Emergency Department, Deaf, American Sign Language, Spanish speaking, limited English proficiency


Emergency Medicine | Health Services Research


Objectives: Non-English speaking patients frequently present to the emergency department (ED) for acute care and may present a challenge to efficient clinical ED management and disposition. This study aimed to assess differences in the disposition and clinical management of Spanish-speaking patients and Deaf American Sign Language (ASL) users, who worked with a certified, in-person interpreter, compared with English proficient patients who did not utilize interpreter services.

Methods: A retrospective study querying electronic medical records was performed at an academic medical center ED. Patients with a chief complaint of abdominal pain were chosen for this study, as this is a common chief complaint and these patients often require numerous tests. Variables obtained from the query included patient demographic information, number of tests and imaging studies ordered, and arrival and disposition times. Bivariate tests were used to assess differences in the management and disposition of patients who worked with an in-person, certified Spanish or ASL interpreter compared with those who did not utilize interpreter services.

Results: The study sample was comprised of 310 patients, 155 of whom utilized interpreter services and 155 controls who did not. Of those who utilized interpreter services, 69% were Spanish speaking and 31% Deaf ASL users. For patients who worked with an interpreter, compared with those who did not, the median door-to-ED disposition time was significantly longer (398 minutes vs. 322 minutes; p=0.0049). There were also more imaging studies ordered (p=0.0135) in the non-English speaking group. For English proficient patients, there was a higher rate of leaving before complete evaluation (2.6% vs. 0.0%) or against medical advice (3.2% vs. 0.0%) [p<0.0088].

Conclusions: In a sample of ED patients with a chief complaint of abdominal pain, there were statistically significant differences in the door-to-disposition time and number of imaging tests among those who were non-English speaking, utilizing in-person certified interpreter services, compared with those who were proficient in English. These results underscore the need for future research to further investigate the reasons for the differences in the evaluation and timely management of Deaf ASL users and Spanish-speaking ED patients.