The design and pilot of a translation aid to help ED clinicians enhance communication with the Portuguese-speaking patient

BACKGROUND Language barriers hinder health care delivery in settings with culturally diverse populations. Interventions to accommodate non-English-speaking patients have been shown to shorten length of stay and reduce non-urgent visits. AIMS Our aim was to design and do a pilot study on an instrument to facilitate history taking with Portuguese-speaking patients in the emergency department (ED). METHODS An instrument was designed to facilitate history taking with Portuguese-speaking patients (PSPs). A pocket-sized document incorporated, bilingual, problem-oriented, closed-ended questions for common ED presentations as well as numbers, measurements of time, and anatomy. A paired audio tutorial on a compact disk (CD) demonstrated correct pronunciation of each phrase. A 3-month pilot was undertaken in a downtown teaching hospital on a convenience sample of PSPs who indicated the need for a translator at triage. A trained Portuguese-speaking observer monitored clinician/patient pairs using the instrument and scored differential patient comprehension in a standardized manner. Qualitative patient and clinician impressions were assessed. A follow-up survey assessed emergency physician (EP) impressions of the instrument. RESULTS Eight of nine eligible clinician/patient pairs were enrolled. The average proportions of questions answered appropriately in English and then using the instrument were 16.7% and 85.5%, respectively, with mean improvement of 68.8% (confidence interval: 45.6-92.1). Most (7/8) patients agreed that the instrument had helped in communication. Half (4/8) of the clinicians indicated that the tool had helped them communicate, and most (7/8) indicated that they would use the instrument in the future. Few (2/17) physicians utilized the audio guide. Suggested modifications included incorporation of phonetics. CONCLUSIONS The pilot of the instrument was well received by patients and resulted in improved communication.