Professional Medical Interpreters Research Articles

Survey of perioperative utilization of professional medical interpreters for limited-English proficient patients: Towards a framework for systems-level improvement

IntroductionSurgical patients in United States’ hospitals have grown more linguistically diverse. However, professional medical interpreter (PMI) utilization remains inconsistent at many healthcare institutions for limited-English proficient (LEP) patients. Numerous studies demonstrate that inadequate perioperative access to PMI leads to worse care and outcomes for LEP patients. The perioperative setting presents unique challenges for providers in caring for LEP patients including obtaining informed consent, a transient team of multi-disciplinary providers, and the time pressure of operating room practice. ObjectiveOur study is the first to assess barriers to consistent PMI use in the immediate perioperative setting and to identify system-level approaches to improve PMI use. MethodWe surveyed a multidisciplinary team of perioperative nurses, advanced practice providers, anesthesiology and surgical trainees and faculty on their personal practices and perceived barriers to PMI use. An anonymous online 13-question survey was used. Answer options included rank order, multiple choice, Likert scale, and free text. Survey data was analyzed using univariate statistics and stratified based on providers having received information on the Title VI Civil Rights Act of 1964 and their medical training status. Pearson's chi-squared test was performed and odds ratios calculated to determine if these provider characteristics were associated with increased preference for PMI over bilingual staff and patients’ family members for interpretation and with other LEP evidence-based care practices. ResultsWe received a total of 262 responses with a 28.3 % response rate. Among survey participants, 19.1 % of participants did not know where to find patients’ language preferences in the electronic health record (EHR) and 69.8 % of participants did not know how to update language preferences in the EHR. When a bilingual staff was present, 31.0 % and 24.8 % of providers would forgo using video and phone PMI, respectively. Comparatively, trainees were more likely to use PMI instead of patients’ family or bilingual staff. Providers who received training on the Title VI Civil Rights Act of 1964 were more likely to use PMI for interpretation and provide translated consent forms, and least likely to utilize patients’ families for interpretation. Barriers to PMI use included difficulty obtaining video consoles or phones, long wait times for interpreters, unavailability of language, unfamiliarity with using video consoles or accessing interpreters, poor sound quality and internet connectivity issues. As many as 26 % of respondents cited time pressure for starting a surgical case as the reason for not using an interpreter. DiscussionBased on these survey results, we developed a framework for quality improvement initiatives to effect system-level change in similar high-output perioperative settings. This framework can be categorized into (1) process refinement and harnessing the EHR for identification and documentation of LEP status, (2) interdepartmental collaboration to address workflow constraints, technical issues and supply-demand mismatch, and (3) increasing awareness among leadership and providers about interpretation laws, cost reduction and improved outcomes with PMI use.

Relationship between Illness Perception and the need for Professional Medical Interpretation for International Patients in Japan.

This study aimed to conduct a cross-sectional questionnaire survey of foreign patients to analyze the impact of patients' illness perceptions on their need for professional medical interpreters. From February 2022 to May 2023, an online questionnaire was distributed to 4,962 individuals aged 18 years or older who were non-native speakers of Japanese. These individuals were enrolled in organizations such as international exchange associations and Japanese language support classes and had utilized medical institutions in Japan due to their own illness or injury or that of their children. Among the 312 valid responses, international patients with a high score for illness perception were more likely to want to utilize professional medical interpreters than those with a low score for illness perception (odds ratio, 1.968; 95% confidence interval, 1.044-3.709; P = 0.036). Our findings suggest that hospitals should be better prepared to meet the potential language needs of international patients with a higher illness perception.

Understanding Professional Medical Interpreters' Perspectives on Advancing Accurate and Culturally Informed Patient-Provider Communication for Filipinos in Hawai'i: Qualitative Analysis.

