Being hospitalized with a serious medical condition, surrounded by strange equipment, and listening to medical jargon you’ve never heard before is an intimidating situation for anyone. Compounding the uncertainty and stress of the situation would be not understanding the primary language spoken by your providers, not being able to read your procedure consents, and knowing that you may not be able to adequately communicate how you are feeling or whether you are in pain.
Those identified to have Limited English Proficiency (LEP) within the U.S. grew 80% between 1990 and 2013 (from 14 million to 25.1 million). An individual is classified by the U.S. Census Bureau as LEP if they over the age of five and report speaking English less than “very well.” Furthermore, according to the AHRQ [PDF], at least 8.6% of the population in the U.S. are at risk of an adverse event due to a language barrier. As diversity in the U.S. population continues to grow, more and more patients with LEP will be at risk if adequate interpretation services are not available.
A number of studies discuss what LEP patients experience when attempting to access healthcare services. In outpatient settings, LEP patients have less access to care, obtain fewer preventive services, and have fewer physician visits. In inpatient settings, LEP patients may experience a higher 30-day readmission rate, longer hospitalizations, and more adverse events.
A recent study published in Medical Care discusses a potential way to improve access to interpretation services and reduce the 30-day readmission rate for LEP patients. A dual-headset interpreter telephone was installed at every bedside on the medicine floor of an academic hospital for the duration of the study period, July 2008 through March 2009. There were 66 phones and all had a button that was programmed to allow immediate access to a professional medical interpreter 24-hours a day. The authors then reviewed discharges for patients at least aged 50 during the implementation timeframe. The study showed a decrease in the 30-day readmission rates for those LEP patients eligible for the study as well as an estimated hospital monthly expenditure savings of greater than $160,000.
While current research certainly displays the potential benefits of accessible interpretation services, the Medical Care article also emphasized a troubling results from other studies–that hospital interpretation service policy frequently does not align with actual practice. An article in the Washington Post discussed how reimbursement can be a significant barrier to the provision of adequate interpretation services. On a related note, a prior Medical Care Blog post highlights the current shortage and future demand for qualified medical interpreters.
From my own experience as a nurse at an inpatient facility, interpretation services were not always available when we needed them. There was a telephone-based interpretation service available, but it wasn’t considered easily accessible and that discouraged a number of time-pressured staff from using it. To complicate the matter, I predominately worked nights and it was almost impossible to find an in-person interpreter between 7pm and 7am. Unfortunately, this left us frequently doing exactly what isn’t recommended, relying on friends or family of the patient to provide interpretation services.
So what’s next? It’s clear that the interpretation services needed by so many patients in the U.S. are not always available, placing patients at risk for errors and adverse events when accurate medical information can’t be effectively communicated. Future research needs to focus not only on the benefits appropriate interpretation services offer, but on the most effective, accessible, and least burdensome methods for those services to be delivered to patients.
If you are interested in additional information on interpreters, check out this other Medical Care blog post: Communication in Healthcare: An Interview with a Professional Medical Interpreter.