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Three Part Question

[In foreign language patients attending the Emergency Department] is [videoconference medical interpretation better than telephone translation] at [increasing patient satisfaction, decreasing admission rates, increasing diagnostic accuracy, and is this acceptable to patients and health workers]?

Clinical Scenario

You are asked to see a patient in the ED who is not fluent in English and requires an interpreter. You find that the telephone translation service is a bit difficult and you wonder if video conferencing or translation services using novel technologies may lead to better outcomes than the telephone service.

Search Strategy

EMBASE 1974-20 June 2016 via OVID.
MEDLINE 1946- 20 June 2016 via OVID.
CINAHL via EBSCO 1981 - current
Cochrane library (all years)

Search strategy for MEDLINE amended for other data bases:

[{(foreign adj language*) or (language adj discordant) or (limited adj English adj proficient) or (non-english adj speak*) or (non-english adj language) or (non-english) or (foreign adj speak*)}.ti,ab. AND {(exp Translating or exp telecommunications/ or exp videoconferencing/ or exp telemedicine/)} OR {((remote adj simultaneous adj medical adj interpret*) or video* or audio-visual* or (interpreter adj service*) or interpret* or (translation adj service*) or translat* or (medical adj interpret*) or language interpret* or (foreign adj language adj translat*) or (video-interpret*) or (remote adj interpret*))}.ti,ab] Limit (English language and humans)

Search Outcome

The initial database searches identified 1926 unique records. After an initial title and abstract screen, the full texts of 11 records were read. Of these, 9 did not meet the inclusion criteria. 2 records of relevance were identified but both of these were conference abstracts and both report results from the same study.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Stevens L.A et al. 2011 USA	Limited English proficient Spanish-speaking patients attending the ED.	Prospective cohort. CONFERENCE ABSTRACT.	Patient satisfaction	No significant difference in satisfaction between in-person vs. live-feed video interpretation.	Conference abstract only. Small sample size.
Vasquez, J. et al., 2011 USA	Registered nurses and medical doctors treating limited English-speaking patients in the ED.	Pre-post training survey. CONFERENCE ABSTRACT.	Staff attitudes	Both pre- and post- training the majority of staff preferred in-person interpreters over video or telephone interpreting.	Conference abstract only.
			Staff satisfaction	Staff satisfaction with live-feed video interpreting significantly increased after standardized training. Post- training majority of staff preferred live feed video to telephone interpreting.

Comment(s)

The findings of these relevant conference abstracts suggest that video-interpreting provides a satisfactory service to both staff and patients. Neither of these papers looked at clinical outcomes such as: diagnostic accuracy or admission rates. Three papers, although not relevant to this review question, report on studies that explored the use of videoconferencing interpretation for non-English speaking patients in primary healthcare settings [3,4,5]. The results from these suggest that video-conferencing interpretation is acceptable to patients and staff and provides a cost-effective service. These findings suggest that further research is needed, among different healthcare professionals and patients, and in other clinical settings, including the ED.

Clinical Bottom Line

There is insufficient evidence to determine whether real-time video interpreting improves patient experience and clinical outcomes in the ED. Further research is needed looking at video interpreting in the emergency department setting that includes, as outcome measures: patient satisfaction, admission rates, diagnostic accuracy, and acceptability to patients and healthcare workers.

References

1. Stevens, L.A., Mitchell, P.M., Vasquez, J., Lopes, G.M., Gutierrez, A. and McGrath, M.E. Spanish-speaking patient satisfaction with interpreter services in the emergency department: Comparison of in-person versus live-feed video interpretation Annals of Emergency Medicine 2011; S308
2. Vasquez, J., Lopez, G.M., Mitchell, P.M., Rahimi, L.M., Wilcox, A.R., Rubin-Smith, J.E., Gutierrez, A., Stevens, L.A., Mcgrath, M.E. Emergency department staff attitudes and satisfaction with live-feed video interpreting for limited English proficient patients: Pre- and post-training Annals of Emergency Medicine S308-309
3. Wofford. J.L., Campos, C.L., Johnson, D.A., Brown, M.T. Providing a Spanish interpreter using low-cost videoconferencing in a community health centre: a pilot study using tablet computers Informatics in Primary Care 2012; 20 (2) pg 141-6
4. Jones, D., Gill, P., Harrison, R., Meakin, R., Wallace, P An exploratory study of language interpretation services provided by videoconferencing Journal of telemedicine and telecare 2003; 9(1) pg 51-56
5. Locatis, C., Williamson, D., Gould-Kabler, C., Zone-Smith, L., Detzler, I., Roberson, J., Maisiak R., and Ackerman, M Comparing in-person, video, and telephonic medical interpretation Journal of General Internal Medicine 2010; 25, 345-350.