One in every eight persons in Hawai'i, USA, have limited English proficiency (LEP) and are entitled to free language assistance for federally funded services under Title IV of the Civil Rights Act of 1964. They also have the right to culturally and linguistically appropriate services (CLAS) provided by professional medical interpreters (PMIs). This study's goals were to uncover barriers and facilitators of CLAS from the perspective of PMIs. PMIs for Filipino languages (n = 10) participated in an online survey and semi-structured interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using conventional content analysis. Six themes emerged in the qualitative analysis: (1) cultural and social factors that can influence patient-provider communication; (2) barriers to effective patient-provider communication: patient, healthcare provider, and PMI levels; (3) facilitators of effective patient-provider communication: patient, healthcare provider, and PMI levels; (4) COVID-19 and remote interpreting barriers and facilitators; (5) strengths and weaknesses of in-person and stand-by interpreting appointments; and, (6) recommendations: system and provider levels. Proposed interventions could include advertising language services among Filipino communities and educating them about their language rights, providing additional resources for language assistance, employing more PMIs, training staff/providers, and supporting the use of PMIs versus untrained individuals.

28 Lost in Translation: Canadian Paediatric Resident Education and Practice of Clinical Translation Services

Abstract Background Canadian paediatric residents provide care to many families with non-English or French language preferences (NEFLP). Lack of communication in a family’s preferred language is inequitable and results in inferior care. Professional medical interpreters offer a route to enhanced understanding and safety. There is no data available about Canadian paediatric residents’ use of interpreters, making it difficult to identify gaps in practice or develop targeted interventions to improve patient experience. Objectives An anonymous, 19-item survey (REDCap) was designed to evaluate: (1) interpreter services available in paediatric training centers; (2) resident perception of their ease of access, utility, and value; and (3) barriers and drivers to interpreter use. This survey represents the first collection of data from Canadian paediatric residents about translator services. Design/Methods Eligible participants included all paediatric residents enrolled in an accredited Canadian paediatric training program. The survey was distributed by email and available for a three-month period. This project was reviewed and considered within the category of quality improvement and thus exempt from formal review by the hospital ethics committee. Descriptive statistics were performed in STATA v15.1. Results 122 residents (approximately 19% of eligible participants) responded. Approximately 40% reported no previous training in interpreter use, and 60% desired more training. Interpreter services are widely available but remain underused in a variety of clinical situations: interpreters are most often used during informed consent (98% ‘mostly’ or ‘always’), family meetings (97%), and history-taking (86%), and least often during physical examinations (41%) and bedside rounds (38%). Residents are more likely to use an interpreter if access is easy (97% ‘more likely’ or ‘likely’) or if there is extra time for the encounter (78%). Most residents (85%) felt they provide better care to patients who share their primary language (English or French), compared with families who prefer other languages. Conclusion Residents are more confident in their clinical and communication skills when working with families who share their primary language compared with NEFLP families, even when an interpreter is present. Our findings suggest that residents lack the training and confidence to provide equal care to families with varying language preferences. Paediatric training programs should develop curriculum content that not only targets safe and effective interpreter use, but also reviews non-spoken aspects of cultural awareness and safety.

Evaluation of Commercially Available Machine Interpretation Applications for Simple Clinical Communication.

Accessing professional medical interpreters for brief, low risk exchanges can be challenging. Machine translation (MT) for verbal communication has the potential to be a useful clinical tool, but few evaluations exist. We evaluated the quality of three MT applications for English-Spanish and English-Mandarin two-way interpretation of low complexity brief clinical communication compared with human interpretation. Audio-taped phrases were interpreted via human and 3 MT applications. Bilingual assessors evaluated the quality of MT interpretation on four assessment categories (accuracy, fluency, meaning, and clinical risk) using 5-point Likert scales. We used a non-inferiority design with 15% inferiority margin to evaluate the quality of three MT applications with professional medical interpreters serving as gold standards. Proportion of interpretation exchanges deemed acceptable, defined as a composite score of 16 or greater out of 20 based on the four assessment categories. For English to Spanish, the proportion of MT-interpreted phrases scored as acceptable ranged from 0.68 to 0.84, while for English to Mandarin, the range was from 0.62 to 0.76. Both Spanish/Mandarin to English MT interpretation had low acceptable scores (range 0.36 to 0.41). No MT interpretation met the non-inferiority threshold. While MT interpretation was better for English to Spanish or Mandarin than the reverse, the overall quality of MT interpretation was poor for two-way clinical communication. Clinicians should advocate for easier access to professional interpretation in all clinical spaces and defer use of MT until these applications improve.

