Interpreter access barriers push clinicians toward ad hoc workarounds and truncated communication

Narrative synthesis #

Across settings the dominant mechanism is the same: because a professional interpreter (or translated document) takes time the clinician does not perceive they have, providers and ad hoc interpreters cut corners. Postpartum clinicians facing a 17-minute median wait (up to 75 minutes) explicitly chose to "get by" with broken Spanish, gestures, and phone apps rather than wait (Jennifer 2023EvidenceE-0082Initial AI draftLong unpredictable interpreter wait times led clinicians to get by with hand gestures broken Spanish and phone appsIn semistructured interviews, postpartum clinicians described long and unpredictable interpreter wait times — driven by interpreter understaffing — as the primary barrier to interpreter use, which in a time-pressured, ef…); psychiatric consultations under time pressure truncated patients' narratives (Kilian 2021EvidenceE-0088Initial AI draftTime constraints led ad hoc interpreters to pressure psychiatric patients into short answers, cutting off their narrativesIn a public psychiatric hospital where bilingual nurses, social workers, and cleaners served as ad hoc interpreters, the time pressure of a busy hospital setting led both clinicians and interpreters to truncate patients'…); discharge translation's hours-to-days turnaround clashed with last-minute discharge so patients went home without concordant written instructions (Davis 2019EvidenceE-0055Initial AI draftOperational complexity from mismatched discharge and translation time frames was the most cited barrier to translating discharge instructions  The most commonly cited barrier to providing translated inpatient discharge instructions was "operatio…). The burden also concentrates on the few bilingual staff who are assigned the discordant patients (L 2023EvidenceE-0036Initial AI draftConcentrating Spanish-speaking patient assignments on dual-role nurses added time-consuming interpreting burden and frustrationBecause the participants were bilingual and certified to interpret on their units, hospital administration purposefully assigned Spanish-speaking patients to them, and nurses described the resulting frustration and time…), and is felt most acutely on inpatient units that cannot pre-book interpreters (Marshall 2016EvidenceE-0098Initial AI draftStaff satisfaction with interpreter timeliness was lower in inpatient settings than in clinics and the ED  A baseline (January 2012) staff language-satisfaction survey (N=351) found that satisfaction wit…) — leaving even patients who requested interpreters covered on both admission and discharge only 39% of the time (Lindholm 2012EvidenceE-0040Initial AI draftOnly 39% of LEP inpatients received professional interpretation on both admission and discharge while 13.8% received none on either day Despite all study patients having requested an interpreter and all having at least one interpreter encounter during their stay, professional interpretation wa…). The SeibleEvidenceE-0115Initial AI draftInitial consultation length did not differ between direct-Spanish and interpreter-services arms (37 vs 33 min)The duration of the initial consultation did not differ significantly between the two communication modalities: interpreter-services consultations averaged 33 minutes versus 37 minutes for direct-Spanish consultations (P… RCT contradicts the strong form: an interpreter-mediated oncology consult was no longer than a direct-Spanish one (33 vs 37 min, P=.33), suggesting that once an interpreter is present the encounter itself need not cost more — the cost is in access/wait, not in conducting the visit.

"Many clinicians cited workflow barriers and stress as the reason for 'getting by' in 'Spanglish and with hand gestures.'" (Jensen, 2023, p. 432)