How Effective is Communication in the ICU with the Use of Medical Interpreters?
How Effective is Communication in the ICU with the Use of Medical Interpreters?
Abstract & Commentary
By Ruth M. Kleinpell, PhD, RN, Center for Clinical Research and Scholarship, Rush University Medical Center; Rush University College of Nursing, Chicago, IL, is Associate Editor for Critical Care Alert.
Dr. Kleinpell reports no financial relationship to this field of study.
Synopsis: This study examined the accuracy of translations provided by medical interpreters during intensive care unit (ICU) family conferences and found that a significant proportion of medical interpretation resulted in additions, omissions, substitutions and editorializations, some of which had potential negative effects including interference with the transfer of information and treatment decision making, which could potentially influence family member understanding and decision making about ICU patient care.
Source: Pham K, et al. Chest. published online on March 17, 2008
Effective patient communication is a critical component to ICU patient care and to family member understanding of a critical illness. Pham and colleagues examined the accuracy of medical interpretation provided by trained medical interpreters for ten ICU family conferences at two hospitals which involved the participation of 70 family members. Interpretation alterations were identified through the use of audiotapes and grouped into categories impacting communication between health care providers and family members.
A total of 583 interpreted passages were examined. Alterations of interpretation were common in ICU family conferences, occurring in 55% (322/583) of all interpreted speech passages. Comparisons of clinician and family member communications revealed a similar proportion of translation alterations, with translation alterations occurring in 54% (261/480) of interpreted clinician speech passages and 58% (61/103) of interpreted family speech passages. Of these, 93% were identified to interfere with the goals of the conference (negative alteration) and 7% were deemed to enhance the goals of the conference (positive alteration). During clinician speech, omissions and editorializations were most likely to be potentially clinically significant (85% for omissions and 83% for editorializations) while during family speech, omissions had the highest likelihood of significance (95%).
The most frequent translation occurrence was a change in the information being conveyed, with the majority of the alterations being associated with changes in the description of the patient's disease or prognosis. Potentially clinically significant alterations in translation included interpretation changes in the wording of medical terminology, interpretation error in translating clinician communications, interpretation failure to convey the healthcare team's recommendations or goals regarding treatment, failure to convey patient or family preferences for care, and failure to convey family or clinician questions. The findings of the study suggest that alterations in medical interpretation occur frequently during ICU family conferences and have the potential for negative consequences on identifying appropriate treatment preferences and goals of care for critically ill patients.
Commentary
Ensuring effective patient communication is an essential component of patient care.
Research has demonstrated that the use of ad hoc interpreters leads to increased miscommunication and medical errors, which can result in ineffective patient and family communication.1-3 Providing accurate translation of communications between the healthcare team and family members utilizing medical interpreters for critically ill patients is an essential component in assuring appropriate and desired treatment preferences. The results of this study highlight that even with the use of trained medical interpreters, inaccuracies in communication frequently occur.
Patient outcomes are influenced by their ability and the ability of their family members to communicate effectively and participate in their care. The literature on health literacy pertaining to hospitalized patients acknowledges the importance of making effective communication a priority to ensure patient safety and to address patient communication needs.4 This study demonstrated that a number of alterations can occur with the use of trained medical interpreters during ICU family conferences. As accurate communication between healthcare professionals and family members of critically ill patients can directly impact the exchange of information as well as treatment preferences and decision making, strategies to enhance communication need to be further investigated to ensure that effective communication is incorporated into the plan of care for ICU patients.
References
- Flores G. Language barriers to health care in the United States. N Engl J Med. 2006;355(3):229-231.
- Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62:255-299.
- Rivadeneyra R, et al. Patient centeredness in medical encounters requiring an interpreter. Am J Med. 2000;108:470-474.
- Grubbs V, et al. Effect of Awareness of Language Law on Language Access in the Health Care Setting. J Gen Intern Med. 2006; 21:683-688.
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