Adherence With Oral Anticancer Therapies: Clinical Trial versus Real-World Experiences with a Focus on Prostate Cancer.

In this review, we address adherence rates in clinical settings, barriers to compliance with dosing schedules, and potential strategies to overcome challenges in maintaining high levels of adherence. Four studies reporting real-world adherence to prostate cancer medications, 52 studies describing barriers to adherence, and 16 studies on methods to minimize poor adherence were reviewed. Mean nonadherence rates of 25 to 51% have been identified in prostate cancer patients prescribed oral therapies, with higher rates in older patients. An extensive review of prostate cancer patients receiving gonadotropin hormone-releasing hormone agonist injections found an overall nonadherence rate of over 27%. Patients may encounter barriers to complying with dosing instructions related to the medication (eg, complex dosing schedules, the total burden of medication management, fasting or dietary requirements, high medication costs, adverse effects, and drug-drug interactions). Barriers may also be related to patient-specific factors (eg, suboptimal education regarding the importance of adherence, physical limitations and cognitive decline associated with advancing age, living alone without a care partner, high symptom burden, needle phobia, and comorbid mental disorders). Interventions to improve dosing adherence may include automated reminders, treatment diaries, educational materials, and the involvement of patients, family members, care partners, and healthcare teams. Many oral anticancer medications improve survival in men with prostate cancer and therefore it is vital to establish good adherence by understanding the pitfalls that patients may encounter. In situations where both oral and injectable drugs are interchangeable, injections of long-acting drugs lead to fewer opportunities for dosing nonadherence than oral therapies. In contrast, oral medicines do not require scheduling for injections and travel for injection appointments. Therefore, maximizing adherence to all treatment regimens will reduce the chance of efficacy failures and likely lead to improved clinical outcomes.

Enhancing Medical Communication and Care Through Professional Medical Interpreters

The quality of care provided to patients with limited English-language proficiency (LEP) is significantly affected by the appropriate use of interpreters.1,2 No formal curriculum on the use of professional medical interpreters (PMIs) exists in medical school or residency programs. Herein, I outline communication through PMIs who assist patients with LEP. These patients have a limited ability at speaking, reading, writing, or understanding the English language. Medical institutions should focus on emphasizing the importance of early education on the use of PMIs and integrating these in various teaching curricula.

Language is brain: Improving neurologic health equity for linguistically diverse populations

Neurologic clinical care requires that clinicians gather and synthesize complex information, including a thorough, precise history and a detailed physical examination that maximizes the patient’s cooperation. Yet, for patients who do not speak the dominant language in the country or region where they live, effective communication with their clinician may not always occur. In this article, we discuss the impact of language on neurologic care, focusing on access to care and on the diagnosis and treatment of two common and potentially life-threatening conditions: stroke and epilepsy. We then review implications for clinical neurologic care as well as medical education and present evidence-based recommendations for improving neurologic health equity for linguistically diverse populations. Strategies should integrate professional medical interpreters (for oral communication) and translators (for written materials) into the neurologic team, account for families and caregivers in a culturally humble manner, and teach learners to apply clinical neurologic skills in both language-concordant and discordant situations.

Educating Clinicians to Improve Telemedicine Access for Patients with Limited English Proficiency

The COVID-19 pandemic prompted the rapid incorporation of telemedicine into healthcare systems, resulting in increased access challenges for patients in the United States with limited English proficiency (LEP). Non-English-language speakers face challenges with telemedicine that magnify pre-existing barriers to language-appropriate care, such as difficulty accessing professional medical interpreters and navigating both electronic health information and online patient portals. Improved medical education on telehealth would increase equitable care for linguistic minorities. Medical education targeting telehealth care delivery should include clinician instruction on working with interpreters in telehealth contexts, increasing patient access to telehealth resources, and addressing patients’ language needs for telemedicine.

