Using professional interpreters lessens length of hospital stay

The scale of international migration has escalated with the advent of major relocation and displacement events over recent years caused by conflict, extreme violence, severe economic and political instability, and the impacts of environmental and climate change. The International Organization for Migration’s ‘World Migration Report 2020’ estimates the number of international migrants to be almost 272 million globally, and reports that with the rising magnitude and frequency of extreme weather events, migration will be increasingly affected. 

This rise in international migration and refugee resettlement has led to an increase in patients with limited English proficiency living in countries where English is an official language, such as the United States, Canada, United Kingdom and Australia.  A new systematic review explores the impact of professional interpreters on outcomes for hospitalised children from migrant and refugee families with limited English proficiency. Dr Sarah Cherian, co-author of the systematic review, explains the importance of the study:

 “Australia, along with many other countries, is culturally diverse with almost a third of the population speaking a language other than English. As such, healthcare providers need to ensure that health delivery for patients with limited English proficiency is accessible and delivered at the same standards compared to those that are native English speakers”. 

“There are data in adult populations that demonstrate worse healthcare outcomes for limited English proficiency patients when professional interpreters are not utilised, including increased length of stay and more frequent readmissions, as well as broader complications such as medication errors and lack of informed consent. Patients with limited English proficiency can also demonstrate more healthcare vulnerability due to limited health literacy, unfamiliarity with healthcare navigation and/or an inability to engage in complaints processes by the nature of language barriers”, Dr Cherian continues.

Six articles were included in the review, which included a total of 1813 families, of whom 1753 had limited English proficiency. The results of the systematic review demonstrate that use of ad hoc interpreters or no interpreter is inferior to use of professional interpreters:

“With the number of families with limited English proficiency rising in many English-speaking countries, there is an increasing need for interpreter services for effective communication to enhance care delivery, patient satisfaction and patient safety, and to decrease adverse events when families seek hospital care. The take-home message from the systematic review is that families with limited English proficiency require a professional interpreter whenever they seek healthcare to decrease children’s length of stay and increase comprehension of healthcare”, says Dr Cherian.

‘Professional interpreters’ are defined in the review as interpreters who practice in a hospital setting and have received training, and have skills and experience that are accredited by professional bodies. Dr Cherian adds that “Importantly, in Australia, use of professional interpreters aligns with the National Health Safety and Quality Standards (NHSQS), with key relevance to the domains of Clinical Governance (Standard 1), Medication Safety (Standard 4), Comprehensive Care (Standard 5) and Communicating for Safety (Standard 6)". 

The term ‘ad hoc interpreter’, on the other hand, is used in the systematic review to refer to a family member or friend. 

The researchers also found that the mode of delivery may not be as significant as the fact that a professional interpreter is being used:

“One finding that surprised us was the perspective that professional video interpretation was deemed equivalent to in-person professional interpreters by patients/caregivers. This may reflect the importance of harnessing the non-verbal aspects of language and interpretation, which are not possible when using telephone interpreters. Notably, the use of professional interpreters was superior to ad hoc interpreters, increased caregiver satisfaction and shortened length of time in emergency department when on-site interpreters were utilised”, says Dr Cherian.

In terms of implications for practice, Dr Cherian says that with the rise of COVID-related telehealth consultations, there is opportunity to utilise interpreters via video consultation, providing that families have capacity to navigate internet/technology. If video consultation is not feasible, using telephone interpreters is still superior to not providing limited English proficiency families with interpreters and will improve healthcare engagement, satisfaction and outcomes. 

Dr Cherian notes that the systematic review highlights the gap in medical literature around patients with limited English proficiency and inclusion in clinical research trials:   

“Despite the growing linguistic diversity of the population, there remain limited health data focusing on the use of professional interpreters, particularly in paediatrics or within Australia. The studies included in the systematic review were US based, focusing on the Hispanic population and predominantly in emergency department settings. As such, the small number of studies was not sufficient for high grade recommendations, nor did it capture engagement of patients on inpatient wards or outpatient settings.”

The systematic review therefore provides a recommendation for further high-quality paediatric research in order to explore the impact on interpreters on healthcare within both inpatient and outpatient settings, as well as in more ethnically diverse populations outside of the United States.

Resources

Systematic Review:

Boylen S, Cherian S, Gill FJ, Leslie GD, Wilson S. Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI Evid Synth 2020;18(7):1360-88.

Best Practice Information Sheet:

Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency