Background: Patients with limited English proficiency (LEP) experience significant healthcare disparities. Clinicians are responsible for using and documenting their use of certified interpreters for patient encounters when appropriate. However, the data on interpreter use documentation in the emergency department (ED) is limited and variable. We sought to assess the effects of dot phrase and SmartPhrase implementation in an adult ED on the rates of documentation of interpreter use.
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Methods: We conducted an anonymous survey asking emergency clinicians to self-report documentation of interpreter use. We also retrospectively reviewed documentation of interpreter-services use in ED charts at three time points: 1) pre-intervention baseline; 2) post-implementation of a clinician-driven dot phrase shortcut; and 3) post-implementation of a SmartPhrase.
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Results: Most emergency clinicians reported using an interpreter “almost always” or “often.” Our manual audit revealed that at baseline, interpreter use was documented in 35% of the initial clinician note, 4% of reassessments, and 0% of procedure notes; 52% of discharge instructions were written in the patients’ preferred languages. After implementation of the dot phrase and SmartPhrase, respectively, rates of interpreter-use documentation improved to 43% and 97% of initial clinician notes, 9% and 6% of reassessments, and 5% and 35% of procedure notes, with 62% and 64% of discharge instructions written in the patients’ preferred languages.
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Conclusion: There was a discrepancy between reported rates of interpreter use and interpreter-use documentation rates. The latter increased with the implementation of a clinician-driven dot phrase and then a SmartPhrase built into the notes. Ensuring accurate documentation of interpreter use is an impactful step in language equity for LEP patients.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"interpreter use"},{"word":"Documentation"},{"word":"provider survey"},{"word":"dotphrase"},{"word":"smartphrase"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5j56r7tm","frozenauthors":[{"first_name":"Katrin","middle_name":"","last_name":"Jaradeh","name_suffix":"","institution":"Department of Emergency Medicine, University of California, San Francisco, California; San Francisco General Hospital, San Francisco, California","department":"None"},{"first_name":"Elaine","middle_name":"","last_name":"Hsiang","name_suffix":"","institution":"Department of Emergency Medicine, University of California, San Francisco, California; San Francisco General Hospital, San Francisco, California","department":"None"},{"first_name":"Malini","middle_name":"K.","last_name":"Singh","name_suffix":"","institution":"Department of Emergency Medicine, University of California, San Francisco, California; San Francisco General Hospital, San Francisco, California","department":"None"},{"first_name":"Christopher","middle_name":"R.","last_name":"Peabody","name_suffix":"","institution":"Department of Emergency Medicine, University of California, San Francisco, California; San Francisco General Hospital, San Francisco, California","department":"None"},{"first_name":"Steven","middle_name":"","last_name":"Straube","name_suffix":"","institution":"Department of Emergency Medicine, University of California, San Francisco, California; San Francisco General Hospital, San Francisco, California","department":"None"}],"date_submitted":"2023-06-06T09:56:54Z","date_accepted":"2023-06-06T09:56:54Z","date_published":"2024-04-02T13:00:00Z","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18352/galley/10318/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18352/galley/9582/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18352/galley/10318/download/"}]}