What's Lost in Translation: A Dialogue-Based Intervention That Improves Interpreter Confidence in Palliative Care Conversations

BackgroundFor US patients with limited English proficiency (LEP), diversity of language and culture can create potential health care disparities in discussions of prognosis and goals of care. Although professional medical interpreters are often thought of as language conduits, they are also trained as clarifiers and mediators of cultural barriers between providers, patients and their families. Identifying interpreter challenges in Palliative Care (PC) conversations and brainstorming and rehearsing solutions could improve their confidence interpreting PC encounters and being cultural mediators. MeasuresPre- and Pre/Postintervention PC confidence questionnaires. Intervention: six-session monthly dialogue-based course. OutcomesInterpreters showed significant increases in postintervention confidence in PC communication compared with pre-intervention (z = −5.646, P< 0.000). Conclusions/Lessons learnedThis dialogue-based intervention eliciting ongoing interpreter challenges, with PC social work facilitation and role-play with PC clinicians in a mutually respectful environment, significantly improved interpreter confidence in partnering with clinicians in PC conversations.

Spanish Medical Interpreters’ Management of Challenges in End of Life Discussions

ObjectiveProfessional medical interpreters facilitate patient understanding of illness, prognosis, and treatment options. Facilitating end of life discussions can be challenging. Our objective was to better understand the challenges professional medical interpreters face and how they affect the accuracy of provider-patient communication during discussions of end of life. MethodsWe conducted semi-structured interviews with professional Spanish medical interpreters. We asked about their experiences interpreting end of life discussions, including questions about values, professional and emotional challenges interpreting these conversations, and how those challenges might impact accuracy. We used a grounded theory, constant comparative method to analyze the data. Participants completed a short demographic questionnaire. ResultsSeventeen Spanish language interpreters participated. Participants described intensive attention to communication accuracy during end of life discussions, even when discussions caused emotional or professional distress. Professional strains such as rapid discussion tempo contributed to unintentional alterations in discussion content. Perceived non-empathic behaviors of providers contributed to rare, intentional alterations in discussion flow and content. ConclusionWe found that despite challenges, Spanish language interpreters focus intensively on accurate interpretation in discussions of end of life. Practice ImplicationsProvider training on how to best work with interpreters in these important conversations could support accurate and empathetic interpretation.

Medical Interpreting in Rwanda: Analysis of Challenges and Opportunities.

Though Rwanda is working hard to open its doors to foreign investors in many areas including health, it greatly lacks professional medical interpreters. Hospitals in the country still rely on ad hoc interpreters improvised from either medical staff or patients' family members. Hinging on co-construction theories developed by Berk-Seligson (1990), Metzger (1999), and Wandensjö (1995), this study considers medical interpreters as co-constructors and facilitators between patients and their health care providers. By means of quantitative and qualitative methods, the researcher used structured and semi-structured interviews to collect data from health care providers (HCPs), interpreters, patients, and family members in Rwanda. The results indicate that whenever communication difficulties arise between HCPs and patients, hospital staff or family members are often requested to serve as interpreters. This has a number of drawbacks such as difficulties by patients in understanding their doctors' responses related to their illnesses. Conversely, some HCPs may end up misinterpreting their patients' feelings. To avoid cases of misdiagnosis and inappropriate treatment, the present paper recommends the use of professionally trained medical interpreters.

Empowering Interpreters to Partner in Palliative Care Conversations: Effect of a Dialogue-Based Curriculum on Interpreter Attitudes and Confidence (GP701)

