Wednesday, May 23, 2012

Trained Interpreters Seen As Necessary To Avoid Mishaps

Kaiser Health News reports: “Trained Interpreters For Patients With Limited English Can Help Avoid Medical Mishaps.”

Find the report (written by Michelle Andrews and posted May 21, 2012) here:

KHN reports that there are 25 million people in the United States with limited English proficiency, creating a heightened potential for medical mishaps due to miscommunications and understandings. (The Census Bureau estimates that nearly 9 percent of the population age 5 or older has limited English proficiency, defined as people who describe themselves as speaking English less than "very well.")

The point of the article: “A trained medical interpreter can make all the difference. Too often, however, interpreter services at hospitals and other medical settings are inadequate. Family members, including children, often step in, or the task falls to medical staff members who speak the required language with varying degrees of fluency.”

And the further point is that it is more than just experience. It’s the training. A study published in March in the online Annals of Emergency Medicine concludes that “such ad hoc interpreters make nearly twice as many potentially clinically significant interpreting errors as do trained interpreters.” Find the study here:

The study examined 57 interactions at two large pediatric emergency departments in Massachusetts. These encounters involved patients who spoke Spanish at home and had limited proficiency in English. Researchers analyzed audiotapes of the visits, looking for five types of errors, including word omissions, additions and substitutions as well as editorial comments and instances of false fluency (making up a term, such as calling an ear an "ear-o" instead of an "oreja")

They recorded 1,884 errors, of which 18 percent had potential clinical consequences.

For professionally trained interpreters with at least 100 hours of training, the proportion of errors with potential clinical significance was 2 percent. For professional interpreters with less training, the figure was 12 percent. Ad hoc interpreter errors were potentially clinically significant in nearly twice as many instances -- 22 percent. The figure was 20 percent for people with no interpreter at all.

The article goes on to discuss the legal obligations of hospitals under Title VI of the Civil Rights Act of 1964 – which prohibits discrimination based on race, color or national origin, and therefore, as applied by the courts, health care providers who accept federal funding (Medicare and Medicaid) must take steps to ensure that their services are accessible to people who are not fluent in English.

KHN reports that this puts hospitals and other medical providers in the a tough spot because the law prohibits them from asking patients to pay for translation services, but at the same time they may not receive adequate or in some cases any other reimbursement.

On this point: some states do reimburse providers for giving language services to enrollees in Medicaid and CHIP (the federal-state health program for children). There is some debate as to how many insurers provide access to interpreter services.

On the clinical side: Hospitals and other providers realize that providing competent interpreter services can help ensure that they don't miss or misdiagnose a condition that results in serious injury or death, say experts. Trained interpreters can also help providers save money by avoiding unnecessary tests and procedures. Some hospitals provide interpreter services around the clock through different modes of communication – face-to-face, telephone and video – delivered by a mix of trained staff interpreters and outside contractors. The report also notes that hospitals that understand the importance of interpreters will make it a budget item.

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