Evaluating a Triage Screen in a Pediatric Emergency Department to Improve Appropriate Identification of Immigrant Populations.

Abstract

Objectives: One in 4 children in the United States is part of an immigrant family. Children in immigrant families (CIFs) experience significant disparities in health care quality and access in the pediatric emergency department (PED). Insufficient utilization of interpreters for those with non-English language preference contributes to these disparities. CIFs are often excluded from clinical research studies, impairing efforts to improve their health care access. We evaluated an immigration and language triage screen in a PED to better identify CIF.

Methods: We conducted a cross-sectional analysis of attitudes toward a triage screen identifying country of origin and language preference. Caregivers who entered the assessment/triage room of an urban PED were asked about the caregiver's and child's country of birth, year of arrival to the US, and preferred language. Patients who were born outside the United States or had a caregiver born outside the United States were identified as CIF. Caregivers of CIF were asked to participate in a survey to understand their attitudes toward the screen. Demographics and attitudes toward the triage screen were then analyzed using basic descriptive statistics.

Results: CIF were identified in 252 or 21.9% of screened encounters. In 51.2% (n=129) of these encounters, caregivers completed a survey. Ninety-two percent of surveyed families were comfortable with the triage screen. In contrast, almost one third of families endorsed that they would have felt uncomfortable had they been asked their immigration status directly. Eighteen percent of families who needed an interpreter did not have this need identified until after the triage screen.

Conclusions: Our findings suggest that a language and immigration triage screen in a PED is feasible and acceptable to improve the identification of CIF and their language needs in electronic medical records with the goal of improving the quality of health care and research for this population.