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Original Investigation |

Effect of Telephone vs Video Interpretation on Parent Comprehension, Communication, and Utilization in the Pediatric Emergency Department A Randomized Clinical Trial

K. Casey Lion, MD, MPH1,2; Julie C. Brown, MDCM, MPH1,3; Beth E. Ebel, MD, MSc, MPH1,2,4,5; Eileen J. Klein, MD, MPH1,3; Bonnie Strelitz, MPH3; Colleen Kays Gutman, MD1; Patty Hencz, RN5; Juan Fernandez, BA5; Rita Mangione-Smith, MD, MPH1,2
[+] Author Affiliations
1Department of Pediatrics, University of Washington, Seattle
2Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
3Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
4Harborview Injury Prevention and Research Center, University of Washington, Seattle
5Center for Diversity and Health Equity, Seattle Children’s Hospital, Seattle, Washington
JAMA Pediatr. 2015;169(12):1117-1125. doi:10.1001/jamapediatrics.2015.2630.
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Importance  Consistent professional interpretation improves communication with patients who have limited English proficiency. Remote modalities (telephone and video) have the potential for wide dissemination.

Objective  To test the effect of telephone vs video interpretation on communication during pediatric emergency care.

Design, Setting, and Participants  Randomized trial of telephone vs video interpretation at a free-standing, university-affiliated pediatric emergency department (ED). A convenience sample of 290 Spanish-speaking parents of pediatric ED patients with limited English proficiency were approached from February 24 through August 16, 2014, of whom 249 (85.9%) enrolled; of these, 208 (83.5%) completed the follow-up survey (91 parents in the telephone arm and 117 in the video arm). Groups did not differ significantly by consent or survey completion rate, ED factors (eg, ED crowding), child factors (eg, triage level, medical complexity), or parent factors (eg, birth country, income). Investigators were blinded to the interpretation modality during outcome ascertainment. Intention-to-treat data were analyzed August 25 to October 20, 2014.

Interventions  Telephone or video interpretation for the ED visit, randomized by day.

Main Outcomes and Measures  Parents were surveyed 1 to 7 days after the ED visit to assess communication and interpretation quality, frequency of lapses in interpreter use, and ability to name the child’s diagnosis. Two blinded reviewers compared parent-reported and medical record–abstracted diagnoses and classified parent-reported diagnoses as correct, incorrect, or vague.

Results  Among 208 parents who completed the survey, those in the video arm were more likely to name the child’s diagnosis correctly than those in the telephone arm (85 of 114 [74.6%] vs 52 of 87 [59.8%]; P = .03) and less likely to report frequent lapses in interpreter use (2 of 117 [1.7%] vs 7 of 91 [7.7%]; P = .04). No differences were found between the video and telephone arms in parent-reported quality of communication (101 of 116 [87.1%] vs 74 of 89 [83.1%]; P = .43) or interpretation (58 of 116 [50.0%] vs 42 of 89 [47.2%]; P = .69). Video interpretation was more costly (per-patient mean [SD] cost, $61 [$36] vs $31 [$20]; P < .001). Parent-reported adherence to the assigned modality was higher for the video arm (106 of 114 [93.0%] vs 68 of 86 [79.1%]; P = .004).

Conclusions and Relevance  Families with limited English proficiency who received video interpretation were more likely to correctly name the child’s diagnosis and had fewer lapses in interpreter use. Use of video interpretation shows promise for improving communication and patient care in this population.

Trial Registration  clinicaltrials.gov Identifier: NCT01986179

Figures in this Article

Figures

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Figure 1.
CONSORT Diagram of Study Enrollment and Retention

ED indicates emergency department.

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Figure 2.
Parent-Reported Frequency of Communication Methods by Study Arm

Only responses of frequently or always are shown for the assigned remote modality; all other modalities show responses of frequently or always and sometimes. Opposite remote modality indicates the use of telephone interpretation for families in the video arm and the use of video interpretation for families in the telephone arm.

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