Using Cognitive Work Analysis to Understand and Improve Communication Between Limited English Proficient Patients and Emergency Department Care Providers
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Nearly 9% of the United States population is not proficient in the English language. Patients with limited English proficiency face significant healthcare disparities related to the quality, safety, and satisfaction with the healthcare they receive. While these disparities have been well-documented over the past 30 years, little progress has been made to improve these inequities. A key gap is lack of knowledge surrounding strategies different care providers and interpreters use to communicate with patients. This work utilizes cognitive work analysis as a framework to understand key communicative tasks and strategies utilized in communication with patients in the emergency department. The structure of tasks and strategies developed is then utilized to discuss how communication with limited English proficient patients in the emergency department may be improved.This work involved three phases of data collection including: initial modeling of the work domain, observations of patients in the emergency department, and member checking interviews with key stakeholder. Sixteen Spanish and English-speaking patients were observed throughout their stay in the emergency department to identify the communicative tasks, strategies, and aids utilized as well as contextual factors that may impact communication. The results of these observations were then vetted and updated through member-checking interviews with key stakeholders.Key themes from the data collected include: complexity of interpreter service use throughout the entire patient stay, the ability of professional interpreters to anticipate and mitigate communication issues, professional interpreters serving as a navigator for the patient, issues associated with using phone-based interpreter services, and difficulties encountered when communicating with the patients without use of an interpreter. These findings can be utilized to improve training for key stakeholders and delivery of further solutions. Further, the conclusions of this work suggest new tools, outside of the realm of human interpreters may be advantageous in improving communication with LEP patients.