Errors of Medical Interpretation and Their Potential Clinical Consequences: A Comparison of Professional Versus Ad Hoc Versus No Interpreters

Division of General Pediatrics, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
Annals of emergency medicine (Impact Factor: 4.68). 03/2012; 60(5):545-53. DOI: 10.1016/j.annemergmed.2012.01.025
Source: PubMed

ABSTRACT To compare interpreter errors and their potential consequences in encounters with professional versus ad hoc versus no interpreters.
This was a cross-sectional error analysis of audiotaped emergency department (ED) visits during 30 months in the 2 largest pediatric EDs in Massachusetts. Participants were Spanish-speaking limited-English-proficient patients, caregivers, and their interpreters. Outcome measures included interpreter error numbers, types, and potential consequences.
The 57 encounters included 20 with professional interpreters, 27 with ad hoc interpreters, and 10 with no interpreters; 1,884 interpreter errors were noted, and 18% had potential clinical consequences. The proportion of errors of potential consequence was significantly lower for professional (12%) versus ad hoc (22%) versus no interpreters (20%). Among professional interpreters, previous hours of interpreter training, but not years of experience, were significantly associated with error numbers, types, and potential consequences. The median errors by professional interpreters with greater than or equal to 100 hours of training was significantly lower, at 12, versus 33 for those with fewer than 100 hours of training. Those with greater than or equal to 100 hours of training committed significantly lower proportions of errors of potential consequence overall (2% versus 12%) and in every error category.
Professional interpreters result in a significantly lower likelihood of errors of potential consequence than ad hoc and no interpreters. Among professional interpreters, hours of previous training, but not years of experience, are associated with error numbers, types, and consequences. These findings suggest that requiring at least 100 hours of training for interpreters might have a major impact on reducing interpreter errors and their consequences in health care while improving quality and patient safety.

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Available from: Glenn Flores, Sep 29, 2015
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    • "(2010) study of family practice consultations using Habermas' Communicative Action Theory (CAT) found distinct differences and identified specific risks when family interpreters impose their own agenda (vs. the patient's one) and control the consultation process. A more recent review concluded that bilingual nurses when supported with a professional interpreter made fewer errors than other interpreters in emergency departments (Flores et al., 2012). "
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    ABSTRACT: The global movements of healthcare professionals and patient populations have increased the complexities of medical interactions at the point of service. This study examines interpreter mediated talk in cross-cultural general dentistry in Hong Kong where assisting para-professionals, in this case bilingual or multilingual Dental Surgery Assistants (DSAs), perform the dual capabilities of clinical assistant and interpreter. An initial language use survey was conducted with Polyclinic DSAs (n = 41) using a logbook approach to provide self-report data on language use in clinics. Frequencies of mean scores using a 10-point visual analogue scale (VAS) indicated that the majority of DSAs spoke mainly Cantonese in clinics and interpreted for postgraduates and professors. Conversation Analysis (CA) examined recipient design across a corpus (n = 23) of video-recorded review consultations between non-Cantonese speaking expatriate dentists and their Cantonese L1 patients. Three patterns of mediated interpreting indicated were: dentist designated expansions; dentist initiated interpretations; and assistant initiated interpretations to both the dentist and patient. The third, rather than being perceived as negative, was found to be framed either in response to patient difficulties or within the specific task routines of general dentistry. The findings illustrate trends in dentistry towards personalized care and patient empowerment as a reaction to product delivery approaches to patient management. Implications are indicated for both treatment adherence and the education of dental professionals. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Social Science & Medicine 03/2015; 132. DOI:10.1016/j.socscimed.2015.03.018 · 2.89 Impact Factor
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    • "The research project in which this paper is framed aims to contribute additional insights to this strand of the literature, by focusing on a different setting. While Flores et al. (2012)'s research focuses on a paediatric ED in an English/Spanish bilingual setting in the US, this research concentrates on an adult ED in a linguistically diverse hospital in Brussels (Belgium). "
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    ABSTRACT: This paper describes the methods used and the challenges encountered during data collection for an ethnographic study on language barriers and ad-hoc interpreting in a linguistically diverse inner-city hospital emergency department (ED). Data collection relied on ethnographic participant observation and transcripts of audio-recorded clinician-patient interactions to describe and analyse how staff, patients, and ad-hoc interpreters interact in an ED setting. This paper reviews the different practical steps that needed to be undertaken before embarking on data collection, with a view to stirring the discussion on these issues and facilitating future research. Keywords: audio recording, language barriers, ad hoc interpreting, emergency department, ethnographic data collection, access to the field
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    • "Pioneering Australian research on ED communication by Slade et al. (2008) focused on patients that had at least a satisfactory command of English, excluding patients who needed an interpreter. Flores et al. (2012) also conduct research in a US ED based on recording of interactions. However, as they focussed on Spanish/English interactions, one bi-lingual collaborator sufficed to facilitate the consent negotiation process. "
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    ABSTRACT: This case study reports on the procedure of obtaining informed consent from foreign-language patients in non-clinical research on multilingual communication in the hospital emergency department (ED). Language barriers often constitute a hurdle in obtaining informed consent from foreign-language patients. A simplified French language consent form was not effective, and the hectic context of the ED did not allow time for lengthy explanations. We experimented with audio-recorded explanations of the consent form in various languages. We propose this strategy for other similar (non-clinical) studies in tense settings which involve negligible risk for participants.
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