K Casey Lion1, Julie C Brown2, Beth E Ebel3, Eileen J Klein2, Bonnie Strelitz4, Colleen Kays Gutman5, Patty Hencz6, Juan Fernandez6, Rita Mangione-Smith1. 1. Department of Pediatrics, University of Washington, Seattle2Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington. 2. Department of Pediatrics, University of Washington, Seattle3Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington. 3. Department of Pediatrics, University of Washington, Seattle2Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington4Harborview Injury Prevention and Research Center, University of Washington, Seattle5. 4. Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington. 5. Department of Pediatrics, University of Washington, Seattle. 6. Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, Washington.
Abstract
IMPORTANCE: Consistent professional interpretation improves communication with patients who have limited English proficiency. Remote modalities (telephone and video) have the potential for wide dissemination. OBJECTIVE: To test the effect of telephone vs. video interpretation on communication during pediatric emergency care. DESIGN, SETTING, AND PARTICIPANTS: Randomized trial of telephone vs. video interpretationat a free-standing, university-affiliated pediatric emergency department (ED). A convenience sample of 290 Spanish-speaking parents of pediatric ED patients with limited English proficiency were approached from February 24 through August 16, 2014, of whom 249 (85.9%) enrolled; of these, 208 (83.5%) completed the follow-up survey (91 parents in the telephone arm and 117 in the video arm). Groups did not differ significantly by consent or survey completion rate, ED factors (eg, ED crowding), child factors (eg, triage level, medical complexity), or parent factors (eg, birth country, income). Investigators were blinded to the interpretation modality during outcome ascertainment. Intention-to-treat data were analyzed August 25 to October 20, 2014. INTERVENTIONS: Telephone or video interpretation for the ED visit, randomized by day. MAIN OUTCOMES AND MEASURES: Parents were surveyed 1 to 7 days after the ED visit to assess communication and interpretation quality, frequency of lapses in interpreter use, and ability to name the child's diagnosis. Two blinded reviewers compared parent-reported and medical record-abstracted diagnoses and classified parent-reported diagnoses as correct, incorrect, or vague. RESULTS: Among 208 parents who completed the survey, those in the video arm were more likely to name the child's diagnosis correctly than those in the telephone arm (85 of 114 [74.6%] vs. 52 of 87 [59.8%]; P = .03) and less likely to report frequent lapses in interpreter use (2 of 117 [1.7%] vs. 7 of 91 [7.7%]; P = .04). No differences were found between the video and telephone arms in parent-reported quality of communication (101 of 116 [87.1%] vs. 74 of 89 [83.1%]; P = .43) or interpretation (58 of 116 [50.0%] vs. 42 of 89 [47.2%]; P = .69). Video interpretation was more costly (per-patient mean [SD] cost, $61 [$36] vs. $31 [$20]; P < .001). Parent-reported adherence to the assigned modality was higher for the video arm (106 of 114 [93.0%] vs .68 of 86 [79.1%]; P = .004). CONCLUSIONS AND RELEVANCE: Families with limited English proficiency who received video interpretation were more likely to correctly name the child's diagnosis and had fewer lapses in interpreter use. Use of video interpretation shows promise for improving communication and patient care in this population. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01986179.
RCT Entities:
IMPORTANCE: Consistent professional interpretation improves communication with patients who have limited English proficiency. Remote modalities (telephone and video) have the potential for wide dissemination. OBJECTIVE: To test the effect of telephone vs. video interpretation on communication during pediatric emergency care. DESIGN, SETTING, AND PARTICIPANTS: Randomized trial of telephone vs. video interpretation at a free-standing, university-affiliated pediatric emergency department (ED). A convenience sample of 290 Spanish-speaking parents of pediatric ED patients with limited English proficiency were approached from February 24 through August 16, 2014, of whom 249 (85.9%) enrolled; of these, 208 (83.5%) completed the follow-up survey (91 parents in the telephone arm and 117 in the video arm). Groups did not differ significantly by consent or survey completion rate, ED factors (eg, ED crowding), child factors (eg, triage level, medical complexity), or parent factors (eg, birth country, income). Investigators were blinded to the interpretation modality during outcome ascertainment. Intention-to-treat data were analyzed August 25 to October 20, 2014. INTERVENTIONS: Telephone or video interpretation for the ED visit, randomized by day. MAIN OUTCOMES AND MEASURES: Parents were surveyed 1 to 7 days after the ED visit to assess communication and interpretation quality, frequency of lapses in interpreter use, and ability to name the child's diagnosis. Two blinded reviewers compared parent-reported and medical record-abstracted diagnoses and classified parent-reported diagnoses as correct, incorrect, or vague. RESULTS: Among 208 parents who completed the survey, those in the video arm were more likely to name the child's diagnosis correctly than those in the telephone arm (85 of 114 [74.6%] vs. 52 of 87 [59.8%]; P = .03) and less likely to report frequent lapses in interpreter use (2 of 117 [1.7%] vs. 7 of 91 [7.7%]; P = .04). No differences were found between the video and telephone arms in parent-reported quality of communication (101 of 116 [87.1%] vs. 74 of 89 [83.1%]; P = .43) or interpretation (58 of 116 [50.0%] vs. 42 of 89 [47.2%]; P = .69). Video interpretation was more costly (per-patient mean [SD] cost, $61 [$36] vs. $31 [$20]; P < .001). Parent-reported adherence to the assigned modality was higher for the video arm (106 of 114 [93.0%] vs .68 of 86 [79.1%]; P = .004). CONCLUSIONS AND RELEVANCE: Families with limited English proficiency who received video interpretation were more likely to correctly name the child's diagnosis and had fewer lapses in interpreter use. Use of video interpretation shows promise for improving communication and patient care in this population. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01986179.
Authors: R D Hays; J A Shaul; V S Williams; J S Lubalin; L D Harris-Kojetin; S F Sweeny; P D Cleary Journal: Med Care Date: 1999-03 Impact factor: 2.983
Authors: Tamara D Simon; Mary Lawrence Cawthon; Susan Stanford; Jean Popalisky; Dorothy Lyons; Peter Woodcox; Margaret Hood; Alex Y Chen; Rita Mangione-Smith Journal: Pediatrics Date: 2014-05-12 Impact factor: 7.124
Authors: Elaine C Khoong; Blythe A Butler; Omar Mesina; George Su; Triveni B DeFries; Malini Nijagal; Courtney R Lyles Journal: J Am Med Inform Assoc Date: 2021-02-15 Impact factor: 4.497
Authors: Seethalakshmi H Davis; Julia Rosenberg; Jenny Nguyen; Manuel Jimenez; K Casey Lion; Gabriela Jenicek; Harry Dallmann; Katherine Yun Journal: Hosp Pediatr Date: 2019-10
Authors: K Casey Lion; Kathleen Kieran; Arti Desai; Patty Hencz; Beth E Ebel; Ali Adem; Shannon Forbes; Juan Kraus; Colleen Gutman; Ivor Horn Journal: Jt Comm J Qual Patient Saf Date: 2018-08-17
Authors: Colleen K Gutman; Eileen J Klein; Kristin Follmer; Julie C Brown; Beth E Ebel; K Casey Lion Journal: Jt Comm J Qual Patient Saf Date: 2020-08-09