Effect of emergency department crowding on documented interpreter use among patients with limited English proficiency

Patients with Limited English Proficiency (LEP) rely on professional interpreter services for safe communication in the emergency department (ED), yet interpreter use is inconsistent. ED crowding has been proposed as a barrier, as clinicians working under time pressure may forgo interpretation. We evaluated whether ED crowding, measured by the National Emergency Department Overcrowding Scale (NEDOCS), was associated with documented interpreter use among ED patients with LEP.

We performed a retrospective study of adult ED encounters with non-English preferred language from 10/1/2024-9/30/2025. The primary outcome was documented interpreter use during the visit. NEDOCS was calculated automatically within the electronic health record at the time of each encounter. We compared mean NEDOCS scores between encounters with and without documented interpreter use using independent-samples t-tests and fit a multivariable logistic regression adjusting for age, sex, race, primary language, arrival time, weekend presentation, and disposition. Sensitivity analyses modeled NEDOCS as a continuous measure, in quartiles, and normalized to the cohort mean.

Among 5665 encounters, interpreter use was documented in 2787 (49.2%). Mean NEDOCS scores were similar between encounters with and without documented interpreter use (235.7 vs 232.2, p = 0.08). Documented interpreter use was stable across NEDOCS quartiles (46.9% to 50.6%, p = 0.22), with no linear trend (p = 0.089). Quartile and ratio-of-mean models confirmed no association.

ED crowding was not associated with documented interpreter use among patients with LEP. Factors other than crowding appear to drive interpreter utilization in this setting.