title: Language barriers and patient safety risks in hospital care. A mixed methods study.
abstract: BACKGROUND
  A language barrier has been shown to be a threat for quality of hospital care. International studies highlighted a lack of adequate noticing, reporting, and bridging of a language barrier. However, studies on the link between language proficiency and patient safety are scarce, especially in Europe. The present study investigates patient safety risks due to language barriers during hospitalization, and the way language barriers are detected, reported, and bridged in Dutch hospital care.
  
  
  METHODS
  We combined quantitative and qualitative methods in a sample of 576 ethnic minority patients who were hospitalized on 30 wards within four urban hospitals. The nursing and medical records of 17 hospital admissions of patients with language barriers were qualitatively analyzed, and complemented by 12 in-depth interviews with care providers and patients and/or their relatives to identify patient safety risks during hospitalization. The medical records of all 576 patients were screened for language barrier reports. The results were compared to patients' self-reported Dutch language proficiency. The policies of wards regarding bridging language barriers were compared with the reported use of interpreters in the medical records.
  
  
  RESULTS
  Situations in hospital care where a language barrier threatened patient safety included daily nursing tasks (i.e. medication administration, pain management, fluid balance management) and patient-physician interaction concerning diagnosis, risk communication and acute situations. In 30% of the patients that reported a low Dutch proficiency, no language barrier was documented in the patient record. Relatives of patients often functioned as interpreter for them and professional interpreters were hardly used.
  
  
  CONCLUSIONS
  The present study showed a wide variety of risky situations in hospital care for patients with language barriers. These risks can be reduced by adequately bridging the language barrier, which, in the first place, demands adequate detecting and reporting of a language barrier. This is currently not sufficiently done in most Dutch hospitals. Moreover, new solutions to bridge language barriers are needed for situations such as routine safety checks performed by nurses, in which a professional or even informal interpreter is not feasible.
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands; Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: f.vanrosse@amc.uva.nl.
authors.forename: Floor
authors.initials: F
authors.lastname: van Rosse
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Martine
authors.initials: M
authors.lastname: de Bruijne
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands.
authors.forename: Jeanine
authors.initials: J
authors.lastname: Suurmond
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
mesh_terms: D003144:Communication Barriers; D006760:Hospitalization / Q000639:trends*; D009426:Netherlands; D061214:Patient Safety / Q000592:standards*; D011787:Quality of Health Care
keywords: Communication barriers; Hospital records; Patient safety; Quality of healthcare