The use of interpreters to improve the quality and safety of healthcare through better communication in obstetrical patients: Effect on primary cesarean delivery rate

Stephen A. Pearlman, MD, Jefferson School of Population Health

Advisor: Dr. Pelegano, Jefferson School of Population Health.


Patients with limited English proficiency have poorer healthcare outcomes. An assessment of the cultural and linguistic competency of Christiana Care Health Systems revealed that our language services were not sufficiently robust and this was affecting care. Therefore, the purpose of this quality improvement study was to improve healthcare outcomes, specifically the rate of primary cesarean delivery, through improved language assistance, to patients with limited English proficiency presenting to labor and delivery. The methods employed included use of the TeamSTEPPS program to educate the staff on how to improve safety for patients with limited English proficiency, adding a live Spanish interpreter and augmented telephonic interpreter services. Our results showed that there were 3510 deliveries in the 6 month period before the intervention and 3176 deliveries following the intervention. The overall primary C-section rate did not change between the two epochs (21.94% vs. 21.45% p=0.69). Because the primary language of our patients is not captured by our information technology system we subdivided them according to ethnicity. There were decreases in the primary C-section rates in the Hispanic (17.8% pre vs. 15.6% post intervention, reduction 12.4% from baseline) and Asian populations (21.1% pre vs. 16.7% post intervention, reduction 20.9% from baseline) but these differences did not reach statistical significance. There was a significant reduction in the number of babies born weighing less than 2500 grams after the intervention (9.4 % pre vs. 7.4% post, p=0.004). Our conclusions are that staff education and the introduction of interpreter services in the Labor and Delivery department of a large teaching hospital improves the quality of care delivered.