Impact of language barriers on patient satisfaction in an emergency department

OBJECTIVE: To examine patient satisfaction and willingness to return to an emergency department (ED) among non-English speakers. DESIGN: Cross-sectional survey and follow-up interviews 10 days after ED vi sit, SETTING: Five urban teaching hospital EDs in the Northeastern United States . PATIENTS: We surveyed 2,333 patients who presented to the ED with one of si x chief complaints. MEASUREMENTS AND MAIM RESULTS: Patient satisfaction, willingness to return to the same ED if emergency care was needed, and patient-reported problems with care were measured. Three hundred fifty-four (15%) of the patients rep orted English was not their primary language. using an overall measure of p atient satisfaction, only 52% of non-English-speaking patients were satisfi ed as compared with 71%, of English speakers (p < .01). Among non-English s peakers, 14% said they would not return to the same ED if they had another problem requiring emergency care as compared with 9.5% of English speakers (p < .05). In multivariate analysis adjusting for hospital site, age, gende r, race/ethnicity, education, income, chief complaint, urgency, insurance s tatus, Medicaid status, ED as the patient's principal source of care, and p resence of a regular provider of care, non-English speakers were significan tly less likely to be satisfied (odds ratio [OR] 0.59; 95% confidence inter val [CI] 0.39, 0.90) and significantly less willing to return to the same E D (OR 0.57; 95% CI 0.34, 0.95). Non-English speakers also were significantl y more likely to report overall problems with care (OR 1.70; 95% CI 1.05, 2 .74), communication (OR 1.71: 95% CI 1.18, 2.47), and testing (OR 1.77: 95% CI 1.19, 2.64). CONCLUSIONS: Non-English speakers were less satisfied with their care in th e ED, less willing to return to the same ED if they had a problem they felt required emergency care, and reported more problems with emergency care. S trategies to improve satisfaction among this group of patients may include appropriate use of professional interpreters and increasing the language co ncordance between patients and providers.