Imagine that English is not your primary language. In your day-to-day life, words are often replaced by gestures and facial expressions, like a game of Charades. Now, imagine yourself wheeled through the doors of the Emergency Department (ED). Beeping everywhere, so many wires being attached to you, so many people. Lots of gesturing and pointing to body parts. You begin to cough and suddenly... the people around you look up at each other, fix their masks, and close the door behind them.

The U.S. Department of Health and Human Services (HHS) refers to this language barrier in healthcare as Limited English Proficiency (LEP). Specifically, if English is not your primary language and you rate your English-speaking ability as “less than very well” (1). At Massachusetts General Hospital (MGH), admission rates showed that over a 2-week period during the Covid-19 surge, total Covid-19 census rose sevenfold, however, the LEP Spanish-speaking census increased nearly 20 times, constituting over 40% of all Covid-19 patients (2).

LEP patients face a number of healthcare inequities, including reduced healthcare access and utilization, patient-physician trust, and patient satisfaction (3,4). Furthermore, there are serious consequences for patient outcomes including longer duration of hospital stay with greater risk of line infections, falls, and pressure ulcers during hospitalization (5).

Consider that nearly three in four Hispanics speak a language other than English at home and one in three report not being fluent in English (6). Now, recall what we know about LEP patients and the associated poorer health outcomes.

Taken together, perhaps it is not all too surprising that similar to findings from MGH, Gil et al. (2021) found that although Hispanics comprise 18% of the U.S. population, this group accounted for nearly 30% of cumulative U.S. Covid-19 cases (7). In New York City, an individual from the Hispanic/Latinx community had a greater rate of hospitalization and was in fact, two times more likely to die from Covid-19 compared to a non-Hispanic/Latinx individual of the same age.

Lack of language access is just one part of a larger, multifactorial problem in addressing health equity. However, during the Covid-19 pandemic, clear, effective communication about testing, treatment, and prevention including vaccination, is especially critical. Furthermore, ED providers are having to more often than before, initiate conversations about life sustaining treatments, goals of care, and code status such that language barriers have become a life-or-death concern in the ED. In addressing disparities in quality of care and patient safety during the pandemic, individual and systemic awareness and efforts focused on language access are imperative.

When a patient comes through your ED doors, how often do you ask about their preferred language and/or offer an interpreter? Begin to assess the availability and accessibility of your institution’s interpreter services. Talk to your colleagues about using these services, rather than using family members or friends, or trying to “get by” with one’s own language skills.

Communication during time of discharge for patients with Covid-19 is particularly important. Clear instructions about quarantining, return precautions, and self-care, can potentially limit ED recidivism (5). Khoong et al. (2019) examined the use of Google Translate for Spanish and Chinese translations of ED discharge instructions. Findings showed that Google Translate can be a useful supplement to written English instructions, particularly when complicated grammar, medical jargon, and colloquial language are avoided (8).

Additionally, using a “teach-back” technique can be effective in assessing patient understanding of discharge instructions. This verbalization serves as a checkpoint for providers who may assume that nonverbal cues such as nodding and smiling, equates to an understanding of information.

Remember back to the clinical scenario above. What emotions arose? Could you trust the people around you? What information about yourself and your symptoms might the medical team have missed? Providers must be proactive and remain curious about finding creative solutions for addressing communication barriers in the ED. The Covid-19 pandemic reminds us that as ED providers, safe and compassionate care begins with connecting with our patients. At the core of this connection is our ability to communicate and have a dialogue with our patient.