Rules and resources for communicating with patients with limited English proficiency

16 Sep 2018

Keeping patients safe through better communication

 

In U.S. homes, 62 million residents use a language other than English, and 25 million of them have limited English proficiency.

The Joint Commission reports, “Language barriers significantly impact safe and effective healthcare.” It cites a study of 1,083 adverse incidents reported by six Joint Commission accredited hospitals, finding 49.1 percent of limited English proficiency patients experienced physical harm — versus 29.5 percent of English-speaking patients.¹

The Association of Healthcare Research & Quality reports, “Communication problems are the most frequent root cause of serious adverse events,” — and for the LEP patient population, the “lack of use of qualified medical interpreters is the root cause of safety events.”

The Joint Commission goes further to report that typical failures related to LEP patients involve:

• Hospitals’ use of family members, friends or nonqualified staff as interpreters
• Provider use of basic language skills to “get by”

In June 2016, the Affordable Care Act redefined who may and may not be qualified to use a second language in communication with patients and their representatives in health care settings. That person must now first pass a test in order to be “qualified” to use a target language other than English. Passing this bilingual test only permits use of that second language in their own practice with the patient or the patient’s representative. Passing that test alone does not qualify them to “interpret” for a third person.

With this law now in place, providers may not use “unqualified” interpreters including:

• Family members
• Bilingual staff (even those who are “qualified bilingual”)

   1. Video remote interpreting
     - VRI is available 24/7
     - VRI machines are available on all inpatient units and in the emergency department
     - VRI machines may also be requested for additional areas of the hospital, as needed

   3. In-house medical interpreters (and contract interpreters)

The ACA does specify an exception to the above when “an emergency involving an imminent threat to the safety or welfare of an individual or the public where no qualified interpreter is immediately available.” Others may be engaged to interpret in that scenario.

The Salem Health human resources office and medical staff office are partnering to explore — with our language testing vendor — the option of testing non-employed members of our medical staff to qualify as bilingual. There will be further communications surrounding that topic once the process is clear.

1. Divi C, Koss RG, Schmaltz SP, Loeb JM: Language Proficiency and Adverse Events in U.S. Hospitals: A Pilot Study. International Journal for Quality in Health Care, 2007;19:60–7