Quality/Patient Safety

Interpretation errors are common during medical encounters with people who have limited English proficiency

About 45 million people in the United States speak a language other than English at home, and about 19 million people are limited in English proficiency (LEP). When these individuals see a doctor or arrive at the hospital, errors in interpretation of what the doctor or patient says are alarmingly common, averaging 31 errors per clinical encounter. Furthermore, many of these errors have potential clinical consequences, such as omitting questions about drug allergies, which can be disastrous. Errors committed by ad hoc interpreters are significantly more likely to have potential clinical consequences than those committed by hospital interpreters (77 vs. 53 percent), according to study supported in part by the Agency for Healthcare Research and Quality (R02 HS11305).

Third-party reimbursement for trained interpreter services should be considered for patients with limited English proficiency, suggests Glenn Flores, M.D., of the Medical College of Wisconsin. Dr. Flores and his colleagues audiotaped and transcribed pediatric encounters in a hospital outpatient clinic in which a Spanish interpreter was used. For each transcript, they categorized each error in medical interpretation and determined whether errors had a potential clinical consequence. Professional hospital interpreters were present for six encounters; ad hoc interpreters included nurses, social workers, and an 11-year-old sibling. The researchers calculated 396 interpreter errors, with a mean of 31 per encounter.

Nearly two-thirds (63 percent) of all errors had potential clinical consequences, with a mean of 19 per encounter. Half of even hospital interpreter errors had potential clinical consequences. Examples included omitting instructions on the dose, frequency, and duration of antibiotics and rehydration fluids; adding that hydrocortisone cream must be applied to an infant's entire body, instead of only the facial rash; and instructing a mother to put amoxicillin in both ears for an ear infection. These findings suggest that hospital interpreters need more adequate training.

See "Errors in medical interpretation and their potential clinical consequences in pediatric encounters," by Dr. Flores, M. Barton Laws, Ph.D., Sandra J. Mayo, Ed.M., and others, in the January 2003 Pediatrics 111(1), pp. 6-14.

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