Medical Language Interpretation
Background
Exceptional patient safety standards and quality of care in anesthesiology requires a critical emphasis on language and communication. The Joint Commission has cited communication barriers and misunderstandings as one of the most frequent contributors to errors and lapses in patient safety. 21.6% of people over age 5 speak a language other than English at home, and 40% of these individuals qualify as being “LEP” or Limited English proficient. About 60% of homes that are not primarily English-speaking use Spanish as their main language.
Under Section 1557 of the Patient Protection and Affordable Care Act (42 USC 18116), healthcare institutions and providers that receive federal financial assistance from the U.S. Department of Health and Human Services must provide LEP patients a qualified interpreter and routine documents in their preferred language free of charge in a timely manner. Similarly, the patient should not be excluded from access to care or discriminated against based on race, color, national origin, sex, gender, sexual orientation, and religion under Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d. If patients are not offered reasonable and adequate language services, they are entitled to file a civil rights complaint to the Office for Civil Rights (OCR). Subsequently, if an entity or physician does not rectify practices, the OCR may seek further actions to suspend or terminate federal financial assistance from the United States Department of Health and Human Services.
Medical Interpreters: Expectations
The role of medical interpreters is to facilitate the exchange of communication between a patient and a provider as verbatim as possible in consideration of cultural practices, context, slang, and linguistic variation within spoken language during the assigned appointment time. Arrangements for consistent matching of interpreter to patient in future appointments are not necessary. Medical interpreters must demonstrate fluency in at least two languages and must complete formal classroom training and examinations that include medical terminology, healthcare systems, sensitivity, roles/limitations, colloquialisms, and the course of medical visits in diverse settings. Their code of professional standards and ethics emphasize accuracy, HIPAA, cultural awareness, impartiality, and advocacy. Because The National Board of Certified Medical Interpreters (NBCMI) and the Certification Commission for Healthcare Interpreters (CCHI) only offer certifications for languages in high demand, not all medical interpreters are certified in addition to their required formal training.
To comply with Section 1557 of the Patient Protection and Affordable Care Act, interpretation must be conducted by a properly trained individual. Google, family members, friends, and bilingual office staff are not equivalent to a qualified interpreter despite fluency. A bilingual staff member may exclusively serve if they have formal training in medical interpreting. The use of patients' family and friends contributes to health disparities, HIPPA violations, and unnecessary trauma, leading to inaccurate, coercive, and biased communication. The only exceptions include emergencies with imminent threat to the safety or welfare of an individual or the public, providers that only benefit from Medicare Part B, and when a LEP patient denies language services despite full understanding that a qualified interpreter is available free of cost. In the latter, the person interpreting may not be a minor.
Clinical Outcomes
LEP patients are especially vulnerable to serious medical errors that may compromise quality of care and even contribute to morbidity and mortality. Using language services in anesthesiology ensures that patients are educated on their pre-operative instructions and preparation, magnitude of their condition and needs, schedule expectations, and future steps for adequate follow up. This is especially valuable for referrals, medication reconciliation, pharmacy, and patient identification of warning signs for possible complications. With access to a deeper level of communication that would otherwise not be possible with LEP patients, the anesthesiology team is able to collect a complete medical history, identify minimizing report of pain, use of alternative medicine that may impact physiology, and relevant cultural beliefs. On the other hand, this offers patients the opportunity to build trust in the team, adequately provide informed consent, and address barriers to perioperative compliance. Collaboration with medical interpreters increases patient healthcare literacy, perioperative safety, and optimizes post-operative comfort and recovery; increased awareness of medical interpreters and reduction of language barriers by anesthesiology teams have the potential to greatly reduce perioperative complications and costs associated with surgical delays and readmission.
References
A Quick Guide to Medical Interpreters in Healthcare and Anesthesiology. Mort CM. 2022. https://www.asahq.org/education-and-career/asa-medical-student-component/a-quick-guide-to-medical-interpreters-in-healthcare-and-anesthesiology
Detailed languages spoken at home and ability to speak English for the population 5 years and over: 2009-2013. U. S. Census Bureau. https://www.census.gov/data/tables/2013/demo/2009-2013-lang-tables.html. Reviewed November 30, 2021.
U.S. Census Bureau QuickFacts: United States. U. S. Census Bureau. https://www.census.gov/quickfacts/geo/chart/US/POP815219
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