Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization.

OBJECTIVE: To determine the impact of interpreters and bilingual physicians on emergency department (ED) resource utilization. DESIGN: Cohorts defined by language concordance and interpreter use were prospectively studied preceding and following the availability of dedicated, professional medical interpreters. SETTING: Pediatric ED in Chicago, Ill. PARTICIPANTS: We examined 4146 visits of children (aged 2 months to 10 years) with a presenting temperature of 38. 5 degrees C or higher or a complaint of vomiting or diarrhea; 550 families did not speak English. In 170 cases, the treating physician was bilingual. In 239, a professional interpreter was used. In the remaining 141, a professional medical interpreter was unavailable. MAIN OUTCOME MEASURES: Incidence and costs of diagnostic testing, admission rate, use of intravenous hydration, and length of ED visit. RESULTS: Regression models incorporated clinical and demographic factors. Compared with the English-speaking cohort, non-English-speaking cases with bilingual physicians had similar rates of resource utilization. Cases with an interpreter showed no difference in test costs, were least likely to be tested (odds ratio OR, 0. 73; 95% confidence interval CI, 0. 56-0. 97), more likely to be admitted (OR, 1. 7; 95% CI, 1. 1-2. 8), and no more likely to receive intravenous fluids, but had longer lengths of visit (+16 minutes; 95% CI, 6. 2-26 minutes). The barrier cohort without a professional interpreter had a higher incidence (OR, 1. 5; 95% CI, 1. 04-2. 2) and cost (+5. 78; 95% CI, 0. 24-11. 21) for testing and was most likely to be admitted (OR, 2. 6; 95% CI, 1. 4-4. 5) and to receive intravenous hydration (OR, 2. 2; 95% CI, 1. 2-4. 3), but showed no difference in length of visit. CONCLUSION: Decision making was most cautious and expensive when non-English-speaking cases were treated in the absence of a bilingual physician or professional interpreter.