•Design a 6-session curriculum for their practice site to improves dialogues with face-to-face interpreters who partner with them in conducting palliative care conversations with patients and their families with limited English proficiency.•Plan to overcome barriers in their practice site to conducting the dialogues, identify colleagues to be recruited to join the sessions (e.g. social workers, chaplains), and identify resources needed (e.g. financing lunches or afternoon snacks). Effective communication across cultural and linguistic barriers during breaking bad news, DNR, and EOL conversations requires professional medical interpreters skilled in PC communication and clinicians skilled in working with interpreters. Train interpreters in palliative care (PC) terminology; Train interpreters to be effective cultural brokers during PC conversations; Increase interpreters' sense of empowerment, professionalism, and team membership. A six-session curriculum: “Palliative Care Dialogues with Interpreters”, facilitated by an experienced PC social worker (SW) and physician, was delivered to medical interpreters from Brigham and Women's Hospital and Dana-Farber Cancer Institute. The curriculum included links to relevant materials, and structured 1-hour sessions including role-plays on: Initiating and managing a pre-encounter conference; Family meetings; Terms used in PC meetings; Family meetings to discuss code status and end of life-prolonging therapies; Cultural Mediating; Interpreting for SWs and chaplains (with SW and chaplains doing role plays); and Experiencing being a cultural mediator in End of Life Care. 41 participants completed a 23-question pre- and post-course survey on their attitudes towards and confidence in interpreting for palliative care conversations. There was a highly significant improvement in interpreter post-course attitude (N = 48; p=.0050) and confidence (N = 41. p=1.4080 x 10-11). Facilitated dialogues enabled interpreters to assert concerns, share knowledge, and practice new behaviors in a “safe” space, behaviors they reported they then used in clinical practice. Dialogues provided clinicians an opportunity to learn about the challenging linguistic, cultural and emotional experiences of medical interpreters. Facilitated and well-structured dialogues, including didactics, discussions and roleplaying caused highly significant improvements in interpreter attitudes about and confidence in interpreting PC conversations.

Barriers to health care services in migrants and potential strategies to improve accessibility: A qualitative analysis

While migrants in Taiwan are entitled to universal health care, barriers to health care services exist. We aimed to explore challenges encountered by migrants when accessing health care services and potential strategies to overcome these barriers. Invitations to participate in the study were sent to all hospitals, 12 migrant organizations, one language school, and one language service company in Taiwan, and convenience sampling was used to recruit study participants. Focus group interviews were held with 111 migrants, clinicians, migrant organization coordinators, and representatives from the medical institutions, language school and language service company. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using a thematic approach. The study participants acknowledged that the current support system for migrants in the health care sector is inadequate. Barriers to health care services were noted in three areas - language and information, sociocultural and economic, and policy and resources. Potential strategies to overcome these barriers included the provision of on-site or distant interpreting services, provision of multilingual instruction notes and forms, and establishing a multilingual medical assistance hotline. While migrants benefit from the current support and welfare system, our study found substantial gaps that need to be filled including a lack of professional medical interpreters and training programs, a lack of legal framework for medical interpreting, and inadequacy in the dispersal of information on existing resources that may facilitate the integration of migrants into society and the health care system. Overcoming these barriers may improve migrants' access to health services.

Empowering interpreters to partner in palliative care (PC) conversations: Effect of a dialogue-based curriculum.

21 Background: Effective communication across cultural and linguistic barriers during breaking bad news, DNR, and EOL conversations requires professional medical interpreters skilled in PC communication and clinicians skilled in working with interpreters. But interpreters are rarely included in meetings preceding these conversations, or made aware of the patient’s prognosis or the emotionally-charged subjects likely to arise. They may know the patient and family, cultural norms, and identify the decision makers, but often do not feel empowered to offer this crucial information to clinicians. To be effective cultural brokers, interpreters must be trained in PC terminology and feel empowered to contribute. Methods: A six-session curriculum: Palliative Care Dialogues with Interpreters, facilitated by an experienced PC social worker (SW) and physician, was delivered to medical interpreters from Brigham and Women’s Hospital and Dana-Farber Cancer Institute. The curriculum included links to relevant materials, and structured 1-hour sessions including role-plays on: Initiating and managing a pre-encounter conference; Family meetings; Terms used in PC meetings; Family meetings to discuss code status and end of life-prolonging therapies; Cultural Mediating; Interpreting for SWs and chaplains (with SW and chaplains doing role plays); and Experiencing being a cultural mediator in End of Life Care. 41 participants completed a 23-question pre- and post-course survey on their confidence in interpreting these conversations. Results: There was a highly significant improvement in interpreter post-course confidence ( N = 41. p=1.4080 x 10−11). Facilitated dialogues enabled interpreters to assert concerns, share knowledge, and practice new behaviors in a “safe” space, behaviors they reported they then used in clinical practice. Dialogues provided clinicians an opportunity to learn about the challenging linguistic, cultural and emotional experiences of medical interpreters. Conclusions: Facilitated and well-structured dialogues, including didactics, discussions and roleplaying caused highly significant improvements in interpreter confidence in interpreting PC conversations.

