Interpreters in ER may help limit medical errors

NEW YORK Tue Apr 17, 2012 1:35pm EDT

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NEW YORK (Reuters Health) - Having professional translators in the emergency room for non-English-speaking patients might help limit potentially dangerous miscommunication, a new study suggests.

The study, done at two pediatric ERs, found that when Spanish-speaking families had access to a professional interpreter, 12 percent of translation slips -- such as adding or omitting certain words and phrases -- could have had "clinical consequences," like giving a wrong medication dose.

But mistakes like that were about twice as likely if there was no interpreter or if the translator was an amateur, like a family member or a bilingual member of the hospital staff. Twenty to 22 percent of all of their translation errors had potential health risks to the child.

"The findings document that interpreter errors of potential clinical consequence are significantly more likely to occur when there is an ‘ad hoc' or no interpreter, compared with a professional interpreter," lead researcher Dr. Glenn Flores, of the University of Texas Southwestern Medical Center in Dallas, said in an email.

An estimated 25 million Americans have limited English proficiency -- that is, they say they speak the language less than "very well."

By law, U.S. hospitals that receive federal funds have to offer some type of translation help for those patients. That can mean a professional interpreter who works for the medical center; some hospitals use telephone- or video-based translation services.

Studies have found that patients like having a translator available, and that it may improve their care and ultimately cut costs -- by avoiding unnecessary tests, for example.

But it hadn't been clear how well professional interpreters perform against amateurs, such as an English-speaking family member, or against no translator at all.

The current findings, reported in the Annals of Emergency Medicine, are based on 57 families seen in either of two Massachusetts pediatric ERs. All were primarily Spanish-speaking.

The research team audiotaped the families' interactions with their ER doctor. Twenty families had help from a professional interpreter and 27 had a non-professional. Ten had no translation help.

It's not clear why some families had no professional interpreter. In some cases, Flores said, there may have been no one available immediately. Or the doctor might not have requested an interpreter.

The findings suggest that professionals can help avoid potentially dangerous miscommunication between patients and doctors, according to Flores and his colleagues.

In one example from their study, an amateur interpreter -- a family friend -- told the doctor that the child was not on any medications and had no drug allergies. But the friend had not actually asked the mother whether that was true.

COST QUESTIONS

There are still plenty of questions regarding professional interpreters, according to Flores.

For one, he said studies are needed to compare the effectiveness of in-person professional translators versus phone and video translation services.

There are also questions about what type of translation help families and doctors prefer, and what's most cost-effective.

Federal law may require many hospitals to offer interpreters, but it does not compel the government or private insurance to pay for them. Right now, some U.S. states require reimbursement, but the majority do not.

So in most states, Flores told Reuters Health, "the hospitals and clinics, and ultimately the taxpayers (because of uncompensated/charity care), are left covering the costs."

But the cost-per-patient can be kept down. One study found that when a group of California hospitals banded together to offer translators by phone and video, the cost per patient was $25.

As for national costs, Flores pointed to a 2002 report from the White House Office of Management and Budget. It estimated that it would cost the U.S. $268 million per year to offer interpreter services at hospitals and outpatient doctor and dentist visits.

Another issue is training -- including the question of how much is enough.

In the current study, errors were least common when interpreters had 100 hours of training or more: two percent of their translation slips had the potential for doing kids harm.

There are numerous training programs for medical interpreters nationwide. But few of them provide at least 100 hours of training, Flores noted.

As for hospitals, it seems that most do not offer their own training programs. And even when they do, the hours vary substantially, Flores said.

Based on these findings, he and his colleagues write, requiring 100-plus hours of training "might have a major impact" on preventing translation errors -- and any consequences for patients' health.

SOURCE: bit.ly/HDDLbj Annals of Emergency Medicine, online March 15, 2012.

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