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Are language barriers associated with serious medical events in hospitalized pediatric patients?
Adam L Cohen1, Frederick Rivara, Edgar K Marcuse
1Child Health Institute, Department of Pediatrics, University of Washington, Children's Hospital and Regional Medical Center, Seattle, Washington, USA. alcohen@u.washington.edu
Insights
Language barriers in pediatric hospitals do not increase overall medical errors. However, Spanish-speaking patients requiring interpreters face a doubled risk of serious medical events, highlighting a critical communication gap.
Area of Science:
- Medical error research
- Patient safety
- Health disparities
Background:
- Language barriers impede effective patient-provider communication.
- Communication challenges can lead to medical errors, impacting patient safety.
Purpose of the Study:
- To investigate if language barriers increase serious medical errors in hospitalized pediatric patients.
- To compare error rates between pediatric patients with and without family language barriers.
Main Methods:
- A case-control study was conducted in a children's hospital.
- Case patients (n=97) had serious medical events; control patients (n=475) did not.
- Language barrier was defined by interpreter need; serious events were identified by quality improvement staff.
Main Results:
- No overall increased risk for serious medical events was found for patients needing interpreters.
- Spanish-speaking patients requiring interpreters had a twofold increased risk of serious medical events.
- Odds ratio for Spanish-speaking patients needing interpreters was 2.26 (95% CI: 1.06-4.81).
Conclusions:
- Spanish-speaking pediatric patients with language barriers face a significantly higher risk of serious medical events.
- Targeted interventions are needed to mitigate risks associated with language barriers in pediatric care.
- Addressing language barriers is crucial for improving safety and equity in pediatric hospitalizations.
Objective:
Language barriers may lead to medical errors by impeding patient-provider communication. The objective of this study was to determine whether hospitalized pediatric patients whose families have language barriers are more likely to incur serious medical errors than patients whose families do not have language barriers.
Methods:
A case-control study was conducted in a large, academic, regional children's hospital in the Pacific Northwest. Case patients (n = 97) included all hospitalizations of patients who were younger than 21 years and had a reported serious medical event from January 1, 1998, to December 31, 2003. Control patients (n = 475) were chosen from hospitalizations without a reported serious medical event and were matched with case patients on age, admitting service, admission to intensive care, and date of admission. The main exposure was a language barrier defined by self- or provider-reported need for an interpreter. Serious medical events were defined as events that led to unintended or potentially adverse outcomes identified by the hospital's quality improvement staff.
Results:
Fourteen (14.4%) of the case patients and 53 (11.2%) of the control patients were assigned an interpreter during their hospitalization. Overall, we found no increased risk for serious medical events in patients and families who requested an interpreter compared with patients and families who did not request an interpreter (odds ratio: 1.36; 95% confidence interval: 0.73-2.55). Spanish-speaking patients who requested an interpreter comprised 11 (11.3%) of the case patients and 26 (5.5%) of the control patients. This subgroup had a twofold increased risk for serious medical events compared with patients who did not request an interpreter (odds ratio: 2.26; 95% confidence interval: 1.06-4.81).
Conclusions:
Spanish-speaking patients whose families have a language barrier seem to have a significantly increased risk for serious medical events during pediatric hospitalization compared with patients whose families do not have a language barrier.
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