Effect of Telephone vs Video Interpretation on Parent Comprehension, Communication, and Utilization in the Pediatric Emergency Department: A Randomized Clinical Trial
Lion KC, Brown JC, Ebel BE, et al
JAMA Pediatr. 2015;26:1-9
This randomized trial compared video with telephone remote language interpretation with families of limited English proficiency (LEP) in a pediatric emergency department (ED). The hypothesis was that providers would prefer the video over the telephone modality and that providers in the video interpretation group would use interpreter services more often than providers in the telephone interpretation group, resulting in fewer lapses of interpreter use. The net benefit of effective language interpretation would be demonstrated in parental comprehension and parental satisfaction with the visit.
The study was conducted in a single, large, pediatric ED, where in-person language interpreter services were usually available. However, when in-person services were not available, remote services (either by video or telephone) were used. The official policy of the institution was that one of these three approved interpretation modalities be used with any family with LEP. Each day during the study was randomly assigned to be either a video interpretation day or a telephone interpretation day.
A convenience sample of 249 LEP (Spanish-speaking) families was recruited from February through August 2014. Only families whose child had a non-life-threatening illness were eligible for enrollment. Providers were also able to eliminate families from consideration if they judged that an in-person interpretation was required. Very few families had private insurance. More than 80% of the parents were born in Mexico, and 20% spoke no English.
The primary outcome of interest was whether the parents could accurately identify their child's diagnosis, and this parental report was classified as correct, incorrect, or incomplete. The investigators evaluated both the quality of the conversation with interpreter services as well as parental reports of how often providers spoke to them in either English or Spanish without an interpreter.
Among parents assigned to video interpretation, 93% reported use of the assigned modality compared with only 79.1% of the parents in the phone interpretation assignment group. That means that providers were more likely to use the nonassigned modality for the families in the telephone interpretation group. The ability to properly name the child's diagnosis was greater among the parents in the video interpretation group at 74.6% compared with 59.8% in the parents enrolled in the telephone interpretation group. Overall lapses in interpretation use were not different between the two groups, nor did the groups differ on parental report of the quality of interpretation. The length of ED stay was not different, but charges for video interpretation were higher than those for telephone interpretation. The investigators concluded that video interpretation services led to better parental recollection of their child's diagnosis and fewer lapses of interpretation use.
In an accompanying editorial, the authors commented on the study's notable limitations (single institution, focus on medical outcomes rather than family outcomes), but I agree with them that the study is very eye-opening. I am particularly struck by the potential that might exist should additional studies demonstrate superiority of video interpretation. With increasing use of telemedicine for medical visits, more and more clinical areas, especially EDs, have telemedicine equipment. Harnessing these technologies to aid in interpretation services seems like a logical addition that may provide substantial medical benefit to children as well as improve parental satisfaction.