312 Language Diversity and Challenges to Communication in Indian Emergency Departments

Abstract

While communication is always a challenge in health care delivery, emergency departments (ED) in India have an added layer of complexity as the population displays significant language diversity with regional variations. Prior research done in India revealed challenges in language and communication as barriers to care. The objective of this study was to better understand the challenges to effective communication pertaining to patient and provider interactions in a sample of EDs in India in order to determine strategies for improvement. This study was carried out in the summer of 2017 at 6 collaborating sites across India. Semi-structured interviews were conducted with the emergency medical services (EMS) staff/techs, nurses, residents, and attending physicians working in the ED. The interview questions were designed to capture themes pertaining to patient-provider and provider-provider interactions. The data was analyzed using a rapid assessment process. A total of 106 participants were interviewed in a combination of group and individual interviews. This included 20 EMS staff/techs, 20 nurses, 52 residents, and 14 ED attending physicians. Within provider-patient interactions, the theme of language discordance was frequently identified as an issue. While translator services were often provided by the hospital for international patients, examples were cited with no formal translation for domestic out-of-state patients. Resident physicians from out-of-state reported having to learn the local language with help from colleagues; however, they often recalled adverse events occurring, especially in the first year. Participants reported that low health literacy among patients and family members, a paucity of widely-known medical terms in the local language, and an overall reluctance to accept the severity of medical diagnoses further complicated effective communication. All of these issues contributed to examples of challenging patient care scenarios. When discussing provider-provider communication, many participants cited positive experiences, often referring to their coworkers as their ED family. Upon further probing, situations were identified during which communication challenges were noted, including patient handover, high volume scenarios, and times of provider fatigue. Providers also cited workplace hierarchy as an obstacle to open channels of communication. In addition, EMS staff/techs, nurses, and physicians reported inconsistencies in written and verbal orders as a source of confusion, especially during high patient volumes. This study documents the impact of language diversity and communication barriers in the setting of Indian EDs. The findings revealed the impact the use of multiple languages had on interactions with patients and amongst providers. The results highlight the need to develop effective means to communicate health information to patients of low health literacy, prepare patients for the flow of the ED system, and provide residents language training support. More widespread translator services may be an important tool to consider in the future.