Errors of Medical Interpretation and Their Potential Clinical Consequences: A Comparison of Professional Versus Ad Hoc Versus No Interpreters - 20/10/12

Doi : 10.1016/j.annemergmed.2012.01.025

Glenn Flores, MD ^a,^b,^⁎ , Milagros Abreu, MD, MPH ^c, Cara Pizzo Barone, MD ^d, Richard Bachur, MD ^e, Hua Lin, PhD ^a
^a Division of General Pediatrics, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
^b Children's Medical Center, Dallas, TX
^c Department of Epidemiology, Boston University School of Public Health, Boston, MA, and the Latino Health Insurance Program, Inc, Framingham, MA
^d Palo Alto Medical Foundation, Palo Alto, CA
^e Division of Emergency Medicine, Children's Hospital Boston, Boston, MA

Address for correspondence: Glenn Flores, MD

Résumé

Study objective

To compare interpreter errors and their potential consequences in encounters with professional versus ad hoc versus no interpreters.

Methods

This was a cross-sectional error analysis of audiotaped emergency department (ED) visits during 30 months in the 2 largest pediatric EDs in Massachusetts. Participants were Spanish-speaking limited-English-proficient patients, caregivers, and their interpreters. Outcome measures included interpreter error numbers, types, and potential consequences.

Results

The 57 encounters included 20 with professional interpreters, 27 with ad hoc interpreters, and 10 with no interpreters; 1,884 interpreter errors were noted, and 18% had potential clinical consequences. The proportion of errors of potential consequence was significantly lower for professional (12%) versus ad hoc (22%) versus no interpreters (20%). Among professional interpreters, previous hours of interpreter training, but not years of experience, were significantly associated with error numbers, types, and potential consequences. The median errors by professional interpreters with greater than or equal to 100 hours of training was significantly lower, at 12, versus 33 for those with fewer than 100 hours of training. Those with greater than or equal to 100 hours of training committed significantly lower proportions of errors of potential consequence overall (2% versus 12%) and in every error category.

Conclusion

Professional interpreters result in a significantly lower likelihood of errors of potential consequence than ad hoc and no interpreters. Among professional interpreters, hours of previous training, but not years of experience, are associated with error numbers, types, and consequences. These findings suggest that requiring at least 100 hours of training for interpreters might have a major impact on reducing interpreter errors and their consequences in health care while improving quality and patient safety.

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Plan

Introduction

Background

Importance

Goals of This Investigation

Materials and Methods

Primary Data Analysis

Results

Limitations

Discussion

	Supervising editor: Robert L. Wears, MD, PhD
	Author contributions: GF had full access to all study data, takes responsibility for the data integrity and accuracy of the data analysis, was responsible for study concept and design, obtained funding, and provided administrative, technical, and material support. GF, MA, CPB, and RB were responsible for acquisition of data. GF, MA, and HL were responsible for analysis and interpretation of data. All authors drafted the article and were responsible for critical revision of the article for important intellectual content and final approval of the version to be published. HL was responsible for statistical analysis. GF and MA supervised the study. GF takes responsibility for the paper as a whole.
	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Funded in part by a grant from the Office of Minority Health, US Department of Health and Human Services.
	Please see page 546 for the Editor's Capsule Summary of this article.
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	Publication date: Available online March 15, 2012.