Errors in Medical Interpretation and Their Potential Clinical Consequences in Pediatric Encounters

Abstract

ABSTRACT. Background. About 19 million people in the United States are limited in English proficiency, but little is known about the frequency and potential clinical consequences of errors in medical interpretation.Objectives. To determine the frequency, categories, and potential clinical consequences of errors in medical interpretation.Methods. During a 7-month period, we audiotaped and transcribed pediatric encounters in a hospital outpatient clinic in which a Spanish interpreter was used. For each transcript, we categorized each error in medical interpretation and determined whether errors had a potential clinical consequence.Results. Thirteen encounters yielded 474 pages of transcripts. Professional hospital interpreters were present for 6 encounters; ad hoc interpreters included nurses, social workers, and an 11-year-old sibling. Three hundred ninety-six interpreter errors were noted, with a mean of 31 per encounter. The most common error type was omission (52%), followed by false fluency (16%), substitution (13%), editorialization (10%), and addition (8%). Sixty-three percent of all errors had potential clinical consequences, with a mean of 19 per encounter. Errors committed by ad hoc interpreters were significantly more likely to be errors of potential clinical consequence than those committed by hospital interpreters (77% vs 53%). Errors of clinical consequence included: 1) omitting questions about drug allergies; 2) omitting instructions on the dose, frequency, and duration of antibiotics and rehydration fluids; 3) adding that hydrocortisone cream must be applied to the entire body, instead of only to facial rash; 4) instructing a mother not to answer personal questions; 5) omitting that a child was already swabbed for a stool culture; and 6) instructing a mother to put amoxicillin in both ears for treatment of otitis media. Conclusions. Errors in medical interpretation

Getting By: Underuse of Interpreters by Resident Physicians

“…Language barriers encountered in the care of patients with limited English proficiency (LEP), a growing segment of the U.S. population 2 , adversely affect healthcare quality. Patients with LEP may have decreased access to acute care and preventive services [3][4][5][6] , decreased satisfaction with care 7,8 , poor understanding of instructions or medications 9,10 , longer hospital stays 11 , and an increased risk of medical errors and misdiagnoses [12][13][14][15][16] .…”

“…The use of professional interpreters improves the quality of care for patients with LEP, resulting in higher patient satisfaction 17 , fewer errors in communication 14 , reduced disparities in utilization of services 18 , and improved clinical outcomes 19 . Despite accumulating evidence of the benefits of professional interpreter use, recent studies suggest that that they are underused by physicians [20][21][22][23] .…”

Translating Genetics Leaflets into Languages Other Than English: Lessons from an Assessment of Urdu Materials

“…Clients often prefer that a friend or relative who they know and trust acts as an interpreter, rather than as a professional (Parnes and Westfall, 2003;Xuo and Fagan, 1999). Clinicians report concerns that untrained interpreters such as the patients' relatives or friends may not translate sensitive or technical information appropriately, accurately, or at all, and their use may raise issues of confidentiality (Flores et al, 2003;Phelan and Parkman, 1995;Shaw, 2003a). Using trained medical interpreters does not necessarily eliminate miscommunication (Brafman, 1995;Kaufert and Putsch, 1997;Phelan and Parkman, 1995;Schaafsma et al, 2002) and may cause anxiety to the patient, especially where the interpreter's role has been inadequately negotiated beforehand (Parnes and Westfall, 2003).…”

Professional Language Interpretation and Inpatient Length of Stay and Readmission Rates

“…Ad hoc interpreters can misinterpret or omit up to half of physicians' questions, are more likely to commit errors with clinical significance, have a higher risk of not mentioning medication side effects, and may ignore embarrassing issues (especially when children are used to interpret). 3,6,7 From an economical standpoint, it has been found that LEP patients stay in the hospital between 0.7 and 4.3 days longer than English speaking patients with similar conditions. 8 In addition non-English speaking patient have a higher 30-day readmission rate compared to their English speaking counterparts.…”