Professional Translators in Emergency Rooms Reduce Medical Error

by Translation Guy on September 21, 2012

Professional interpreters cut the risk of medical miscommunication in half, according to a study recently published in the Annals of Emergency Medicine.

The study found that using professional linguists made a big difference. “The findings document that interpreter errors of potential clinical consequence are significantly more likely to occur when there is an ‘ad hoc’ or no interpreter, compared with a professional interpreter,” said lead researcher Glenn Flores, of the University of Texas Southwestern Medical Center. (Ad hoc interpreters are random bilinguals recruited on the spot to act as interpreters.)

The research team recorded conversations between Spanish-speaking families and emergency room doctors in two Massachusetts pediatric ERs. Of 57 analyzed, 20 encounters included professional interpreters, 27 ad hoc interpreters, and 10 occurred with no interpreters at all. Of 1,884 interpreter errors identified, 18% had potential clinical consequences, affecting diagnosis, drug dosages and course of treatment. The proportion of errors of potential consequence was lower for professional (12%) versus ad hoc (22%) versus no interpreters (20%).

In one typical example, a family friend assisting as an amateur interpreter told the doctor that the child under care was not on any medication and had no drug allergies, without actually asking the child’s mother to confirm.

While the sample size is small, the poor showing of ad hoc interpreters against no interpreters suggest that bad interpretation might be worse than none at all. Introducing an amateur translator into a patient care conversation may be like adding a joker to a deck of cards. Every poker player knows that wild cards increase risk.

The quality of ad hoc translators varies widely. A distraught family member in the emergency room is unlikely to perform as well as a hospital staff member regularly roped into an interpreter role. That both are sub-par is no surprise to those of us familiar with the challenge of identifying and training competent linguists.

Flores discovered that the quality of professional translators varied widely too. Those who had more than 100 hours of training were six times less likely to make an error than their untrained counterparts, reducing their clinical consequence error rate to 2%.

Dramatic results are the province of small sample sizes, but Flores’ findings reinforce my own impressions. Recourse to professionals is always the last choice of busy caregivers on their rounds, and patients may be paying a high price for the convenience of doctors and the desire of institutions to reduce un-reimbursable spend.

Flores plans to examine the difference in performance between telephone and on-site interpreters, a report I anxiously await.

MSNBC story here.


  1. Jenks says:

    At least distraught family members have some skin in the game.

  2. Marietta says:

    I think this should be mandatory for all hospitals to have at least a few translators on staff. And if they don’t have them on staff than to have them “on call” in case something happens and it needs translating. With professional translators on staff it might bring the errors of a hotel down. Great article!

  3. Sarah Lynch says:

    This seems rather common sense to me.

    • Ken says:

      Common sense isn’t all that common.

  4. The sample size is too small for my liking to draw any concrete conclusions, but I can understand the concern.

    • Ken says:

      That’s the problem with a lot of these studies.

  5. Anisa Hassan says:

    Right there with you, it’s borderline criminal, in fact these hospitals are wide open to malpractice suits.

  6. See, real health care reform should address issues like this.

  7. Lennox Termi says:

    I am never getting medical help from someone who can’t speak my language.

  8. I think that the instance of the fmaily friend and the child should not necessarily be classified as an amateur interpreter, as he may very well have been fluent in both languges, but just incredibly stupid.

  9. Kate says:

    The problematic element in this is cost, health care is already expensive, add in the cost of full time on staff translators and I’m sure it would be a frightening added expense.

    • Ken says:

      I read somewhere that it comes to around $25 per patient, a drop in the bucket compared to other costs. But I don’t have a citation. A good question and I should investigate.

  10. Lynn says:

    But how many languages must a hospital account for?

  11. Jean Bread says:

    Great article, certainly something everyone should know about and think hard about.

  12. Elena says:

    Not surprised in the least.

  13. Those numbers are just frightening.

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