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Abstract

Objectives: To survey pediatric hospitalists about their perceptions on 1) access to interpreter services, 2) how the COVID-19 pandemic affected access to interpreter services, and 3) methods and barriers to providing discharge instructions for families who prefer languages other than English (LOE).

Methods:

A cross sectional, observational study was conducted utilizing an online survey via REDCap that was distributed on the Pediatric Hospital Medicine (PHM) LISTSERV® from February 23 to March 23, 2022. Inclusion criteria included faculty and advanced practice providers who practice medicine in a hospital setting greater than 50% of their clinical time as well as medical students, residents, or fellows interested in PHM. Survey questions inquired about common interpreter modalities used, frequency of interpreter use at various points during a hospital stay and difficulty accessing a certified interpreter. The survey asked if the COVID-19 pandemic had affected access to an interpreter, wait times for an interpreter, and reliance on a remote interpreter. Providers were asked to describe how they provide discharge instructions to their patients who spoke LOE and to identify any barriers to providing translated discharge instructions. A multivariate logistic regression was used to examine 1) factors associated with self-reported difficulty accessing interpreters and 2) factors associated with self-reported decreased access to interpreters during the COVID pandemic. Variables in the model included practice location (urban vs. not), hospital characteristics (freestanding vs not, teaching vs. not), provider position (attending vs. not), and whether respondents primarily used in-person versus remote interpreters.

Results: 186 responses representing 40 states were captured. Most respondents worked in urban, non-free standing, teaching hospitals. Remote interpretation with video services was the most commonly used mode of interpretation (50%), followed by remote interpreter with audio (26%). During the hospitalization, the lowest use of an interpreter reported was during pre-rounds followed by post-rounds. Almost a quarter of respondents reported the perception of difficulty accessing a certified interpreter. Overall, a third of respondents reported perceiving the pandemic decreased access to an interpreter. Practicing at a freestanding children’s hospital (OR 2.5, 95% CI 1.25 – 4.96, p = 0.01) and utilizing in-person interpreter services (OR 2.32, 95% CI 1.1 – 4.9, p = 0.03) were both associated with decreased access to interpreter services during the pandemic. Discharge instructions were variably translated with common cited barriers to this being: access to translator services, concerns with accuracy of translated documentation, and concerns for delayed care or discharge.

Conclusion: There exists wide variability in interpreter and translator practices across pediatric hospitals with a third of pediatric providers perceiving that the COVID-19 pandemic decreased their access to interpreter services. This variability can have serious inequity and safety implications and continued research to look for more equitable and culturally competent practices is necessary.

Key Take Away Points

  • Almost a quarter of pediatric hospital providers reported a perception of difficulty accessing an interpreter.
  • A third of respondents perceived that the COVID-19 pandemic reduced access to an interpreter in the pediatric inpatient setting.
  • Pediatric hospitals provide discharge instructions to patients speaking LOE in varied manners and barriers include lack of access to certified translator services and concerns about inaccuracy of the translated material.

Author Biography

Dr. Sheela Gavvala is a pediatric hospitalist at Children's Memorial Hermann Hospital and an Assistant Professor of Pediatrics at McGovern Medical School at the University of Texas Health Science Center in Houston, Texas. Jessica Gonzalez is a 4th year medical student at McGovern Medical School. Kaleigh Riggs is a statistician within the Department of Pediatrics at the McGovern Medical School. Dr. Raymond Parlar-Chun is a pediatric hospitalist at Texas Children’s Hospital and Senior Faculty of Pediatrics at Baylor College of Medicine.

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