Limited Parental English Proficiency Tied to Adverse Events in Pediatric Patients

By Lisa Rapaport

October 20, 2020

(Reuters Health) - Hospitalized children are more likely to experience adverse events when their parents have limited English proficiency or don't feel comfortable speaking English, a new study in JAMA Pediatrics suggests.

Researchers examined medical records for patients aged 17 years and younger treated at pediatric units of seven North American hospitals from December 2014 to January 2017, and collected so-called language comfort data from 1,666 parents based on the language they preferred to use for conversations with nurses and physicians.

Overall, 147 parents (8.8%) reported limited comfort speaking English, and most of these individuals (71.4%) preferred to communicate with clinicians in Spanish.

Compared to kids whose parents were comfortable speaking English with providers, children whose parents had limited comfort speaking English were more likely to experience one or more adverse events (adjusted odds ratio 2.1) after accounting for factors like parental race and education as well as kids' comorbidities and length of stay.

In addition, 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 (aOR 2.3).

"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, Dr. Khan said by email.

"Interpreters are underutilized in hospitals, particularly for informal communications that doctors, nurses, and other staff have with patients and families throughout hospitalization," Dr. Khan added. "Clinicians may be busy or stressed and take shortcuts in communicating with families with language barriers."

Overall, researchers identified a total of 217 adverse events, including 142 preventable adverse events.

Adverse events were more common when children had longer mean length of stay and when kids were hospitalized prior to interventions they received during their stay. In addition, adverse events were more common when patients had one or more chronic medical conditions.

The study included parents who spoke Arabic, Chinese, English and Spanish. Among parents with limited comfort speaking English, 6.1% expressed a preference for speaking French, and 4.1% reported a preference for Arabic.

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 note. The languages spoken by parents expressing limited comfort with English also were not representative of the national population with limited English proficiency.

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," Dr. Flores, who wrote an editorial accompanying the study, said by email.

More training on how to identify these patients and then provide care aided by interpreters is also needed, Dr. Flores said.

"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," he said.

SOURCE: and JAMA Pediatrics, online October 19, 2020.