Use of Untrained Interpreters in the Inpatient Setting: What Does the Record Show?

Area of Science:

• Healthcare access and disparities
• Medical communication
• Health informatics

Background:

• Federal mandates require qualified interpreters, yet untrained ad hoc interpreters are common for patients with non-English language preference (NELP).
• Previous research on ad hoc interpreter use relies on self-report or administrative data, limiting understanding of real-world documentation.
• This study addresses gaps in understanding the frequency, documentation, and context of ad hoc interpreter use in clinical settings.

Purpose of the Study:

• To characterize the frequency and documentation of untrained ad hoc interpreter use in inpatient medicine.
• To identify contextual factors associated with ad hoc interpreter use.
• To evaluate the completeness of documented rationales for ad hoc interpreter use.

Main Methods:

• Retrospective cohort study of adult inpatients with NELP from 2019-2023.
• Analysis of clinical notes using a large language model to identify interpreter use documentation.
• Manual validation and categorization of ad hoc interpretation cases, including role and rationale.

Main Results:

• Ad hoc interpreter use was documented in 16.2% of patients and 14.9% of admissions, most often by family members (64.7%).
• Documented ad hoc use was more common in older patients, longer stays, higher comorbidity, and non-Spanish language groups.
• Nearly 75% of ad hoc interpreter notes lacked a documented rationale, highlighting documentation gaps.

Conclusions:

• Ad hoc interpreter use is prevalent in NELP inpatients, especially for less common languages and longer stays.
• Gaps in documented rationales indicate systemic issues in language access workflows.
• Improved access to professional interpretation, standardized documentation, and use of qualified bilingual staff are crucial for equitable communication.