Language Data Collection & Patient Safety: A Correlative Look

A lack of reliable data on language can make it hard for providers, hospitals, and public health organizations to effectively study and improve care.

Over 8% of the U.S. population is considered limited-English proficient (they cannot read, speak, or understand English well enough to communicate without an interpreter). That means for almost 26 million people in the U.S., getting high-quality care is not guaranteed, even after they arrive in a hospital or healthcare setting.

A 2007 study found that for limited-English proficient (LEP) patients, almost half of adverse events in a hospital setting (49.1%) resulted in physical harm. By contrast, someone who speaks English well or very well was 40% less likely to experience physical harm after an adverse event in the same setting. The same concerns for patient safety and language access have been observed in multiple studies over the years.

Collecting Language Data

Multiple studies confirm the fact that patients with LEP are more likely to experience negative health outcomes because of communication barriers. However, a lack of reliable data in this area can make it hard for providers, hospitals, and public health organizations to effectively study and improve care.

Data can help organizations and researchers:

• Measure the prevalence of adverse events
• Understand what types of adverse events are occurring
• Provide insight into the ways that language barriers contribute to these events

Every healthcare organization should have a process to identify and document a patient’s English proficiency. The information should be consistent across all aspects of patient care, including the emergency room, urgent care, clinical care, and inpatient or outpatient hospital care. Organizations should also document:

• Patients’ race and ethnicity
• Healthcare providers’ language skills
• Whether an interpreter was present during each patient encounter
• The interpreting service(s) that were available (telephone, video, or in-person)

In 2006, the Joint Commission — which accredits and certifies over 22,000 healthcare organizations in the U.S. — established specific accreditation standards for entering language and communication needs in a medical record. That standard is now part of their accreditation process.

Effective Communication: The Cornerstone of Quality Care

Effective communication is one of the most critical tools that patients and providers have for optimizing care and reducing the chance of adverse events and negative health outcomes. Many providers have limited time to spend with each patient, so accurate and direct communication becomes even more important.

With effective communication, patients can:

• Take a more active role in their overall health and care
• Improve their chances for recovery and positive health outcomes
• Engage in shared decision-making with their providers
• Ask questions and feel confident that they understand their treatment plan
  

LEP Patient Safety

For millions of LEP patients, the ability to communicate with a provider can also have very real and lasting consequences. In a three-year study published by the U.S. National Library of Medicine, researchers found that LEP patients without access to a professional interpreter stayed in the hospital almost twice as long as those who had one. Professional interpreters also reduced readmission rates by more than 38%.

Studies of taped and transcribed pediatric encounters found that medical interpretation errors put a patient at risk of negative clinical consequences. That risk was significantly higher if the person translating was not a trained medically qualified interpreter. Patient safety is significantly impacted when someone cannot understand:

• Their diagnosis or medical condition
• Provider-recommended treatment plan(s)
• What they are consenting to for treatment
• Discharge instructions
• Medication dosage and/or instructions
• Risk of complications
• Symptoms of complications
• How, when, and where to go for follow-up care
  

Access to Qualified Medical Interpreting

One of the most effective ways to eliminate language barriers that lead to adverse events is to have a qualified medical interpreter available for LEP patients. Hospitals or healthcare organizations are required by law to cover the cost of these services and cannot pass these costs along to the patient.

There is a common (but mistaken) belief that if someone else can interpret for a patient, they don’t need a professional interpreter. These ad hoc interpreters may be a bilingual staff member or someone the patient knows, such as a friend, family member, parent, or child. This presents significant problems when they are asked to interpret in a medical setting.

The use of an ad hoc interpreter can lead to serious and, in some cases, deadly mistakes. Research shows that ad hoc interpreters may:

• Omit or misinterpret as much as half of what physicians say, especially if the conversation includes complex medical terminology
• Leave out or ignore things they are embarrassed to repeat (this is especially common when children interpret for their parents in a healthcare setting)
• Omit information that is emotionally difficult to share with someone they know or love
• Not mention or explain all the medication side effects

Ad hoc interpreters are also far more likely to commit an error that has “clinical significance,” meaning it could affect the outcome for treatment in a negative way. That can lead to longer hospital stays, more complications, and can even result in death or permanent disability.

Qualified medical interpreters are specifically trained to interpret in a healthcare setting. They demonstrate a specific level of language proficiency in two languages but also have specialized training and experience with medical terminology and phraseology. They also understand patient privacy laws and confidentiality. They are trained to communicate:

• Directly
• Impartially
• Compassionately

Use of a medically qualified interpreter improves the care you provide to LEP patients. These interpreters can help with all aspects of care, from scheduling and patient intake to discharge and follow-up care. As patient access expands to include virtual care through telemedicine and telehealth, the use of qualified medical interpreters must extend to this care as well.

Standardize and Improve Care with GLOBO

GLOBO's team of highly trained professional interpreters can help you provide the best care for patients and ensure your high standards for quality are available to everyone in your healthcare setting, regardless of English proficiency. Talk to us today to learn more about how we can help you standardize and improve care for LEP patients.

Additional Resources

• What is Language Support Data (and Why Does Having it Matter?)
• Best Practices for Working with an Interpreter: Guide for Healthcare Professionals
• 5 Tips for Improving Patient Safety for Limited-English Speakers
• Cultural Competence in Healthcare: A Guide
• Tracking ROI for Your Health System's Language Support
• How to Make the Most of Your Language Support