September 3, 2014

Lost in translation: Why hospitals need professional interpreters

Daily Briefing

    As the United States grows increasingly multilingual, hospital safety experts are stressing the importance of professional interpreters rather than relying on family members or other untrained interpreters, Sabriya Rice writes in Modern Healthcare.

    Having a translator in ED may halve potential errors

    The number of people who spoke a language other than English at home in the nation grew by 158% from 1980 to 2010, and the employment of interpreters and translators is expected to increase 46% by 2022, according to the U.S. Bureau of Labor Statistics.

    The Joint Commission requires hospitals to provide interpreters to any patient needing one, but hospitals often rely on a bilingual staff member or patient's family for fear that delaying care may put a patient's life in danger. Nearly 9% of the U.S. population is at risk of an adverse event because of a language barrier, according to the Agency for Healthcare Research and Quality.

    How language barriers can cause harm

    "Everybody has a story about some risky situation where lack of adequate interpretive services put a patient in harm's way," says Melanie Wasserman of Abt Associates. Wasserman co-authored a report published in May in the Journal for Healthcare Quality that found language barriers contributed to medication errors and lack of informed consent issues.

    A 2012 study in the Annals of Emergency Medicine analyzing audio recordings from visits at two large pediatric EDs found thousands of interpretation mistakes, even when the hospitals used professional interpreters. Such mistakes including adding, omitting, or substituting words, using words that did not exist in the original language, and adding their own perspectives. Of these mistakes, 18% had potentially harmful consequences. Mistakes were less frequent among professional medical interpreters who had at least 100 hours of training.

    Additionally, a study published in the American Journal of Managed Care in June found that patients whose primary language was not English were significantly more likely to have multiple 30-day readmissions.

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    Hospitals struggle to pay for such services

    At about $150 a visit, the cost of an interpreter often exceeds a physician's payment for the visit—a "significant hardship" for practices, according to an American Medical Association survey.

    Companies such as Stratus Video offer professional interpretation services via video for as little as $1.50 a minute, according to Stratus President David Fetterolf. Through the service, providers use an iPad (usually attached to an IV pole) that can contact a certified medical interpreter within 30 seconds.

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    Northside Hospital in Atlanta has been using Stratus since 2012 and had 83,000 total interactions in 2013—about 230 interpretation encounters daily, according to interpretation services coordinator Darrin Bearden.

    Thirteen states and the District of Columbia directly reimburse providers for interpretation services used with Medicaid beneficiaries and children in the Children's Health Insurance Program. "The fact that states can pay directly for interpreters is a great opportunity to help hospitals meet federal requirements and help them offset the costs," says Mara Youdelman, managing attorney for the National Health Law Program.

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    Still, inconsistencies between interpretation training remain because there is no standardization for certification for medical interpreters. Moreover, providers need to monitor and report language-related errors to assess how well U.S. providers are addressing the issue, experts say. And at hospitals with interpretation services, providers need to do a better job of informing staff how to access those services (Rice, Modern Healthcare, 8/30 [subscription required]).

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