Study objectives: Hispanic patients compose the largest minority population in the United States. The federal government mandates that health care providers be able to communicate with those patients who have limited English ability. The primary purpose of this study is to assess the English-language proficiency of self-declared English-speaking Hispanic patients in the emergency department (ED). The secondary purpose is to determine concordance between patients' tested English proficiency and perceived proficiency by nurses and physicians. We hypothesize that many patients who state that they are able to speak English do not in fact possess sufficient ability to communicate in English.

Methods: A convenience study was conducted in an urban Level I pediatrics and adult trauma center with 45,000 annual visits. Participants included adult patients and parents of pediatric patients, all of whom spoke Spanish as their first language. Patients were selected according to their Hispanic names. Research assistants administered the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Short Test of Functional Health Literacy in Adults (STOFHLA) to assess the English comprehension of patients who stated that they spoke English. Score of seventh grade or higher on the REALM and 23 or higher on the STOFHLA was considered a level of English competency. Data were entered into SPSS software and analyzed for correlations. This study was institutional review board approved.

Results: Three hundred fifty-four patients with Hispanic names were approached and asked whether they spoke English, Spanish, or both. One hundred five patients, all self-proclaimed English speakers, were enrolled in the study. Patients ranged from 18 to 89 years, with 37.1% (39/105) male patients and 62.9% (66/105) female patients. Forty-nine percent (49) of patients had completed only grade school; 66.3% (65 of 98) of self-proclaimed English speakers scored at or above a seventh-grade reading level on the REALM, and 72.0% (67 of 93) scored in the category of adequate or higher on the STOFHLA. There was a significant difference between patients' tested level of English competency and the physicians' and nurses' assessments of the patients' language competency (P=.002).

Conclusion: This study demonstrates that a significant number of patients who report English proficiency have an inadequate level of English comprehension. Furthermore, there is a discrepancy in the perceived English competency of the patients in the judgment of the physicians and nurses in the ED. This study demonstrates that emergency physicians and nurses are unable to judge a patient's language ability, and it suggests that a more liberal use of interpreters may be indicated.