Background: The COVID-19 pandemic has affected every aspect of the healthcare system and has led to various restrictions including strict visitation policies, limited patient interactions with healthcare workers to mitigate exposure risk, and donning/doffing personal protective equipment (PPE) before each interaction. These interactions have disproportionately affected patients with limited English proficiency (LEP) in Austin, Texas. In the initial four months of the pandemic (March -June 2020), patients confirmed with COVID-19 at Dell Seton Medical Center (DSMC) were mostly Latinx (78%), Spanish-speaking (57%), and identified as a patient that was unfunded, publicly funded, and/or with high social need (Sanchez et al. 2021). Resources and outcomes for LEP patients are already worse at baseline in the United States when compared with fluent English speakers (Premji et al. 2010), and the relationships between those outcomes and availability of LEP interpretation services have been previously been explored. Yet, the value of interpretation services as perceived by healthcare workers merits further investigation, especially during the time period of the COVID-19 pandemic.
Methods: A survey was developed to gather perspectives, testimonies, and qualitative assessment of the impact of interpretation services on treating LEP patients during the pandemic using a combination of Likert-scale and open-ended questions. A total of 107 health care professionals responded to the survey between August and October 2021 at DSMC in Austin, Texas (though responses are ongoing).The majority of respondents were physicians (50.4%) and the largest specialties represented were internal medicine, hospital medicine, and medical subspecialties (36.4%).
Results: Most respondents utilized phone and/or iPad interpretation, with iPad being the preferred method (34.9%). Most respondents reported using interpretation services for LEP patients for 50% of interactions or more (82.1%). However, 71% of providers who assessed themselves as not being fluent in Spanish reported patient encounters without interpretation services. Reasons for interpretation failures included lack of in-person interpreters, availability of family members, PPE as a barrier, and patients being too sick to effectively engage in communication. Despite these barriers, 80.3% of respondents felt that LEP patients received appropriate, safe, and timely care.
Conclusions: Preliminary data from this study suggest that healthcare providers value the use of interpretation services in caring for LEP patients with COVID-19. Despite the majority of respondents having used electronic interpretation services, the perception of safe and appropriate care was prevalent. Future analyses will further explore the dissociation between the perceived value and the real use of interpretation services in treating LEP patients with COVID-19.