Hospital patients in the United States who have limited English proficiency are more likely to be harmed by adverse events than other patients, a new study shows.
Nearly half of the adverse events looked at in the study that occurred in patients with limited English involved physical harm to these patients, whereas only 30% of adverse events recorded as having occurred in proficient English speakers resulted in harm, says the study, which was published online on 2 February in the International Journal for Quality in Health Care (http://intqhc.oxfordjournals.org, doi: 10.1093/intqhc/mzl069).
The authors, who say that the absence of trained interpreters is normal in most clinical settings in the United States, think that current language services may be inadequate.
“Language barriers appear to increase the risks to patient safety. It is important for patients with language barriers to have ready access to competent language services,” write the authors, from the Joint Commission, an independent, non-profit organisation that evaluates and accredits nearly 15 000 healthcare organisations and programmes in the US.
The report says that less than 25% of US hospitals provide training for medical interpreters and that most hospital staff are not trained to work with interpreters and have little or no education in linguistic and cultural issues in clinical care. It says, “Bilingual nurses who have not been trained in medical interpretation are frequently asked to translate.”
The report says that more than 20 million people in the US are classed as “limited English proficient” and that between 1990 and 2000 the number grew by a third, from 6% to 8% of the population. It says that this group is one of the fastest growing segments of the US population and that these people are particularly vulnerable to disparities in healthcare quality.
It says that there is a paucity of literature on the issue and that the effects of language barriers are not well understood.
In the study the authors analysed 1083 adverse events reported at six hospitals. The results showed that 49% of adverse effects in patients with limited English and 30% in patients who spoke English proficiently involved some physical harm.
The results also show that adverse events that occurred in patients with limited English were more likely to be the result of communication errors (52%) than in proficient speakers (36%).
“When compared with English speaking patients, adverse events experienced by limited English patients more often result in some detectable harm to the patient and the severity of that harm tends to be greater. The limited English patient adverse events are also more frequently a consequence of some failure in communication,” the authors wrote.
“This implies that although hospitals may be providing language services, those services could be inadequate for mitigating the patient safety risks posed by language barriers.
“Results from this study highlight the risks to patient safety that can be attributed to language barriers in hospitals and reinforce that it is important for limited English patients to receive competent language services.”