Effect of Telephone vs Video Interpretation on Parent Comprehension, Communication, and Utilization in the Pediatric Emergency Department: A Randomized Clinical Trial.
OBJECTIVE
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.


METHODS
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.


METHODS
Telephone or video interpretation for the ED visit, randomized by day.


METHODS
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
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.


BACKGROUND
clinicaltrials.gov Identifier: NCT01986179.
Department of Pediatrics, University of Washington, Seattle2Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington.
K Casey
KC
Lion
Department of Pediatrics, University of Washington, Seattle3Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.
Julie C
JC
Brown
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.
Beth E
BE
Ebel
Department of Pediatrics, University of Washington, Seattle3Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.
Eileen J
EJ
Klein
Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.
Bonnie
B
Strelitz
Department of Pediatrics, University of Washington, Seattle.
Colleen Kays
CK
Gutman
Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, Washington.
Patty
P
Hencz
Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, Washington.
Juan
J
Fernandez
Department of Pediatrics, University of Washington, Seattle2Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington.
Rita
R
Mangione-Smith
D002648:Child; D003142:Communication; D003144:Communication Barriers; D032882:Comprehension; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino; D006776:Hospitals, Pediatric; D006801:Humans; D007802:Language; D008297:Male; D010290:Parents; D011795:Surveys and Questionnaires; D013689:Telephone; D014175:Translating; D049269:Videoconferencing