Background: Of the 61.6 million immigrants identified on the 2013 U.S. Census, 41% are considered Limited English Proficient (LEP). Despite legal mandates defining appropriate interpreter services, LEP patients report a high degree of miscommunication during their medical encounters. There is a large body of literature describing the health harms that result, including incorrect diagnoses, over-testing, and medication errors. The objective of this study was to assess ED patient knowledge of language access laws in a setting where most patients have limited English proficiency.

Methods: Study Design: Anonymous survey. Setting: A public emergency department. Subjects: A convenience sample of English and Non-English speaking patients being discharged from the ED. Measures and Outcomes: Age, ethnicity, language preferences, frequency and type of interpreter use. Patients were also asked about their knowledge of language laws and perceived barriers to using interpreter services. Analysis: Descriptive statistics.

Results: Of the 206 individuals approached, 198 agreed to participate (96.1% response rate), with 50.5% (100/198) of interviews in English and 46.5% (92/198) in Spanish. Mean age was 46.8 years. 47% (93/198) of patients were of Mexican origin, 20.2% (40/198) were Central American, and 17.2% (34/198) were Not Hispanic/Latino. 58.1% (115/198) patients were characterized as LEP, meaning they spoke English less than “very well” on a 4 point Likert Scale. 99.1% (114/115) of these patients reported Spanish as their preferred language. At ED triage, only 24.3% (28/115) of LEP patients were asked if they would like an interpreter. Of those reporting not being offered an interpreter, 90.1% (82/91) asked for one. 69.6% (80/115) of LEP patients knew the legal right to a language interpreter, and 17.4% (20/115) were informed of the law at triage. 51.3% (59/115) of LEP patients knew that language interpretation is free. Of the 121 patients who completed Spanish-language surveys, 62.8% (76/121) received language interpretation at triage, 70.3% (85/121) from nurses, and 70.3% (85/121) from the medical provider.

Conclusion: A high percentage of LEP patients report significant gaps in knowledge of language access laws, and in disclosure of these laws during visits to the Emergency Department. Future language access policies must be guided to better serve LEP individuals.