Obtaining history with a language barrier in the emergency department: Perhaps not a barrier after all

Megan Litzau, Joseph Turner, Katie Pettit, Zachary Morgan, Dylan Cooper

Research output: Contribution to journalArticle

Abstract

Introduction: Patients with limited English proficiency may be at risk for inc omplete history collection, potentially a patient safety issue. While federal l aw requires qualified medical interpreters be provided for these patients, little is known ab out 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 th e 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 facult y physicians caring for adult patients with a chief complaint of chest or abdominal pai n 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 dif ferences in whether specific elements were collected based on the primary language o f 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 ef fect; however, providers and observers were blinded to the nature of the study in an attempt to minimize the effect.

Original languageEnglish (US)
Pages (from-to)934-937
Number of pages4
JournalWestern Journal of Emergency Medicine
Volume19
Issue number6
DOIs
StatePublished - Jan 1 2018

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Communication Barriers
Hospital Emergency Service
History
Physicians
Medical History Taking
Language
Patient Safety
Medical Students
Observational Studies

ASJC Scopus subject areas

  • Emergency Medicine

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Obtaining history with a language barrier in the emergency department : Perhaps not a barrier after all. / Litzau, Megan; Turner, Joseph; Pettit, Katie; Morgan, Zachary; Cooper, Dylan.

In: Western Journal of Emergency Medicine, Vol. 19, No. 6, 01.01.2018, p. 934-937.

Research output: Contribution to journalArticle

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abstract = "Introduction: Patients with limited English proficiency may be at risk for inc omplete history collection, potentially a patient safety issue. While federal l aw requires qualified medical interpreters be provided for these patients, little is known ab out 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 th e 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 facult y physicians caring for adult patients with a chief complaint of chest or abdominal pai n 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 dif ferences in whether specific elements were collected based on the primary language o f 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 ef fect; however, providers and observers were blinded to the nature of the study in an attempt to minimize the effect.",
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