Bridging Language Gaps in Emergency Care: Expanding Qualified Bilingual Staff and Evaluating Interpreter Modalities

Area of Science:

• Healthcare Quality Improvement
• Medical Education
• Health Equity

Background:

• Language concordant care (LCC) is crucial for patient safety and equity, particularly for those with non-English language preferences (NELP).
• Emergency departments (EDs) face challenges in providing LCC due to high patient volume and acuity, exacerbating language barriers.
• A significant Spanish-speaking patient population at Parkland Health's ED had limited access to Qualified Bilingual Staff (QBS)-designated physicians.

Purpose of the Study:

• To increase QBS certification by 25% and exam attempts by 50% among ED physicians within an 8-month period.
• To address barriers preventing physicians from obtaining QBS designation.
• To assess interpreter modality preferences among non-bilingual physicians in the ED.

Main Methods:

• A quality improvement initiative utilized Plan-Do-Study-Act cycles.
• Physicians (n=181) were surveyed on language proficiency, QBS awareness, and testing barriers.
• Interventions included adjusted exam logistics, recognition of Spanish-speaking medical school graduates, and publicized changes based on feedback.

Main Results:

• Survey response rate was 81% (147/181); 56% spoke a non-English language, primarily Spanish (83%).
• QBS designation among Spanish-speaking physicians increased from 6% (4/69) to 17% (12/69) within 8 months, with 22% attempting certification.
• Non-bilingual physicians overwhelmingly preferred in-person interpreters (100%) due to perceived rapport and accuracy.

Conclusions:

• Removing logistical barriers and incorporating physician feedback significantly increased QBS designation in a multilingual ED.
• A notable gap exists between the preference for and availability of in-person interpretation services.
• Sustaining improvements requires ongoing feedback, preparation resources, and outcome tracking for potential expansion.