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The problem
On the medical-surgical unit described in this paper, about one in eight patients prefers a language other than English. Staff often rely on family members, including teenage children, to interpret admission histories and discharge teaching, because the video interpreting service takes several minutes to connect. This is an equity problem as much as a communication problem: patients with limited English proficiency (LEP) end up with less accurate information about their own care.
What the evidence shows
Errors in medical interpretation are common. In a study of pediatric clinic visits, interpreters made an average of 31 errors per visit, and 63% of the errors had potential clinical consequences, such as omitted questions about drug allergies or missing instructions for antibiotics. Errors by ad hoc interpreters, such as family members or untrained staff, were significantly more likely to have clinical consequences than errors by professional hospital interpreters: 77% compared with 53% (Flores et al., 2003).
A systematic review found that professional interpreters improve communication, use of services, clinical outcomes and satisfaction with care for patients with LEP. Professional interpreters appear to raise the quality of their care to approach or equal that of patients without language barriers (Karliner et al., 2007).
The nurse as advocate
Advocacy here means changing the unit's defaults, not only individual practice:
- Record each patient's preferred language at admission and flag it on the whiteboard and in the electronic health record.
- Keep a video interpreting device on each hallway and test it at the start of every shift so it connects quickly.
- Use family members to interpret only in emergencies, never minors, and document who interpreted.
- Use teach-back through the interpreter for all discharge teaching.
Measuring the change
The unit will audit charts monthly for the proportion of LEP admissions with a professional interpreter documented for the admission history and the discharge teaching, and review patient experience comments from patients with LEP.
References
Flores, G., Laws, M. B., Mayo, S. J., Zuckerman, B., Abreu, M., Medina, L., & Hardt, E. J. (2003). Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics, 111(1), 6–14. https://doi.org/10.1542/peds.111.1.6
Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42(2), 727–754. https://doi.org/10.1111/j.1475-6773.2006.00629.x
