Clinicians triaged encounters as noncritical and withheld interpreters reserving them for consents

Description #

A recurring interview theme was that clinicians informally triaged encounters into "critical" versus "noncritical," reserving interpreter use for events such as obtaining consent and not calling interpreters for encounters they judged routine — a discretionary rationing that the authors identify as a driver of the observed underuse. One maternal–fetal medicine physician reflected that the team had "triaged what's considered critical and what's not," even though the ideal is an interpreter present "the entire time."

"Participants described low usage of interpreters for 'noncritical' encounters." (Jensen, 2023, p. 430)

"And so I don't think that, like, our providers don't use interpreters in, like, the critical moments when they should, but I also think that we have kind of triaged what's considered critical and what's not. But I think for—the best case scenario is that, you know, a patient would have an interpreter with them the entire time they need it, the entire time they're there—for any dialogue with anybody. (H013)" (Jensen, 2023, p. 435)

"clinicians not certified in Spanish language competency did not use interpretation services if they deemed the encounter to be not 'critical' enough to require them." (Jensen, 2023, p. 436)

Methods Context #

What? #ⓘ

The observable: clinicians' self-described decision rule for when to summon an interpreter — a qualitative account of how perceived encounter "criticality" gates concordant-care use.

"Participants described low usage of interpreters for 'noncritical' encounters." (Jensen, 2023, p. 430)

How? #ⓘ

Semistructured telephone interviews coded inductively by three authors and synthesized into themes by discussion to axial saturation, consistent with Standards for Reporting Qualitative Research.

"To reach axial saturation, an additional interview with an inpatient health care team member was conducted (HN001)." (Jensen, 2023, p. 434)

Who? #ⓘ

14 inpatient postpartum-unit clinicians who requested interpreter services (RNs, certified nurse-midwives, NPs, an MFM physician, a pediatrician, an IBCLC, a health unit coordinator), interviewed June–Dec 2020 at a tertiary academic medical center in the southeastern United States.

"The sample size of health care team members included in this study is 14, because the roles for this analysis were limited to clinicians who practiced on the postpartum unit and requested interpreter services for patient care." (Jensen, 2023, p. 433)

Other Notes #

This "criticality triage" is the clinician-side complement to the wait-time mechanism: even where access existed, discretionary judgment about which encounters "deserved" an interpreter suppressed routine concordant communication.

Caveats #

• Single-site small sample limited to Spanish-speaking postpartum patients limits generalizability The study drew small samples (50 couplets in the chart review; 14 clinicians interviewed) from a single tertiary academic medical center and restricted attention to Spanish-speaking patients. These descriptive proportions and themes therefore characterize one unit's local practice and may not generalize to other sites, other languages, or other care settings.