Obtaining History with a Language Barrier in the Emergency Department: Perhaps not a Barrier After All

Introduction: Patients with limited English proficiency may be at risk for incomplete history collection, potentially a patient safety issue. While federal law requires qualified medical interpreters be provided for these patients, little is known about the quality of information obtained in these e...

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Main Authors: Megan Litzau, Joseph Turner, Katie Pettit, Zachary Morgan, Dylan Cooper
Format: Article
Language:English
Published: eScholarship Publishing, University of California 2018-10-01
Series:Western Journal of Emergency Medicine
Online Access:https://escholarship.org/uc/item/8mm306r5
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spelling doaj-72811a5db06842249f6b36541dd8b7772020-11-25T03:27:56ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182018-10-0119610.5811/westjem.2018.8.39146wjem-19-934Obtaining History with a Language Barrier in the Emergency Department: Perhaps not a Barrier After AllMegan LitzauJoseph TurnerKatie PettitZachary MorganDylan CooperIntroduction: Patients with limited English proficiency may be at risk for incomplete history collection, potentially a patient safety issue. While federal law requires qualified medical interpreters be provided for these patients, little is known about the quality of information obtained in these encounters. Our study compared the medical histories obtained by physicians in the emergency department (ED) based on whether the patients primarily spoke English or Spanish. Methods: This was a prospective, observational study conducted at a single, urban, academic ED during a six-month time period. Resident and faculty physicians caring for adult patients with a chief complaint of chest or abdominal pain were eligible for participation. Patient encounters were directly observed by medical students who had been trained using simulated encounters. Observers documented which key historical data points were obtained by providers, including descriptions of pain (location, quality, severity, radiation, alleviating/aggravating factors), past medical/family/surgical history, and social history, in addition to the patient’s language in providing history. Providers, interpreters, and observers were blinded to the nature of the study. We used chi-square analyses to examine differences in whether specific elements were collected based on the primary language of the patient. Results: Encounters with 753 patients were observed: 105 Spanish speaking and 648 English speaking. Chi-square analyses found no statistically significant differences in any history questions between Spanish-speaking and English-speaking patients, with the exception that questions regarding alleviating factors were asked more often with Spanish-speaking patients (45%) than English-speaking patients (30%, p=.003). The average percentages of targeted history elements obtained in Spanish and English encounters were 60% and 57%, respectively. Conclusion: In this study at a large, urban, academic ED, the medical histories obtained by physicians were similar between English-speaking and Spanish-speaking patients. This suggests that the physicians sought to obtain medical histories at the same level of detail despite the language barrier. One limitation to consider is the Hawthorne effect; however, providers and observers were blinded to the nature of the study in an attempt to minimize the effect.https://escholarship.org/uc/item/8mm306r5
collection DOAJ
language English
format Article
sources DOAJ
author Megan Litzau
Joseph Turner
Katie Pettit
Zachary Morgan
Dylan Cooper
spellingShingle Megan Litzau
Joseph Turner
Katie Pettit
Zachary Morgan
Dylan Cooper
Obtaining History with a Language Barrier in the Emergency Department: Perhaps not a Barrier After All
Western Journal of Emergency Medicine
author_facet Megan Litzau
Joseph Turner
Katie Pettit
Zachary Morgan
Dylan Cooper
author_sort Megan Litzau
title Obtaining History with a Language Barrier in the Emergency Department: Perhaps not a Barrier After All
title_short Obtaining History with a Language Barrier in the Emergency Department: Perhaps not a Barrier After All
title_full Obtaining History with a Language Barrier in the Emergency Department: Perhaps not a Barrier After All
title_fullStr Obtaining History with a Language Barrier in the Emergency Department: Perhaps not a Barrier After All
title_full_unstemmed Obtaining History with a Language Barrier in the Emergency Department: Perhaps not a Barrier After All
title_sort obtaining history with a language barrier in the emergency department: perhaps not a barrier after all
publisher eScholarship Publishing, University of California
series Western Journal of Emergency Medicine
issn 1936-9018
publishDate 2018-10-01
description Introduction: Patients with limited English proficiency may be at risk for incomplete history collection, potentially a patient safety issue. While federal law requires qualified medical interpreters be provided for these patients, little is known about the quality of information obtained in these encounters. Our study compared the medical histories obtained by physicians in the emergency department (ED) based on whether the patients primarily spoke English or Spanish. Methods: This was a prospective, observational study conducted at a single, urban, academic ED during a six-month time period. Resident and faculty physicians caring for adult patients with a chief complaint of chest or abdominal pain were eligible for participation. Patient encounters were directly observed by medical students who had been trained using simulated encounters. Observers documented which key historical data points were obtained by providers, including descriptions of pain (location, quality, severity, radiation, alleviating/aggravating factors), past medical/family/surgical history, and social history, in addition to the patient’s language in providing history. Providers, interpreters, and observers were blinded to the nature of the study. We used chi-square analyses to examine differences in whether specific elements were collected based on the primary language of the patient. Results: Encounters with 753 patients were observed: 105 Spanish speaking and 648 English speaking. Chi-square analyses found no statistically significant differences in any history questions between Spanish-speaking and English-speaking patients, with the exception that questions regarding alleviating factors were asked more often with Spanish-speaking patients (45%) than English-speaking patients (30%, p=.003). The average percentages of targeted history elements obtained in Spanish and English encounters were 60% and 57%, respectively. Conclusion: In this study at a large, urban, academic ED, the medical histories obtained by physicians were similar between English-speaking and Spanish-speaking patients. This suggests that the physicians sought to obtain medical histories at the same level of detail despite the language barrier. One limitation to consider is the Hawthorne effect; however, providers and observers were blinded to the nature of the study in an attempt to minimize the effect.
url https://escholarship.org/uc/item/8mm306r5
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