Applying a patient-provider communication framework to assess cardiac arrest calls between 911 telecommunicators and limited English proficient (LEP) callers

Abstract

Background: Effective communication between 911 telecommunicators and limited English proficient (LEP) callers is critical to ensure an appropriate and timely response to a reported crisis. LEP communities experience disparities in cardiac arrest outcomes such as lower likelihood of receiving bystander CPR and longer call times for telecommunicator-assisted CPR to begin. Improving emergency communication between telecommunicator and LEP callers can facilitate clearer understanding and achievement of goals during cardiac arrest calls. Objective: This qualitative, exploratory study examined the communication between 911 telecommunicators and LEP callers based on communication factors that affect the goals of both parties and the outcome of the cardiac arrest calls. Methods: 24 language barrier-identified audio recorded cardiac arrest calls collected by the UW Northwest Center for Public Health Practice were reviewed. Six calls were excluded due to certain study criteria (e.g. language line, no communication challenges, unclear voice). Of the 18 remaining calls, 5 calls were identified as negative outcome and analyzed using a patient-provider communication framework to examine and identify the communication factors most influential to goal attainment during calls. A qualitative, inductive analysis of the 5 LEP calls was conducted using conversation analysis (CA), which identified how speech behaviors (e.g. tone of voice, interruptions, raised pitch) during the call corresponded to the components of the communication framework and affected the goals. Results: The patient-provider framework components of skills, emotions and environment were represented most in the communicative process between telecommunicators and LEP callers in the cardiac arrest calls studied. The skills of both parties in handling the conversation, their emotional state and the emergency environment in which communication took place affected whether their defined goals were attained. The interaction of these framework components also influenced call’s outcome on multiple occasions. Conclusion: The findings increased understanding of aspects of communication that affect 911 cardiac arrest call outcomes and contribute to the limited research on improving emergency communication with LEP callers to inform best practices. Future interventions could benefit from addressing framework components that most influenced communication in this study; these can include improving emotional management training for telecommunicators or educating LEP communities on basic information to convey in English (e.g. address, type of response needed) during an emergency call to receive a timely response.