Partnering With Interpreter Services: Standardized Patient Cases to Improve Communication With Limited English Proficiency Patients.

As the number of patients with limited English proficiency grows, there is increasing awareness in the medical community about disparities in health outcomes for this population. The proper use of professional medical interpreters improves communication between physicians and patients with limited English proficiency. Typically, however, little curricular time in medical training is devoted to this competency. We developed a two-station objective structured clinical examination (OSCE) in which learners worked with interpreters to conduct medical interviews with Spanish-speaking standardized patients (SPs). Cases were designed for use with residents from any medical specialty and to have personal and emotional richness in keeping with the real-life circumstances of many patients. Twelve residents from six medical specialties completed a session evaluation and were assessed by faculty, SPs, and interpreters using existing validated instruments and case-specific checklists. All residents reported that the cases mimicked real patient encounters. The checklists were well received and easy to use. While scores varied between residents, deficiencies were identified in basic communication skills for interacting with a non-English-speaking SP through an interpreter, including maintaining proper eye contact and open body posture with patients and introducing and clearly articulating the role of the interpreter. A two-station OSCE utilizing professional medical interpreters and Spanish-speaking SPs was well received by all participants. Residents' scores helped identify common skill gaps in their work with interpreters. Based on the success of the pilot deployment, we plan to target educational interventions at these common deficiencies and offer the OSCE to more trainees.

Physician perceptions of the types of roles interpreters play in limited English proficient pediatric encounters and how they evaluate the quality of interpretation.

The purpose of this study is to understand different roles that interpreters play in a pediatric, limited English proficient (LEP) health care encounter and to describe what factors within each role inform physicians' assessment of the overall quality of interpretation. Language barriers contribute to lower quality of care in LEP pediatric patients compared to their English-speaking counterparts. Use of professional medical interpreters has been shown to improve communication and decrease medical errors in pediatric LEP patients. In addition, in many pediatric encounters, interpreters take on roles beyond that of a pure language conduit. We conducted 11 semi-structured interviews with pediatricians and family medicine physicians in one health system. Transcripts were audio-recorded and transcribed verbatim. We analyzed our data using directed content analysis. Two study team members coded all transcripts, reviewed agreement, and resolved discrepancies. Physicians described four different interpreter roles: language conduit, flow manager, relationship builder, and cultural insider. Within each role, physicians described components of quality that informed their assessment of the overall quality of interpretation during a pediatric encounter. We found that for many physicians, a high-quality interpreted encounter involves multiple roles beyond language transmission. It is important for health care systems to understand how health care staff conceptualize these relationships so that they can develop appropriate expectations and trainings for medical interpreters in order to improve health outcomes in pediatric LEP patients.

What's Lost in Translation: A Structured Series of Dialogues Exploring Challenges Experienced by Medical Interpreters Providing End-of-Life Care and Offering Strategies to Overcome Them (FR416)

