BACKGROUND: Patients with language barriers encounter healthcare disparities, which may be alleviated by leveraging interpreter skills to reduce cultural, language, and literacy barriers through improved bidirectional communication. Evidence supports the use of in-person interpreters, especially for interactions involving patients with complex care needs. Unfortunately, due to interpreter shortages and clinician underuse of interpreters, patients with language barriers frequently do not get the language services they need or are entitled to. Health information technologies (HIT), including artificial intelligence (AI), have the potential to streamline processes, prompt clinicians to utilize in-person interpreters, and support prioritization.
METHODS: From May 1, 2023, to June 21, 2024, a single-center stepped wedge cluster randomized trial will be conducted within 35 units of Saint Marys Hospital & Methodist Hospital at Mayo Clinic in Rochester, Minnesota. The units include medical, surgical, trauma, and mixed ICUs and hospital floors that admit acute medical and surgical care patients as well as the emergency department (ED). The transitions between study phases will be initiated at 60-day intervals resulting in a 12-month study period. Units in the control group will receive standard care and rely on clinician initiative to request interpreter services. In the intervention group, the study team will generate a daily list of adult inpatients with language barriers, order the list based on their complexity scores (from highest to lowest), and share it with interpreter services, who will send a secure chat message to the bedside nurse. This engagement will be triggered by a predictive machine-learning algorithm based on a palliative care score, supplemented by other predictors of complexity including length of stay and level of care as well as procedures, events, and clinical notes.
CONCLUSIONS: This pragmatic clinical trial approach will integrate a predictive machine-learning algorithm into a workflow process and evaluate the effectiveness of the intervention. We will compare the use of in-person interpreters and time to first interpreter use between the control and intervention groups.
BACKGROUND: NCT05860777. May 16, 2023.

Because many hospitals have no mechanism for written translation, ED providers resort to the use of automated translation software, such as Google Translate (GT) for patient instructions. A recent study of discharge instructions in Spanish and Chinese suggested that accuracy rates of Google Translate (GT) were high.
To perform a pragmatic assessment of GT for the written translation of commonly used ED discharge instructions in seven commonly spoken languages.
A prospective assessment of the accuracy of GT for 20 commonly used ED discharge instruction phrases, as evaluated by a convenience sample of native speakers of seven commonly spoken languages (Spanish, Chinese, Vietnamese, Tagalog, Korean, Armenian, and Farsi). Translations were evaluated using a previously validated matrix for scoring machine translation, containing 5-point Likert scales for fluency, adequacy, meaning, and severity, in addition to a dichotomous assessment of retention of the overall meaning.
Twenty volunteers evaluated 400 google translated discharge statements. Volunteers were 50% female and spoke Spanish (5), Armenian (2), Chinese (3), Tagalog (4), Korean (2), and Farsi (2). The overall meaning was retained for 82.5% (330/400) of the translations. Spanish had the highest accuracy rate (94%), followed by Tagalog (90%), Korean (82.5%), Chinese (81.7%), Farsi (67.5%), and Armenian (55%). Mean Likert scores (on a 5-point scale) were high for fluency (4.2), adequacy (4.4), meaning (4.3), and severity (4.3) but also varied.
GT for discharge instructions in the ED is inconsistent between languages and should not be relied on for patient instructions.

BACKGROUND: The underuse of interpreters for limited English proficiency (LEP) patient encounters is pervasive, particularly in the emergency department (ED).
OBJECTIVE: To measure the outcome of strategies to improve the use of interpreters by ED providers.
METHODS: Pre- and post- intervention evaluation of the unmet need for language assistance (LA) in a public ED. Informed by the Behavior Change Wheel (BCW), strategies included: education, training, technology-based facilitators, local champions and environmental cues.
RESULTS: Pre-intervention, of the 110 patient charts with interpreter requests, 17 (15.5%) had documentation of an interpreter-mediated encounter or were seen by a certified bilingual provider (unmet need = 84.5%). Post intervention, of the 159 patient charts with interpreter requests, 47 (29.6%) had documentation of an interpreter-mediated encounter or were seen by a certified bilingual provider (unmet need = 70.4%), difference + 0.14 (95% CI = 0.03-0.23).
CONCLUSIONS: In this pilot study, we found a statistically significant increase in the met need for language assistance.

Research suggests that language barriers in health care settings may adversely affect clinical outcomes and patient satisfaction. We describe the characteristics of adults with limited English proficiency (LEP) and diagnosed HIV in the United States. The Medical Monitoring Project is a complex sample survey of adults with diagnosed HIV in the United States that uses two-stage, probability-proportional-to-size sampling. We analyzed weighted interview and medical record data collected from June 2015-May 2018. The prevalence of LEP among adults with HIV was 10%. Higher percentages of adults with LEP, compared with adults with English proficiency (EP), were female, Hispanic/Latino, less educated and poor, only had Ryan White HIV/AIDS Program (RWHAP) health care coverage, attended RWHAP-funded facilities, were satisfied with their HIV medical care, were prescribed antiretroviral therapy (ART), were virally suppressed and received testing for sexually transmitted diseases. We found no statistical difference in ART adherence among adults with LEP and EP. Despite the association between LEP and the risk for health disparities, more persons with LEP were virally suppressed compared with persons with EP. One possible explanation is attendance at RWHAP-funded facilities by adults with LEP; however, future studies are needed to explore other possible explanations.

