Professional language interpretation and inpatient length of stay and readmission rates

Abstract

Background: The population of persons seeking medical care is linguistically diverse in the United States. Language barriers can adversely affect a patient's ability to explain their symptoms. Among hospitalized patients, these barriers may lead to higher readmission rates and longer hospitalizations. Trained interpreters help overcome communication barriers; however, interpreter usage among patients is suboptimal.

Objective: To investigate differences among patients with limited English proficiency (LEP) in their length of stay (LOS) and 30-day readmission rate associated with their receiving professional interpretation at admission or discharge.

Design: We analyzed the rates of interpretation at admission and discharge of all LEP patients admitted to a tertiary care hospital over a three-year period. We calculated length of stay in days and as log of LOS. We also examined 30-day readmission. Using multivariable regression models, we explored differences among patients who received interpretation at admission, discharge, or both, controlling for patient characteristics, including age, illness severity, language, and gender.

Participants: All LEP patients admitted between May 1, 2004 and April 30, 2007.

Main measures: Length of hospital stay as related to use of professional interpreters; readmission to the hospital within 30 days.

Key results: Of the 3071 patients included in the study, 39 % received language interpretation on both admission and discharge date. Patients who did not receive professional interpretation at admission or both admission/discharge had an increase in their LOS of between 0.75 and 1.47 days, compared to patients who had an interpreter on both day of admission and discharge (P<0.02). Patients receiving interpretation at admission and/or discharge were less likely than patients receiving no interpretation to be readmitted with 30 days.

Conclusions: The length of a hospital stay for LEP patients was significantly longer when professional interpreters were not used at admission or both admission/discharge.

Figure 1.

Adjusted length of hospital stay among patients who requested interpreter services and presence of interpreter on day of admission or discharge from hospital. Source: Adjusted means from mixed model regression with patient characteristics (age, illness severity, gender, major diagnosis, and language) and a random effect for patient, assuming a mean age of 60 and a mean severity weight of 1.05.