A patient arrives at an emergency department suffering from a serious illness. His initial contact, a triage nurse, must quickly determine a number of things: Is he a Level 1 patient with a migraine or is he at Level 5 and having a major heart attack? What's his medical history? Is he allergic to any medications?
There are also consent forms to fill out, medicines to explain, medical procedures that need to be communicated and accurately explained.
The catch: The patient doesn't speak the same language as the doctors, nurses and administrators.
This anxiety-provoking scenario plays out routinely in hospitals across the United States, and "we are only in our infancy in addressing the matter," says Dr. Val Warhaft, who has dealt with hospital language barriers firsthand for more than 25 years.
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"As an emergency department physician working at two in the morning, having someone with whom I cannot communicate with is very, very risky," says Warhaft, chief medical officer of Emergent Medical Associates, an organization that manages the emergency departments of several hospitals in Southern California.
A 2002 study conducted by Health Access, a nonprofit health care reform advocacy group in California, highlighted some blunders attributable to language barriers.
What about fatal mistakes? Amy Wilson-Stronks, a health services researcher at the Joint Commission on Accreditation of Healthcare Organizations, says they do occur, but it's hard to quantify how often. Preventable deaths are a sensitive issue, she says, because health care organizations don't want to be identified as providing lesser care to certain people.
Many employ bilingual staff to help alleviate the burden, but Warhaft says that comes at a cost.
"If I need to call down an intensive care unit nurse because she's the only one in the hospital who speaks a particular language, she must drop her duties, find herself down to the emergency department and help me communicate with my patient," Warhaft says. "She's a very expensive employee being paid to do one thing - now she's doing another."
The use of family members or friends is a risky alternative since they're more prone to commit errors, according to a 2001 study published in the journal Pediatrics. Such interpreters also can be insufficiently precise.
Warhaft recently joined the board of Language Access Network, an Ohio-based company that hopes to address some of the language problem through real-time video technology.
Last year the company began contacting hospitals in California, Florida and Ohio to introduce them to MARTTI (My Accessible Real-time Trusted Interpreter), a portable unit that connects doctors, nurses and patients with interpreters in Columbus - 40 people covering 100 languages, including sign language .