Professional interpretation improves quality of care for patients with limited English proficiency (LEP). However, many health care settings lack access to professional interpreters, and even in locations with good access, logistical factors and perceived barriers have limited their widespread use. Remote methods of professional interpretation, including telephone and video, hold great promise for expanding access, but only limited data exist on the relative impacts of these modalities on patient care and provider uptake. Comparing how these modalities impact multiple aspects of health care quality, including family comprehension, provider communication, and consistency of provider interpreter use will inform dissemination of strategies for delivery of safe, efficient, and equitable care to LEP families.

Aim 1: To determine whether randomly assigned remote interpreter modality (telephone versus video) impacts parent-reported quality of communication and interpretation, diagnosis comprehension, and length of stay (LOS) among LEP Spanish-speaking families seen in a pediatric Emergency Department (ED).

Hypothesis 1: Parent-reported quality of communication and interpretation and parent diagnosis comprehension will be higher among families assigned to video interpretation compared to telephone interpretation.

Hypothesis 2: LOS will not differ between families assigned to video and telephone interpretation.

Aim 2: To determine whether assigned interpreter modality is associated with provider decision to communicate without professional interpretation.

Hypothesis 3: Parent-reported provider communication without professional interpretation (e.g. using the patient or a family member to interpret for some part of the visit) will be lower for families assigned to video interpretation compared to telephone interpretation.

Inclusion Criteria:

• Preferred language for medical care of Spanish
• At least one primary caregiver requires interpretation
• Presenting to Seattle Children's ED during recruiting hours

Exclusion Criteria:

• Triage level 1 (life-threatening illness)
• No parent or legal guardian present
• Reason for visit is concern for abuse
• reason for visit is primary behavioral or psychiatric complaint