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Families Lacking English Fluency Risk Poor Patient Outcomes

— November 2, 2020

Children whose parents do non speak English tend to experience adverse conditions during hospital stays, study shows.

A new study published in JAMA Pediatrics details how hospitalized children with parents not fluent in the English language are more likely to experience adverse conditions and poor outcomes than those whose parents are proficient. The study included families who speak a variety of other languages, including Arabic, Chinese, English and Spanish.  Among those with limited comfort speaking English, “6.1% expressed a preference for speaking French, and 4.1% reported a preference for Arabic,” researchers reported.

The team analyzed hospital records for patients ages 17 years and younger treated at the pediatric units of seven North American hospitals from December 2014 to January 2017.  As part of the analysis, they collected “language comfort data from 1,666 patients,” targeting the family’s preferred language.  The findings suggest, overall, “147 parents (8.8%) reported limited comfort speaking English, and most of these individuals (71.4%) preferred to communicate with clinicians in Spanish.”

What’s more, children whose parents were uncomfortable with their English proficiency were more likely to be negatively impacted “after accounting for factors like parental race and education as well as kids’ comorbidities and length of stay,” according to the team.  The researchers added, “Children with parents who reported limited comfort speaking English with providers in the hospital were more likely to experience one or more preventable adverse events.”

Families Lacking English Fluency Risk Poor Patient Outcomes
Photo by Volodymyr Hryshchenko on Unsplash

“I believe that kids had more adverse events when parents had limited comfort with English because of a combination of factors, including communication disparities, implicit bias, and empowerment,” said lead study author Dr. Alisa Khan, an assistant professor of pediatrics at Harvard Medical School and a pediatric hospitalist at Boston Children’s Hospital. “Communication challenges are a root cause of medical errors in hospitals and families with language barriers are – by definition – more prone to communication challenges.  Interpreters are underutilized in hospitals, particularly for informal communications that doctors, nurses, and other staff have with patients and families throughout hospitalization.  Clinicians may be busy or stressed and take shortcuts in communicating with families with language barriers.”

As the length of in-patient stay increased, the probability for poor outcomes also increased.  This probability, too, went up when the patient went straight to in-patient care prior to any initial interventions and when the children suffered from one or more chronic medical illnesses making them more susceptible to poor outcomes.

“One limitation of the study is that it was conducted at academic centers, which may have different access to interpretation services and different parent populations than other hospitals, limiting generatability,” the authors noted.

“Still, the results underscore that clinicians should routinely screen all patients, and parents of pediatric patients, for limited English proficiency at admission,” said Dr. Glenn Flores, director of the Health Services Research Institute at Connecticut Children’s Medical Center in Hartford and a professor of pediatrics at the University of Connecticut School of Medicine in Farmington. “Because interpreters may be inconsistently used or not used at all, adverse events can result from delays in care, inaccurate assessment of the severity and duration of symptoms, inability of clinicians to accurately evaluate the hospitalized child’s daily progress and response to therapies, impediments to limited English proficiency parents communicating early indications of potential adverse reactions, and inability of limited English proficiency parents to inform clinicians of duplicate doses and procedures.”

Flores added, “More training on how to identify these patients and then provide care aided by interpreters is also needed.  Most clinicians do not receive training on how to identify those who need language services and how to provide those services and work with interpreters and translators.”


Association Between Parent Comfort With English and Adverse Events Among Hospitalized Children

Limited Parental English Proficiency Tied to Adverse Events in Pediatric Patients

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