How are language barriers bridged in acute hospital care? The tale of two methods of data collection

OBJECTIVE: To explore language service provision in a pilot hospital study with two methods of data collection. METHODS: This mixed mode study design comprises a multilingual telephone survey followed by a medical records audit, undertaken at Liverpool Hospital in 2004-05. RESULTS: Two hundred and fifty-eight patients responded from 360 patients representing nine language groups. About a third of patients with limited English proficiency had used a professional interpreter in hospital. Concordance between the multilingual telephone survey and the medical records audit was apparent, although the telephone survey mostly showed non-significant, higher rates than the audit. While the methods showed high agreement (76%) for frequency of interpreter usage, kappa indicated only fair agreement (PABAK 0.40). Forty-eight percent of the patients preferred relatives as interpreters and 51% felt that their inability to speak English negatively affected their hospital stay. CONCLUSIONS: Professional interpreter usage is lower than desirable in the hospital, especially in the Emergency Department. Relatives frequently interpret. Under-reporting on the medical record is suggested, implying a need for improved documentation, while possible over-reporting in the telephone survey may relate to recall bias and social acquiescence.