Despite widespread public and professional attention devoted to medical errors and ways to prevent them, few efforts have focused on addressing a leading cause of errors -- communication problems involving patients with limited proficiency in English. A new study reported in the Journal for Healthcare Quality (JHQ) assessed high-risk clinical situations where medical errors are most likely to occur among limited English proficiency patients and when consequences could be severe.
JHQ is the peer-reviewed publication of the National Association for Healthcare Quality (NAHQ, www.nahq.org).
In the JHQ study, lead author Melanie Wasserman of Abt Associates and, a healthcare research firm, and colleagues reviewed and evaluated two evidence-based tools from recommendations published by the Agency for Healthcare Research and Quality (AHRQ) titled “Improving Patient Safety Systems for Limited English Proficient Patients.”
Three common causes for medical errors attributed to insufficient patient language proficiency were identified from data collected. They are:
• Use of family members, friends or non-qualified staff as interpreters
• Clinicians with basic foreign language skill who try to communicate without using qualified interpreters
• Cultural beliefs and traditions that effect health care delivery.
Situations in which adverse events and medical errors were most likely to occur are medication reconciliation, patient discharge, the informed consent process, emergency department visits and surgical care.
Recommendations were proposed by AHRQ to improve detection of medical errors across diverse populations and prevent high-risk scenarios from becoming safety events. Strategies and systems to prevent medical errors should include strengthening interpreter services, improving coordination of clinical services, providing translated patient education materials, and improving training for healthcare staff for communication, interpreter use, cultural awareness and advocacy.
“We found the tools contained in the AHRQ’s recommendations for improving communication with limited English proficiency patients are implementable and conducive to learning, but further research on the impact of the guide is needed to shed light on its value as a multifaceted intervention,” said Wasserman.
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