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How does limited proficiency in a country’s dominant language affect patient safety, satisfaction, and clinical outcomes?

Posted: 14 Nov, 2016   Recommendations: 5   Replies: 10



Elissa Dakers Replied at 8:50 AM, 14 Nov 2016

In preparation for this week's discussion, I wanted to share some resources that might be of interest. We encourage you to share additional resources on this important topic across the discussion threads, as well as any questions you'd like to see our panel address over the course of the week. Looking forward to a great discussion!

All resources for this Expert Panel can be found at

Attached resources:

Thomas Bauer Replied at 10:43 AM, 14 Nov 2016

Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature written by Leah S Karliner, Elizabeth A Jacobs, Alice Hm Chen, and Sunita Mutha found health care providers need to recognize that language barriers place LEP patients at a disadvantage that can be overcome by providing better linguistic access. Without access to professional interpreters, this large and growing population will continue to suffer differentials in both health and access to quality health care. Future research will contribute most to this area by focusing on how interpreters can decrease errors in comprehension and improve clinical outcomes, as well as studying the cost-effectiveness of these interventions.

Please see attached link for full details

Attached resource:

MYCHELLE FARMER Replied at 11:51 AM, 14 Nov 2016

In addition to linguistic challenges, providers and interpreters need to be sensitive to cultural variations in expressions. These may vary depending on the age, gender, and country of origin. Hopefully, interpreters and providers will consider these issues. Baseline health literacy may also be an issue, especially for populations that traditionally depend on community-based, minimally trained healers.

Kathleen Addison Panelist Replied at 4:43 PM, 14 Nov 2016

Regarding Patient Safety, According to some studies, including by UC San Francisco and 8 other institutions, clinical errors may be the third leading cause of death in the US, after heart disease and cancer. Those same studies indicate that improving communication can reduce errors by approximately 30%. When providers and medical staff are not able to adequately traverse the communication process due to language barriers, these numbers inherently increase, contributing to the occurrence of medical errors with the US’s LEP population
Speaking a language other than a country’s primary language:
- Increases the likelihood of subjecting patients and providers to misinformation, decreasing the ability to provide and receive accurate, quality care
- Prevents patients from taking an active role in their care, and being a part of the decision making process regarding to their care
- May place patients at the mercy of non-objective or medically qualified parties (ie. bi-lingual friends or family,) further decreasing the chances that the patient/ provider are getting/receiving accurate and objective information, and making educated decisions about the care given/received

Attached resources:

Thomas Bauer Replied at 9:44 AM, 15 Nov 2016


I agree with each point you have eloquently made... I often think that according to the Department of Health and Human Services 9 out 10 Americans do not get health information in a way they can use or understand... Health information by itself is a challenge... Add a third language (Medical terminology by some is considered a language in its own) the risk for error is magnified.


HANAN SACA-HAZBOUN Replied at 2:54 AM, 16 Nov 2016

I concur with other, most of the health care professionals discussed the challenges faced with limited English and it s consequences such as stress and inability to follow treatment regimen, and a challenge for appointment follow up. From my perspective, there are some who return to the hospital with complications more sooner than others who are literate and speaks English well. So, the need for interpreters remains essential in health care even the cost might be high. some of the attachments discusses the Mal-practice and challenges faced.

Attached resources:

Thomas Bauer Replied at 10:05 AM, 16 Nov 2016

Patient Safety, Quality, and Cost Drivers

The Institute of Medicine report Crossing the Quality Chasm states that quality means that patients are not harmed by the care that is intended to help them, and they remain free from accidental injury, misdiagnosis, and inappropriate treatment. Communication between patients and health care providers, and the barriers many LEP patients face in this regard, has an important impact on quality, cost, and patient safety and may lead to misdiagnosis and inappropriate treatment.19 For example:

According to AHRQ "LEP patients are at greater risk of line infections, surgical infections, falls, and pressure ulcers due to longer hospital stays than English-speaking patients with the same clinical condition." "Medical errors are not the only result of communication difficulties in the inpatient setting that are problematic and costly:

* Longer length of hospital stays for LEP patients when professional interpreters were not used at admissions and/or discharge.
* LEP patient have greater difficulty understanding discharge instructions, including how to manage their condition, take their medications, recognize symptoms that should prompt a return to care, and know when to follow up.
* Racial and ethnic minorities are more likely to be readmitted for certain chronic conditions than their non-Hispanic white counterparts. This difference may relate to the greater likelihood for a patient with limited English proficiency, low literacy, or other communication barriers to misunderstand discharge and medication instructions. When financial disincentives exist for re-admissions, greater attention should be placed on ensuring effective communication, including appropriate medication reconciliation, at discharge.

For full details please see attached link

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Kathleen Addison Panelist Replied at 4:28 PM, 16 Nov 2016

Further to that, the "Pennsylvania Patient Safety Authority analysts reviewed 232 events associated with language barriers and LEP reported to the Authority from June 2004 through May 2010. Analysis of these events and review of the relevant literature identify LEP as an issue that can affect patient safety in all settings. This article reviews LEP-associated events reported to the Authority, reviews the laws that govern and protect patients with LEP, and discusses ways that facilities can enhance the quality of care for LEP patients." Patients with Limited English Proficiency (Pa Patient Saf Advis 2011 Mar;8(1):26-33. )

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Monique Germain Replied at 1:48 PM, 19 Nov 2016

Thank you for such an important topic. Yes, interpreters should be collaborating partners in providing culturally-congruent information to people whose language proficiency is limited (that includes deaf populations). The cost of hiring an interpreter can be prohibitive to some institutions, and the patient either does not receive any information or receives information that is inappropriate.

Saad Hashmi Replied at 2:24 PM, 19 Nov 2016

It is essential for interpretator to have knowledge about physical symptoms in order to translate them for doctors.A single mistake can lead to misdiagnosis in this regard.The confidentiality must be maintained in engagement sessions.Keeping these challenges in Mind the interpretators need proper training to avoid any error.

This Expert Panel is Archived.

This Expert Panel is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.