Hospital Care May Get Lost in Translation

Sept. 7, 2005 -- Children of Spanish-speaking families may be more likely to endure hospital errors due to language barriers, a new study shows.

The study, published in Pediatrics, focuses on one pediatric hospital in the Pacific Northwest. But the issue is bigger than that, write Adam Cohen, MD, MPH, and colleagues.

"Language barriers may contribute to medical errors by impeding patient-provider communication," they write. "One particularly vulnerable group is immigrant children and the children of immigrant parents, the fastest growing segment of the U.S. child population."

Cohen is on staff at the CDC. He worked on the study while at the University of Washington and Children's Hospital and Regional Medical Center in Seattle.

Language & Hospital Errors

Cohen's team studied 572 children treated at a pediatric hospital in the Pacific Northwest from 1998 to 2003. The patients were up to 21 years old.

Most had no problems in their hospital care. However, 97 patients had what the researchers call a "serious medical event." Examples of these adverse events defined by this study include getting the wrong diagnostic procedures, missed or delayed diagnoses, and medication errors.

Overall, they found no link between requests for interpreters and hospital errors. However, Spanish-speaking families that asked for hospital interpreters were twice as likely to have hospital errors as those that didn't request an interpreter, the study shows.

No Link Seen With Other Languages

Children from Spanish-speaking families that requested a hospital interpreter accounted for 11% of the patients. The study also included other Hispanic families that didn't ask for an interpreter.

Spanish wasn't the only non-English language noted in the study. Other language groups included Cambodian, Cantonese, French, Haitian, Italian, Japanese, Russian, Somali, Ukrainian, and Vietnamese. However, patients from families speaking those languages made up less than 1% of the study's participants.

"Serious medical events" were reported by the hospital's quality improvement staff, so many other medical errors likely weren't included, the researchers note.

Underestimating the Spanish Language Barrier?

The reasons for the results aren't clear. Perhaps some hospital staffers mistakenly think their Spanish is better than it really is, write the researchers.

"Some medical providers may erroneously believe that they have an adequate command of Spanish," they write.

"We speculate that although interpreters were requested more frequently for Spanish-speaking families who incurred a serious medical event, providers may not rely on interpreters for Spanish-speaking patients as much as for patients who speak neither English nor Spanish," write the researchers.

Bridging the Language Gap

Patients' families may want to draw interpreters back into hospital discussions.

"Many patients with language barriers may not be given interpreters as often as they should, and poor interpretation can lead to medical errors and adverse outcomes," write the researchers.

"These results have large implications for improving the quality of pediatric care and suggest that minimizing language barriers may be an important key to limiting medical errors in hospitalized pediatric patients," they continue.

Other hospitals may have similar issues, write Cohen and colleagues.

"Because this hospital serves a racially and ethnically diverse pediatric population over a five-state region, we believe that these results are generalizable to other regional pediatric hospitals," they write.