TOPLINE:

Patients with limited English proficiency (LEP) who required interpreters had 27% longer wait times for providers in the emergency department (ED) to initiate care than those without interpreter needs, with significantly higher weighted median times to physician self-assignment, according to a new study.

METHODOLOGY:

• Researchers conducted a retrospective analysis using electronic medical record data from two affiliated EDs in a single metropolitan area with similar triage processes and included 47,038 adult encounters (median age, 52 years; 57.9% women; 56% White individuals) between May and October 2024.
• On arrival, patients were triaged, assigned an Emergency Severity Index score, and roomed based on acuity or wait time, after which they were evaluated by self-assigning providers; interpreter services were mainly accessed via phone.
• The primary outcome was time to provider self-assignment (TTPS). A secondary exploratory variable, "perceived interpreter need," was assessed by presenting five blinded emergency providers with patient information (name, age, and sex) from a random sample of 500 patients and asking them to predict whether each patient needed an interpreter.

TAKEAWAY:

• Patients who required an interpreter had longer weighted median TTPS than those who did not (7.4 vs 5.8 minutes; weighted difference, approximately 1.6 minutes), representing a 27% increase relative to patients without interpreter needs.
• When stratified by race, the delay in TTPS was observed for patients requiring an interpreter across all groups, but it was statistically significant only for White individuals (patients requiring an interpreter waited 4.5 minutes longer than those not requiring an interpreter) and Black individuals (patients requiring an interpreter waited 2.18 minutes longer than those not requiring an interpreter).
• Providers correctly identified patients not needing interpreters 99.5% of the time but correctly identified patients needing an interpreter only 68% of the time. For 31.9% of the patients that providers perceived as needing an interpreter, the perception was inaccurate, and an interpreter was not required.

IN PRACTICE:

"This retrospective analysis of the time it took for providers to sign up for patients after they were roomed in the emergency department reveals that patients who require interpreters experienced a modest, but statistically significant, delay," the authors wrote.

"This delay may reveal a subtle implicit bias rooted in the many barriers emergency providers experience in obtaining adequate interpreter services. Further study is required to determine the downstream effect of this delay and how to best address it in our health systems," they added.

SOURCE:

The study was led by Caleb Hernes, Sanford School of Medicine, Sioux Falls, South Dakota. It was published online on March 08, 2026, in The American Journal of Emergency Medicine.

LIMITATIONS:

The study included two urban hospitals within a single metropolitan area, possibly limiting generalizability due to similar patient demographics. The retrospective design introduced potential biases related to missing and erroneous data. The relatively low prevalence of LEP compared with previously reported rates may have affected provider familiarity with interpreter services and affected TTPS. The analysis did not account for specific languages spoken, which may have affected interpreter availability and provider behavior. Provider-level factors, including individual biases and language proficiency, were not captured. Additionally, TTPS may not have fully reflected actual delays in care, as providers may have reviewed charts before or after assignment, and the measure did not account for time required to access interpreter services. Residual confounding may also have affected the results.

DISCLOSURES:

The study did not receive any funding. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.