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

Language concordant care (LCC) improves safety and equity for patients with non-English language preferences (NELP). In emergency departments (EDs), high volume and acuity can exacerbate language barriers. At Parkland Health, a large safety-net hospital, few ED physicians held Qualified Bilingual Staff (QBS) designation despite a significant Spanish-speaking patient population. This quality improvement initiative aimed to increase QBS certification by 25% and exam attempts by 50% from February 2024 to October 2024, with a secondary aim to assess interpreter modality preferences among non-bilingual physicians.

Using Plan-Do-Study-Act cycles, we surveyed 181 ED physicians on language proficiency, QBS awareness, and testing barriers. Interventions included adjusting exam logistics and clinical relevance, recognizing Spanish-speaking medical school graduates as QBS-eligible without testing, and publicizing changes to acknowledge physician feedback. Interpreter preferences were collected from non-bilingual respondents. Data were analyzed descriptively.

Survey response rate was 81% (147/181). Of respondents, 83/147 (56%) spoke a non-English language, with 69/83 (83%) reporting Spanish. At baseline, 4/69 (6%) of Spanish-speaking physicians held QBS designation. Eight months later, 15/69 (22%) had attempted certification, resulting in 12/69 (17%) becoming QBS-designated. Almost all non-bilingual respondents preferred in-person interpreters (44/44, 100%). In-person services were valued for rapport and accuracy; technical issues were reported with video interpretation.

Removing logistical barriers and incorporating physician feedback increased QBS designation in a large, multilingual ED. The gap between preference and use of in-person interpretation highlights the need for faster access to in-person services or more reliable alternatives. Sustaining gains will require ongoing feedback, preparation resources, and tracking patient outcomes to inform expansion.