Language barriers and resource utilization in a pediatric emergency department

Background. Although an inability to speak English is recognized as an obst acle to health tare in the United States, it is unclear how clinicians alte r their diagnostic approach when confronted with a language barrier (LB). Objective. To determine if a LB between families and their emergency depart ment (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 provide d to patients who presented to a pediatric ED from September 1997 through D ecember 1997. Patients included were 2 months to 10 years of age, not chron ically ill, and had a presenting temperature greater than or equal to 38.5 degrees C or complained of vomiting, diarrhea, or decreased oral intake. Ex amining physicians determined study eligibility and recorded the Yale Obser vation Score if the patient was <3 years old, and whether there was a LB be tween the physician and the family. Standard hospital charges were applied for each visit to any of the 22 commonly ordered tests. Comparisons of tota l charges were made among groups using Mann-Whitney U tests. Analysis of co variance 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 (1 2%) 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 s lightly younger (mean 31 months vs 36 months), but had similar acuity, tria ge vital signs, and Yale Observation Score (when applicable). In cases in w hich a LB existed, mean test charges were significantly higher: $145 versus $104, and ED stays were significantly longer: 165 minutes versus 137 minut es. 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 phy sician-family LB was associated with a higher rate of resource utilization for diagnostic studies and increased ED visit times. Additional study is re commended to explore the reasons for these differences and ways to provide care more efficiently to non-English-speaking patients.