Evaluating a conceptual framework for quality assessment of medical interpretation

OBJECTIVE

We aimed to evaluate a proposed conceptual framework for quality assessment of medical interpretation using actual data from clinical settings.

METHODS

A mixed methods approach was used. Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese physicians, and hospital-provided and ad hoc interpreters were digitally recorded and transcribed. A questionnaire survey examining participants' satisfaction was conducted; 111 and 13 encounters by hospital-provided and ad hoc interpreters, respectively, were recorded. Segments of consecutively interpreted utterances were coded as "altered," whereby the interpreter changed the meaning of the source utterance, or "unaltered (accurate)." Frequency and type of alteration were analyzed. The effect of positive interpretation alterations on physician-patient interactions was qualitatively described.

RESULTS

Interpretation accuracy was significantly higher for hospital-provided interpreters, but was not associated with overall patient satisfaction. Overall physician satisfaction was associated with accurate interpretation, clinically negative altered interpretations, and positive voluntary interventions (p < 0.05). Positive alterations promoted patient, physician, and interpreter interactions, which helped to achieve clinical outcomes.

CONCLUSION

A new conceptual framework for quality assessment of medical interpretation was developed for clinical settings. Healthcare provider satisfaction can provide a measure of interpretation alterations.

PRACTICE IMPLICATIONS

Healthcare providers can effectively use the conceptual framework to improve medical interpretation and collaboration with healthcare interpreters.

[The need for medical interpreters: a questionnaire survey of municipal hospitals in Japan]

Objectives　This study aimed to investigate the need for medical interpreters, in relation to hospital size, the number of foreign patients accepting, and risk management in municipal hospitals in Japan.Methods　In 2016, we conducted a questionnaire survey at 894 municipal hospitals in Japan. The questionnaire included hospital characteristics, the number of foreign patients, the need for medical interpreters, and the respondents' background. We used the incident classification of the Safety Management Council of National University Hospitals (0-5 levels and others). We applied pairwise analysis to hospital size: small hospitals (20-99 beds), medium hospitals (100-399 beds), and large hospitals (400 or more beds).Results　The response rates of the small, medium, and large hospital were 30.1%, 32.5%, and 32.8%, respectively. The percentage of hospitals that had accepted foreign patients over the previous year ranged from 84.9% to 97.6%, a higher with larger hospitals. Larger hospitals attended to emergencies, hospitalization, and surgical patients more frequently than the smaller hospitals. Hospital staff who communicated with non-Japanese-speaking foreign patients via ad-hoc interpreters accompanying the patients ranged from 84.3% to 86.7% in larger hospitals. Of the staff at small, medium, and large hospitals, 66.7%, 58.5%, and 44.7%, respectively, considered the interpretations of the ad-hoc interpreters accompanying the patient to be accurate. Of the small, medium, and large hospitals, 31.6%, 76.5% and 92.3% claimed that they would use interpreting services if the interpretation costs were covered by the National Health Insurance System (P<0.001). When foreign patients are accepted, 75.7%, 84.7% and 94.6% of small, medium and large hospitals require trained medical interpreters, respectively (P=0.014). Hospital staff reporting that the most common reason for using an interpreter was to reduce medical risks ranged from 81.1% to 94.3%. Of the 274 hospital staff surveyed, 4.7% had experiences of incidents due to the language barriers when dealing with foreign patients. The incident classification was as follows: 3 cases with Impact Level 0, including MRI withdrawal; 9 cases with Level 1, including unauthorized discharge and self-extraction of an in-travenous drip; 1 case of precipitate labor; 1 case of Level 5 death; and 3 other cases. Small hospitals have not been reporting incidents, but larger hospitals, despite the small number of foreign patients, have been reporting incidents.Conclusion　Large or medium-sized hospitals need medical interpreters more than smaller hospitals because of the greater number of foreign patients being attended to, and diversity and complexity of reasons for seeking hospital services. Our results suggest that language barriers when dealing with foreign patients are a threat to patient safety. The majority of the responding Japanese municipal hospitals believe that they require trained language interpreters to improve risk management.