Skip to Main Content
Skip Nav Destination

The Consequences of Care Without Appropriate Translational Services

November 16, 2023

Taking the extra time to use appropriate translation services for families with a non-English language preference (NELP) really is a best practice and one we know we should follow but can be easier said than done. Creating the systems to provide competent care for families with NELP is difficult but vitally important as not doing so has real-world quality of care implications. In an article early releasing this month in Pediatrics entitled, “Caregiver Language Preference and Health Care Utilization Among Children With Asthma,” Emmanuel et al. published outcome data on children with asthma in Washington, DC based on a large asthma registry and found that children with NELP caregivers were significantly more likely to have an asthma-related emergency department visit, hospitalization, or intensive care unit admission (10.1542/peds.2023-061869). This work out of Children’s National Hospital comes on the heels of another recent publication from Dr. Rojas and colleagues, also from Children’s National Hospital, demonstrating families with NELP are more likely to be undertriaged.1

The evidence base for using appropriate translation services to care for families with NELP continues to grow, and these studies show poor outcomes for children when services are not utilized—something we all want to avoid. In addition to the studies noted above, a recent systematic review confirms that while in-person professional translation services are the best, any translation services that include phone or a staff member are better than none.2

How can pediatricians be part of the solution?


We must advocate for the resources needed for translation services in our practices or institutions. For those who work in hospital settings, The Joint Commission, the organization that certifies hospitals, has required this for years so it may already exist. But pediatricians in independent practice settings may struggle with the cost needed to provide these services. One approach would be to look for bilingual staff or to partner with local non-profit organizations in the community to work on creating shared translator or community health worker positions that can help everyone.

Review Current Practices

We should all be assessing the quality of our translator services. Do you have a system to review the quality of the translation? Track patient satisfaction data? If we are going to use a system, we must make sure it actually works as intended.

Use the Correct Language

We need to ensure that our patient education and discharge instructions are in the correct language. Sending a family with NELP home with complicated written instructions in a language they do not understand well is a setup for failure and poor outcomes.

Review Outcomes in Your Institution

The Children’s National Hospital group has now equipped all of us with outcome measures we can add to our performance improvement efforts, such as rates of undertriage and admission rates of children from NELP families for disease specific conditions. There are likely metrics like percentage of families with NELP who receive translation services. Recognizing health disparities is not enough; we need to use metrics to demonstrate that we are improving. With many organizations and a push from The Joint Commission to improve health disparities, you may be more likely to garner the resources needed to provide the best care to your families with NELP by tracking your outcomes and showing if there is a problem in your institution.

Read this article to learn more about how to engage with and help families with NELP in your community.


  1. Rojas CR, Chamberlain JM, Cohen JS, et al. Undertriage for children with caregivers preferring languages other than English. Pediatrics. 2023;151(6):e2022059386
  2. Heath M, Hvass AMF, Wejse CM. Interpreter services and effect on healthcare - a systematic review of the impact of different types of interpreters on patient outcome. J Migr Health. 2023;24(7):100162
Close Modal

or Create an Account

Close Modal
Close Modal