The impact of language barriers on patient care in the emergency department

Canada is a multicultural country. However, many frontline healthcare providers only speak English. Previous studies have shown that language barriers can impact care, but limited Canadian data exist. This study aims to determine the utilization of interpreter services and the impact of language barriers on Emergency Department (ED) patient care in a Canadian setting.

A health records review was conducted of ED patients' ≥ 18 years old with a documented preferred language, who presented to two Canadian tertiary care EDs between November 2019 and October 2020. The primary outcome was the impact of the language barrier on ED length of stay, investigations ordered, disposition, 30 day return ED visits, and use of interpreter services. Secondary outcomes included the type of interpreter services and their impact on the above ED care metrics. Statistical analysis was performed using a two-sided T-test, and chi-square tests with Bonferroni correction, and multivariable logistic regression.

A total of 1266 patients were included, with 427, 434, and 405 patients identified as having a primary language of English, French, or Other, respectively. Language barriers were identified in 462 patients (36.5%) and only 52.2% utilized interpreter services. Comparing patients with and without language barriers, patients with language barriers had significantly longer ED length of stay (mean 406.9 vs. 342.4 min, p < 0.001), a higher proportion of investigations in the ED, hospitalizations, and return ED visits (blood work 68.8% vs. 52.5%, p < 0.001; imaging 53.9% vs. 47.4%, p = 0.026; hospitalized 19.7% vs. 12.3%, p < 0.001; return ED visits 23.6% vs. 15.6%, p < 0.001). Of those who received translation, 198 (82.2%) utilized a family member and only 12 (5%) used a professional translation service.

Our findings demonstrate underutilization of professional interpreter services despite available services in the ED. Furthermore, the results highlight that care inequities still exist and support the importance of continued advocacy for improved access to interpreter services and further investigations to mitigate the barriers in accessing these services.