As we talked with dozens of healthcare professionals about their workflow regarding non-English speaking patients, one big pillar emerged: the waiting time to deploy a professional medical interpreter.

Usually, there are two types use cases:

1. Prior scheduling - typically in outpatient settings where institutions have the patient's language preference. Administrators can order interpreters beforehand from the interpretation agency in place. The upside is that an interpreter is likely available for that encounter with reasonable waiting time. The downside is that many organizations don't have (or don't collect) patients' language preferences (there is no mandatory obligation to collect it), especially for first encounters with new patients . One study¹ indicated differences in accuracy of language preference data in the EHR in Canada.
   Another downside is that this workflow must be managed by the administrator. There's also the consideration of interpreter cancellation fees if the patient doesn't show up.
   
   
2. On-demand - in many cases, there's no prior knowledge of the patient's preferred language. This applies to unplanned encounters like ER visits but also to other scheduled encounters. Although public stats are lacking, we estimate that the vast majority (95% or higher) of utilization is on-demand. This relates to both remote interpreters and on-site interpreters who move from one patient to another as needed.

On-Demand Waiting Time

Assuming on-demand is the practical method, let's examine possible factors impacting waiting time:

1. Language Diversity: Less common languages may have fewer available interpreters, increasing wait times. Spanish would likely get a faster response time than Turkish, for example.
   
   
2. Time of Day: Nights and weekends often have reduced interpreter availability, leading to longer waits.
   
   
3. Workload: For in-house interpreters, the facility's overall patient load can impact availability. In one study² in busy surgical and procedural practice - it took a mean time of 19 minutes for the in-house interpreter to show up (with high variation, range extended out to 100 minutes). However - it can be argued that even a remote interpreting agency that serves multiple institutions in peak hours might suffer from overload in demand.
   
   
4. Technical Issues: For remote interpretation services, connectivity problems can cause unexpected delays.
   
   
5. Long Introductions, formalities and disclaimers: a bit out of scope but even when interpreter was deployed - there is still script to be followed by the interpreter - including introduction, niceties, disclaimers - many times in both languages.  

Remote Interpretation - Promises, Reality, and Perception

In practice, although different interpretation agencies commit to quite fast service times (some claiming less than a minute), our discussions with providers consistently highlighted access to interpreters as a top challenge. This suggests that either the practical wait time is longer than advertised, or that even waiting 30-40 seconds is perceived as a hassle in a provider's busy schedule.

The main driver to eliminate waiting time for medical interpreting would be health-oriented technology that's always ready on-demand to remove language barriers. 

Conclusion

Addressing the waiting time for medical interpreters is crucial for providing timely, quality care to non-English speaking patients. There's still room for improvement. Future solutions may lie in technological advancements. As healthcare continues to evolve, so too must our approaches to breaking down language barriers.

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References

1. 2020 Accuracy of the Preferred Language Field in the Electronic Health Records of Two Canadian Hospitals
2. 2017 - Assessment of the efficiency of language interpreter services in a busy surgical and procedural practice