Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization.
OBJECTIVE
To determine the impact of interpreters and bilingual physicians on emergency department (ED) resource utilization.


METHODS
Cohorts defined by language concordance and interpreter use were prospectively studied preceding and following the availability of dedicated, professional medical interpreters.


METHODS
Pediatric ED in Chicago, Ill.


METHODS
We examined 4146 visits of children (aged 2 months to 10 years) with a presenting temperature of 38.5 degrees C or higher or a complaint of vomiting or diarrhea; 550 families did not speak English. In 170 cases, the treating physician was bilingual. In 239, a professional interpreter was used. In the remaining 141, a professional medical interpreter was unavailable.


METHODS
Incidence and costs of diagnostic testing, admission rate, use of intravenous hydration, and length of ED visit.


RESULTS
Regression models incorporated clinical and demographic factors. Compared with the English-speaking cohort, non-English-speaking cases with bilingual physicians had similar rates of resource utilization. Cases with an interpreter showed no difference in test costs, were least likely to be tested (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.56-0.97), more likely to be admitted (OR, 1.7; 95% CI, 1.1-2.8), and no more likely to receive intravenous fluids, but had longer lengths of visit (+16 minutes; 95% CI, 6.2-26 minutes). The barrier cohort without a professional interpreter had a higher incidence (OR, 1.5; 95% CI, 1.04-2.2) and cost (+$5.78; 95% CI, $0.24-$11.21) for testing and was most likely to be admitted (OR, 2.6; 95% CI, 1.4-4.5) and to receive intravenous hydration (OR, 2.2; 95% CI, 1.2-4.3), but showed no difference in length of visit.


CONCLUSIONS
Decision making was most cautious and expensive when non-English-speaking cases were treated in the absence of a bilingual physician or professional interpreter.
Hampers
Louis C
LC
Section of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital, Denver, Colo 80218, USA. hampers.lou@tchden.org
McNulty
Jennifer E
JE
D002641:Chicago; D002648:Child; D002675:Child, Preschool; D003144:Communication Barriers; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012017:Referral and Consultation; D012959:Socioeconomic Factors; D013997:Time Factors