Science Update: Use of interpreter services inconsistent in pediatric emergency departments, NICHD-funded study suggests

Pattern could deprive families, physicians of important health information

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When dealing with families with limited English language proficiency, pediatric emergency department practitioners were more likely to use professional interpreters for taking medical histories and less likely to use them when administering medication and performing medical procedures, according to a study of 50 cases funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The study also found that professional interpreters were used for only 36% of communication events with families low in English proficiency.

The researchers were led by K. Casey Lion, M.D., of the University of Washington. The study was published online in Pediatrics.


Previous research has shown that the services of medical interpretation professionals have improved the quality of care available to the 25 million people in the United States with limited proficiency in English. However, professional interpretation is used in less than half of health care provider interactions with limited-English-proficiency patients. Federal law requires health care to be provided in a language understood by patients. However, for an interpreter’s service to be used, a health care provider must decide if the service is needed. Patients are not always involved in the decision. Researchers undertook the current study to understand factors influencing use of professional interpretation services.

They analyzed data from a larger study comparing telephone and videocast interpretation provided to Spanish-speaking, limited-English-proficiency patients. Researchers recorded a total of 312 medical communications interactions between health care providers and 50 families with limited English proficiency, half of whom had been assigned to receive interpretation by telephone and half by videocast.


Professional interpretation services were used at least once for all cases, comprising 36% of communication events overall. Interpreters were used most often to obtain medical histories (86%) and least often for medical procedures (11%) and medication administration (8%). For physicians and nurse practitioners, families assigned to the videocast group were nearly 3 times more likely to receive professional interpretation services than those assigned to the telephone group. For nurses, there was no difference in professional interpretation services for families assigned to either group.

Professional interpreter services were more likely to be used by physicians and nurse practitioners compared to registered nurses (51% vs. 16%). A possible explanation for this finding is that registered nurses are more likely to rely on physicians and practitioners for information, rather than seeking it directly from patients and families.


The authors theorize that health care providers are more likely to seek interpretation services when they require information, such as a medical history. They may be less likely to use it when accomplishing a task, like administering medication or performing a medical procedure—high-risk activities in which a patient’s ability to ask questions and seek clarification may prevent serious medical errors. For example, not using a professional interpreter when discussing medication could result in the health care practitioner failing to learn important information, such as a patient’s medication allergy.

The authors suggested that because practitioners knew they were being recorded for a study about professional interpreter use they may have been more likely to use interpreters than they would have normally. The authors called for increased emphasis on ensuring that patients and families can communicate throughout a medical visit, rather than only when a health care provider feels it is needed.


Lion, KC, et al. Patterns and predictors of professional interpreter use in the pediatric emergency department. Pediatrics. 2021.

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