Impact of Telephone versus Video Interpretation on Parent Comprehension, Communication and Utilization in the Emergency Department: A Randomized Trial

Abstract

Importance

Consistent professional interpretation improves communication with limited English proficient (LEP) patients. Remote modalities (telephone and video) have potential for wide dissemination.

Objective

To test the effect of telephone versus video interpretation on communication as measured by diagnosis comprehension, lapses in interpreter use, quality of communication and interpretation, and healthcare utilization during pediatric emergency care.

Design

Randomized trial of telephone versus video interpretation. Investigators were blinded to interpretation modality during outcome ascertainment.

Setting

Free-standing, university-affiliated pediatric emergency department (ED)

Participants

Spanish-speaking LEP parents of pediatric ED patients. A convenience sample of 290 parents were approached, of whom 249 (86%) enrolled, and 208 (84% of enrolled) completed the follow-up survey (91 telephone arm, 117 video arm). Groups did not differ significantly by consent or survey completion rate, ED factors (e.g. ED crowding), child factors (e.g. triage level, medical complexity), or parent factors (e.g. birth country, income).

Intervention

Assignment to telephone or video interpretation for the ED visit, randomized by day

Main Outcomes and Measures

Parents were surveyed 1–7 days following 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 chart-abstracted diagnoses and classified them as correct, incorrect, or vague. Length of stay (LOS) and charges were obtained from administrative data. Effect of interpretation modality assignment on outcomes was assessed using chi-squared and Student’s t-tests.

Results

Video-assigned parents were more likely to correctly name the child’s diagnosis than those assigned to telephone (75% vs 60%, p=.03), and less likely to report frequent lapses in interpreter use (2% vs 8%, p=.04). There were no differences in parent-reported quality of communication or interpretation, or in ED LOS or charges. Video interpretation was more costly (per-patient mean $61 vs $31, p<.001). Parent-reported adherence to assigned modality was higher for the video arm (93% vs 79%, p=.004).

Conclusions and Relevance

LEP families who received video interpretation were more likely to correctly name the child’s diagnosis, and had fewer encounters with frequent lapses in interpreter use. Use of video interpretation shows promise for improving communication and patient care.

Trial Registration

clinicaltrials.gov Identifier: NCT01986179