•Gain the ability to describe the impact of including professional interpreters in family meetings to overcome cultural and linguistic barriers to palliative care.•Identify linguistic and cultural challenges faced by interpreters during palliative care encounters and describe methods the palliative care clinician can use to support and enhance the role of the interpreter in these encounters.•List at least three reasons why pre-encounter huddles with interpreters are needed for optimal communication across language and cultural barriers, and three strategies interpreters can use to optimize their chances of being included in the huddle. The United States is becoming increasingly diverse with over 300 languages spoken in homes across the country. When this diversity of language and culture is encountered in healthcare settings, our Western healthcare culture may bump up against that of a patient and family. Language barriers may result in healthcare disparities when professional medical interpreters are not available or not accessed. The need for effective navigation of language and cultural barriers is no more urgent than in the field of palliative care, health care that emphasizes effective communication and attention to psychosocial needs of patients and families. Effective communication across cultural and linguistic barriers requires the skills of professional medical interpreters. It also requires good teamwork between providers and medical interpreters. Yet this teamwork can present challenges as interpreters are not always members of a palliative care team, and may not even be known to the palliative care team. Providers may have a limited view of interpreters as language conduits doing little more than providing a translation of what they say. The presenters created a series of facilitated dialogues with professional medical interpreters to learn from them about their needs, their challenges and how to better work with them to improve patient care and to mediate their experience of vicarious trauma. These dialogues included interpreters, physicians, social workers and a chaplain all from the palliative care team at a large tertiary care inpatient facility. Interpreters shared their unique stressors. These included difficulties interpreting end of life vocabulary, violating cultural norms of their patients and families, experiencing emotional, cognitive and mental stress when not included in pre-encounter huddles. This presentation will provide participants with a description of how the dialogues were developed, lessons learned from having the conversations and the value of this modality for improving interpreter/provider communication.

“It’s the difference between life and death”: The views of professional medical interpreters on their role in the delivery of safe care to patients with limited English proficiency

BackgroundPatients with limited English proficiency (LEP) experience poorer quality care and more adverse events in hospital. Consequently, there is interest in understanding the role of professional medical interpreters in efforts to improve patient safety.ObjectiveTo describe the views of professional medical interpreters on their role in the delivery of safe patient care.DesignQualitative analysis of in-depth semi-structured interviews.Participants15 professional medical interpreters affiliated with the Healthcare Interpretation Network in Toronto, Canada.ApproachParticipants’ views on their role in patient safety were analyzed and organized into themes.Key resultsProfessional medical interpreters described being uniquely situated to identify and prevent adverse events involving patients with LEP by: 1) facilitating communication and enhancing patients’ comprehension, 2) giving voice to patients, and 3) speaking up about safety concerns. Participants described a tension between ‘speaking up’ and interpreters’ ethical imperative to remain impartial. Interpreters also highlighted several challenges, including 4) medical hierarchy and healthcare providers’ limited knowledge of the role of interpreters. These challenges introduced safety issues if providers asked interpreters to act outside of their scope of practice.ConclusionsOur study found that professional medical interpreters view their work as integral to the delivery of safe care to patients with LEP. In order to effectively engage in patient safety efforts together, interpreters and providers require a mutual understanding of their roles. Team hierarchy and limited provider knowledge of the role of interpreters can introduce safety concerns. In addition, interpreters describe a tension between “speaking up” about patient safety and the need for interpreters to remain impartial when facilitating communication. Healthcare institutions, providers, and interpreters must engage in discussion on how to best to “speak up” and integrate interpreters into safety efforts. Importantly, the benefits of partnering with interpreters can only be realized when providers consistently use their services.

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English.

BackgroundThe inability to communicate effectively in a common language can jeopardize clinicians’ efforts to provide quality patient care. Professional medical interpreters (PMIs) can help provide linguistically appropriate health care, in particular for the >25 million Americans who identify speaking English less than very well. We aimed to evaluate the relationship between use of PMIs and quality of acute ischemic stroke care received by patients who preferred to have their medical care in languages other than English.Methods and ResultsWe analyzed data from 259 non–English‐preferring acute ischemic stroke patients who participated in the American Heart Association Get With The Guidelines–Stroke program at our hospital from January 1, 2003, to April 30, 2014. We used descriptive statistics and logistic regression models to examine associations between involvement of PMIs and patients’ receipt of defect‐free stroke care. A total of 147 of 259 (57%) non–English‐preferring patients received PMI services during their hospital stays. Multivariable analyses adjusting for other socioeconomic factors showed that acute ischemic stroke patients who did not receive PMIs had lower odds of receiving defect‐free stroke care (odds ratio: 0.52; P=0.04).ConclusionsOur findings suggest that PMIs may influence the quality of acute ischemic stroke care.