional interpreters, and culturally appropriate interaction and information dissemination, not only as it relates to planning for public health crises, but in the day-to-day function of the healthcare system at large. Continued research into the factors driving these inequities and ways to mitigate them is warranted.