Inpatient Interpreter Use by Residents and Nurses

Background: Urban children’s hospitals care for a diverse patient population, including patients with limited English proficiency (LEP). Studies show that pediatricians often rely on untrained interpreters when communicating with these patients. Objectives: 1) Identify patterns of interpreter use by residents and nurses in the inpatient setting 2) Explore clinician characteristics associated with use of interpreters 3) Describe barriers to interpreter use Hypothesis: Residents and nurses do not use interpreters for all communication with LEP families and interpreter use varies across professions. Methods: A survey was sent to 98 pediatric residents and 100 inpatient nurses working on the general pediatrics floor at a free standing tertiary urban children’s hospital. Participants reported their demographics, barriers to interpreter use, and in which clinical encounters they use interpreters, based on the “high risk scenarios” (admissions, medication reconciliation, informed consent, discharge instructions) described by the Agency for Healthcare Research and Quality’s guidelines for improving LEP patient safety. Participants were also able provide free-text, narrative responses about their perceptions of care for LEP patients. The data were then analyzed for association, with chi-squared and Fisher’s exact test, between the participant characteristics and reported interpreter use. Results: Both nurses and residents report inconsistent interpreter use. A majority, 135/147 (91.8%), report past communication with LEP families with no interpreter. Only one out of 147 (0.7%) reported “always” using an interpreter for all of the clinical scenarios. Residents and nurses report different patterns of interpreter use. Residents are more likely to use interpreters for medication reconciliations (p=0.02), informed consent (p=0.003), and admissions (p=0.01); nurses are more likely to use interpreters for routine patient checks (p=.01). Junior residents are more likely than senior residents to use an interpreter while pre-rounding, while nurses with more than 5 years experience are more likely to use an interpreter for routine checks (p=0.03). Although familiarity with suboptimal care for LEP patients is common, 125/147 (85%), residents perceive the quality of care for LEP patients more negatively than nurses (p=0.003). Familiarity with poor outcomes for LEP patients is associated with a higher prioritization of interpreter use (p=0.04). Commonly cited barriers to using interpreters include the time commitment and technical difficulties with interpretation technology. In the narrative responses to the survey, common themes were dissatisfaction with interpreter availability, physician exclusion of LEP families on rounds, and negative perception of how other healthcare professionals use interpreters. Conclusions: Residents and nurses consistently underutilize interpreters. Profession and years of experience are associated with different patterns of interpreter usage and may be leveraged in future attempts to increase interpreter utilization.