Gaps in Documenting Interpreter Service Utilization Among Emergency Department Clinicians Treating Patients With Limited English Proficiency

Patients with Limited English Proficiency (LEP) often face language barriers that can hinder understanding and their ability to fully participate in their own care. Federal law requires publicly funded health systems to provide meaningful interpreter access, but real-world use and documentation of these services remain inconsistent. The objective of this study was to assess documentation of interpreter service utilization among patients with LEP in the emergency department (ED).

A retrospective study was conducted of all ED encounters in a single healthcare system from 10/01/24-9/30/25. Eligible encounters included patients with a documented preferred language other than English. Exclusions consisted of individuals who left without being seen, were unresponsive, or had no encounter details. Two reviewers were trained with a pre-piloted extraction tool and codebook and independently evaluated 20 charts with 100% interrater reliability. They then reviewed charts independently for demographics, documentation of an interpreter, interpreter number, and reason for not using an interpreter by either the resident or attending physician. At this institution, there is a required interpreter used in the ED physician notes.. Data were reported descriptively.

At the time of analysis, 2400 total records were identified, with 1746 meeting inclusion criteria. 251 were excluded due to left without being seen or missing encounter details and 404 were excluded due to either being bilingual or with language not listed. The mean age was 62 years and 56.3% were female. The most common language was Spanish (n=1379; 79.0%), followed by Cantonese (n=148; 8.5%) and Mandarin (n=66; 3.8%). Of the total sample, 1004 (57.5%) had no interpreter use documented. Of those who documented using an interpreter, only 170 (22.9%) entered the interpreter identification number in the chart.

Interpreter services were documented infrequently. Details such as interpreter identification, patient preference, or refusal were often missing, indicating that language support is not reliably captured in the electronic health record. Poor documentation of interpreter use obscures how language support is delivered and may negatively impact continuity of care across encounters.