Evaluation of Patient Access to Spanish-Language-Concordant Care on a Postpartum Unit

Abstract

Objective: To evaluate patient access to Spanish-language-concordant care on a postpartum unit and to identify facilitators and barriers to the use of interpretation services.

Design: Mixed-methods research study, comprising a cross-sectional chart review from September to December 2019 and semistructured interviews from June to December 2020.

Setting/local problem: A tertiary academic medical center in the southeastern United States where individuals with limited English proficiency are at risk for poor health outcomes when they are unable to communicate with clinicians in their preferred language.

Participants: We conducted a chart review of 50 randomly selected birthing parent-newborn couplets and interviews with 14 inpatient health care team members.

Measurements: The chart review examined patient characteristics, health care team composition including Spanish language proficiency, length of stay, number of interpreter requests, and time between clinician interpreter requests and interpreter arrival on the unit. Interviews evaluated facilitators and barriers to interpreter use.

Results: Access to a clinician certified in medical Spanish or an interpreter was offered to 12 of 50 (24%) couplets upon admission to the unit and to 7 of 50 (14%) of couplets for daily maternal and newborn medical rounds. Clinicians reported long and unpredictable wait times to access interpreters, which led them to rely on hand gestures, broken Spanish, and smartphone apps to "get by" when communicating with patients without certified interpretation services. Participants described low usage of interpreters for "noncritical" encounters.

Conclusion: Interpreters and other forms of Spanish-language-concordant care were underused on the postpartum unit. This deviation from national standards may put families at risk for harm. Recommendations from this study include advancing a culture of respectful care, improving the interpreter request workflow, addressing safe staffing, facilitating direct patient access to interpreters, and providing ongoing evaluation and support.

Keywords: Spanish; accountability; communication; health equity; interpreter; language concordance; patient rights; postpartum; system of care.