PEDIATRICS Vol. 103 No. 6 June 1999, pp. 1253-1256
Language Barriers and Resource Utilization in a Pediatric Emergency Department
Received Nov 12, 1998; accepted Jan 13, 1999.
, and
From the From the Divisions of * Pediatric Emergency Medicine,
and General Academic Pediatrics, Department of Pediatrics,
Northwestern University Medical School, Children's Memorial Hospital,
Chicago, Illinois.
Background. Although an inability to speak English is recognized as an obstacle to health care in the United States, it is unclear how clinicians alter their diagnostic approach when confronted with a language barrier (LB).
Objective. To determine if a LB between families and their emergency department (ED) physician was associated with a difference in diagnostic testing and length of stay in the ED.
Design. Prospective cohort study.
Methods. This study prospectively assessed clinical status
and care provided to patients who presented to a pediatric ED from
September 1997 through December 1997. Patients included were 2 months
to 10 years of age, not chronically ill, and had a presenting
temperature 
38.5°C or complained of vomiting, diarrhea, or
decreased oral intake. Examining physicians determined study
eligibility and recorded the Yale Observation Score if the patient was
<3 years old, and whether there was a LB between the physician and the family. Standard hospital charges were applied for each visit to any of
the 22 commonly ordered tests. Comparisons of total charges were made
among groups using Mann-Whitney U tests. Analysis of
covariance was used to evaluate predictors of total charges and length
of ED stay.
Results. Data were obtained about 2467 patients. A total of 286 families (12%) did not speak English, resulting in a LB for the physician in 209 cases (8.5%). LB patients were much more likely to be Hispanic (88% vs 49%), and less likely to be commercially insured (19% vs 30%). These patients were slightly younger (mean 31 months vs 36 months), but had similar acuity, triage vital signs, and Yale Observation Score (when applicable). In cases in which a LB existed, mean test charges were significantly higher: $145 versus $104, and ED stays were significantly longer: 165 minutes versus 137 minutes. In an analysis of covariance model including race/ethnicity, insurance status, physician training level, attending physician, urgent care setting, triage category, age, and vital signs, the presence of a LB accounted for a $38 increase in charges for testing and a 20 minute longer ED stay.
Conclusion. Despite controlling for multiple factors, the presence of a physician-family LB was associated with a higher rate of resource utilization for diagnostic studies and increased ED visit times. Additional study is recommended to explore the reasons for these differences and ways to provide care more efficiently to non-English-speaking patients.language barriers, resource utilization, test ordering. .
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  F. A Carnevale, B. Vissandjee, A. Nyland, and A. Vinet-Bonin Ethical Considerations in Cross-Linguistic Nursing Nursing Ethics, November 1, 2009; 16(6): 813 - 826. [Abstract] [PDF]
|
|
|
|
 |
|
 S. D. Krugman, L. Parra-Roide, W. L. Hobson, L. C. Garfunkel, and J. R. Serwint Spanish-Speaking Patients Perceive High Quality Care in Resident Continuity Practices: A CORNET Study Clinical Pediatrics, April 1, 2009; 48(3): 304 - 310. [Abstract] [PDF]
|
|
|
|
 |
|
 S. Lee, H. A. Nguyen, M. Jawad, and J. Kurata Linguistic Minorities in a Health Survey Public Opin Q, September 1, 2008; 72(3): 470 - 486. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. O'Malley, K. Brown, S. E. Krug, and and the Committee on Pediatric Emergency Medicine Patient- and Family-Centered Care of Children in the Emergency Department Pediatrics, August 1, 2008; 122(2): e511 - e521. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Beach, A. B. Flood, C. M. Robinson, A. N. Cassells, J. N. Tobin, M. A. Greene, and A. J. Dietrich Can Language-Concordant Prevention Care Managers Improve Cancer Screening Rates? Cancer Epidemiol. Biomarkers Prev., October 1, 2007; 16(10): 2058 - 2064. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Stebbing, I. C K Wong, R. Kaushal, and A. Jaffe The role of communication in paediatric drug safety Arch. Dis. Child., May 1, 2007; 92(5): 440 - 445. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Z. Kuo, K. G. O'Connor, G. Flores, and C. S. Minkovitz Pediatricians' Use of Language Services for Families With Limited English Proficiency Pediatrics, April 1, 2007; 119(4): e920 - e927. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. C. Wu, J. M. Leventhal, J. Ortiz, E. E. Gonzalez, and B. Forsyth The interpreter as cultural educator of residents: improving communication for latino parents. Arch Pediatr Adolesc Med, November 1, 2006; 160(11): 1145 - 1150. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Yu, Z. J. Huang, R. H. Schwalberg, and R. M. Nyman Parental English Proficiency and Children's Health Services Access Am J Public Health, August 1, 2006; 96(8): 1449 - 1455. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. L. Cohen, F. Rivara, E. K. Marcuse, H. McPhillips, and R. Davis Are Language Barriers Associated With Serious Medical Events in Hospitalized Pediatric Patients? Pediatrics, September 1, 2005; 116(3): 575 - 579. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Flores The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review Med Care Res Rev, June 1, 2005; 62(3): 255 - 299. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Brach, I. Fraser, and K. Paez Crossing The Language Chasm Health Aff., March 1, 2005; 24(2): 424 - 434. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Ku and G. Flores Pay Now Or Pay Later: Providing Interpreter Services In Health Care Health Aff., March 1, 2005; 24(2): 435 - 444. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. James, F. T. Bourgeois, and M. W. Shannon Association of Race/Ethnicity with Emergency Department Wait Times Pediatrics, March 1, 2005; 115(3): e310 - e315. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Brahan and H. Bauchner Changes in Reporting of Race/Ethnicity, Socioeconomic Status, Gender, and Age Over 10 Years Pediatrics, February 1, 2005; 115(2): e163 - e166. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. B. Vandervort and G. D. Melkus Linguistic Services in Ambulatory Clinics J Transcult Nurs, October 1, 2003; 14(4): 358 - 366. [Abstract] [PDF]
|
|
|
|
|
|
G. Flores, M. B. Laws, S. J. Mayo, B. Zuckerman, M. Abreu, L. Medina, and E. J. Hardt Errors in Medical Interpretation and Their Potential Clinical Consequences in Pediatric Encounters Pediatrics, January 1, 2003; 111(1): 6 - 14. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. C. Hampers and J. E. McNulty Professional Interpreters and Bilingual Physicians in a Pediatric Emergency Department: Effect on Resource Utilization Arch Pediatr Adolesc Med, November 1, 2002; 156(11): 1108 - 1113. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Flores and F. S. Mendoza {inverted question}Dolor Aqui? {inverted question}Fiebre?: A Little Knowledge Requires Caution Arch Pediatr Adolesc Med, July 1, 2002; 156(7): 638 - 640. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Cash Translation services an important part of quality pediatric care AAP News, December 1, 2001; 19(6): 252 - 254. [Full Text] [PDF]
|
|
|
|
|
|
J. E. McNulty, L. C. Hampers, and S. E. Krug Primary Care and Emergency Department Decision Making Arch Pediatr Adolesc Med, November 1, 2001; 155(11): 1266 - 1270. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Brach and I. Fraserirector Can Cultural Competency Reduce Racial and Ethnic Health Disparities? a Review and Conceptual Model Med Care Res Rev, December 1, 2000; 57(4_suppl): 181 - 217. [Abstract] [PDF]
|
|
|
|
 |
|
 Language Barriers Increase Costs and ED Length of Stay Journal Watch Emergency Medicine, August 1, 1999; 1999(801): 7 - 7. [Full Text]
|
|