Many ED patients have limited English proficiency (LEP). Under Title VI of the 1964 Civil Rights Act, LEP patients are entitled to language assistance, however, multiple studies demonstrate that language assistance is underutilized. We aimed to characterize the knowledge, practice patterns, and preferences of ED providers and staff regarding language assistance for LEP patients. We performed a self-administered, anonymous questionnaire in an urban, public ED where most patients have LEP. Subjects included all ED providers and staff with substantial patient contact. We recorded ED role, knowledge of language assistance policy, prior training on working with interpreters, non-English language skills and bilingual certification. Outcomes included frequency of and comfort level with respondent\'s own non-English language (NEL) use in the ED, and the preferred and most frequently used modalities of language assistance. Of the 354 total ED employees, 261 were approached and 259 agreed to participate, which represents a 73% response rate (259/354). Respondents were 37% MD/NPs, 34% RNs and 29% other ED staff. Only 50/259 (19%) had prior training on working with interpreters. 171/257 (67%) were \"unsure\" if the hospital had a policy on language assistance. The most frequent modalities accessed for spoken language assistance were \"Other ED staff\" 106/259 (41%) or \"ad hoc interpreter\" 62/259 (24%). Although 227/274 (83%) use a non-English language with patients regularly, comfort levels in using their NEL for clinical care were variable. Most ED providers and staff had little training in the use of language assistance and were unaware of hospital policy. Use of NEL skills by providers for clinical care is common. Dissemination of best practices for the provision of language assistance and the clinical use of NEL skills has the potential to improve communication with LEP patients.

Language barriers and access to telephone advice have been shown to affect patient care. Less is known about access to telephone advice for families whose usual language is not English. The objective was to characterize the use of pediatric primary care telephone advice by families based on usual language spoken at home. A total of 277 surveys were completed by families presenting for sick visits at an academic pediatric primary care practice. No meaningful differences in the use of telephone advice when a child was sick were found by language category. Overall, 80.5% reported calling the clinic first when the clinic was open, but 77.6% went to the emergency department when the clinic closed. In conclusion, use of telephone advice was similar among families regardless of usual language. Most families reported going to the emergency department when the clinic was closed. More research is needed to identify barriers to the use of telephone advice, particularly after hours.

Families limited in English proficiency (LEP) often do not receive appropriate medical language services, resulting in health disparities. Little is known about the use and effectiveness of language services provided via telephone when families call for medical advice.
To characterize language service provision to LEP families calling for medical advice in a pediatric primary care setting.
A self-administered survey was given to parents of children presenting for sick visits at an urban academic pediatric primary care practice.
277 out of 300 surveys were completed, 92% in English and 8% in Spanish. 7% (19/271) of those who answered the language proficiency question reported LEP (spoke English \"not well,\" or \"not at all\"). Among LEP parents, 68% calling for advice during clinic hours received appropriate language services (a trained interpreter or a bilingual provider). 53% received these services when calling after hours.
Over half of LEP families seeking telephone advice from their pediatric primary care office received adequate language services. Future research should identify barriers to providing telephone language services to LEP families.

Surgical and procedural patient care settings require efficient patient flow. The primary goal of this study was to assess use and efficiency of language services for our limited English proficiency (LEP) patients undergoing surgical and outpatient procedures.
Patient language services needs were recorded from our operating room and procedural locations over a two and a half month period in 2016. Time from in-person interpreter request to arrival was recorded. Frequency of language service modality used and reason for telephone and professional video remote interpreting (VRI) rather than in person professional services was queried.
Mean time from in-person interpreter request until arrival was 19 min. Variation was high. No cases were cancelled due to lack of available interpretive services and no LEP patient underwent a procedure without requested interpretative service assistance.
Time for in person professional interpreter assistance was short but highly variable. Access to telephone interpretive services and VRI services ensured assistance when in person interpreters were immediately unavailable. With the numbers of LEP patients increasing over time along with any new mandates for providing language assistance, the stress on hospital patient service units and the financial implications for many health care facilities will likely continue as challenges.

Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services.
Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1251 pediatric hospice agencies. Variable selection was guided by structural contingency theory, which posits that organizational effectiveness is dependent upon how well an organization\'s structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services.
The majority of hospices provided translation services (74.9 %) and interpreter services (87.1 %). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services.
Findings indicate that nursing unit environment predicts provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staffs who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency and ultimately reduce ethnic disparities in end-of-life care for children and their families.

OBJECTIVE: Health providers need reliable estimates of the number of families with limited English proficiency (LEP) to assess language need and language service provision. Hospitals often lack reliable language screening tools and fail to provide interpretation for LEP families. The objective of this study was to develop a simple audit tool to more accurately identify LEP patients and families.
METHODS: We conducted a cross-sectional analysis of a retrospective cohort of patients admitted to a large pediatric hospital between July 1 and December 31, 2009. We used a \"capture-recapture\" approach to develop a simple audit tool to measure language screening, determine the rate of language interpretation, and estimate the number of LEP families. The captures were based on 2 independent sources: (1) language need identified at registration and (2) request for interpretation during hospital admission. Assuming a closed population, we estimated the number of LEP families missed by both captures.
RESULTS: During the study period, 6887 patients were admitted for care. There were 948 LEP families identified at registration and 847 families received interpretation at least once during hospital admission. We determined that the \"ascertainment corrected\" number of LEP families was 1031 (95% confidence interval: 1022-1040). The number of patients who had been \"missed\" by both methods was 15 (95% confidence interval: 7-24). Only 76% of LEP patients were identified in both data sources.
CONCLUSIONS: A simple language audit tool can be used to determine language need, rates of interpretation, and unmet demand for language services, even when both sources of data are incomplete.