Department of Emergency Medicine, University of California, San Francisco, California.
San Francisco General Hospital, San Francisco, California.
West J Emerg Med. 2024 May;25(3):345-349. doi: 10.5811/westjem.18352.
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.
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.
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.
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.
英语能力有限的患者（LEP）在医疗保健方面存在显著差距。临床医生有责任在适当的时候使用并记录他们在患者就诊时使用的认证口译员。然而，在急诊室（ED）中，关于口译员使用记录的数据有限且可变。我们旨在评估在成人 ED 中实施点短语和 SmartPhrase 对记录口译员使用情况的影响。
我们进行了一项匿名调查，要求急诊临床医生自行报告口译员使用情况的记录。我们还回顾性地审查了 ED 图表中口译服务使用情况的记录，时间点为：1）干预前基线；2）实施临床医生驱动的点短语快捷方式后；3）实施 SmartPhrase 后。
大多数急诊临床医生报告说“几乎总是”或“经常”使用口译员。我们的手动审核显示，在基线时，口译员的使用情况在初始临床医生记录中有 35%，重新评估中有 4%，程序记录中则没有；52%的出院医嘱是用患者首选的语言书写的。在实施点短语和 SmartPhrase 后，口译员使用记录的比例分别提高到初始临床医生记录的 43%和 97%，重新评估的 9%和 6%，程序记录的 5%和 35%，患者首选语言书写的出院医嘱的比例为 62%和 64%。
报告的口译员使用率与口译员使用记录率之间存在差异。后者随着临床医生驱动的点短语的实施以及随后内置到记录中的 SmartPhrase 的实施而增加。确保对口译员使用情况的准确记录是实现 LEP 患者语言公平的一个有影响力的步骤。
