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Language barriers keep parents from asking questions about kids’ care

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Handoffs are the most dangerous number of patient cares: When one team of caregivers pass the case to the next shift, the clinician neglects to write down important observations or forgets to enter an order for the test before returning home. You may not even notice that the medicine was ordered. You didn’t arrive by morning overnight.

However, hand-over does not have to be very dangerous, and patients and their families themselves can provide valuable protection against medical malpractice resulting from these inevitable transitions. Especially for children, parents are those who find out if an infant’s prescription is accidentally exchanged or if the preschooler is still injured after it should have been relieved. With this expertise in mind, 32 hospitals Throughout the United States and Canada, we are improving transfer procedures and encouraging patients and families to participate in more processes. However, providers need to think carefully about how to do this, especially when parents and families care for children who are not fluent in English.

A New research announced at JAMA Pediatrics on Monday, surveys patients and families in pediatrics at 21 hospitals, and speaks when people who are not fluent in English are not good at asking questions about their care and think something is wrong. It turned out to be unlikely. An estimated 8.3% of people in the United States meet Federal standard English proficiency is considered limited.

According to the survey results, children who are not fluent in English and their parents are almost twice as unlikely to be afraid to ask “when something seems wrong” and “speak freely”. The possibility of saying is reduced to 1/4. If they find something that could adversely affect their care and are one-fifth likely to say “feel free to ask the decision or behavior of the healthcare provider.”Discovery echoes Past research It shows that the language barrier worsens health outcomes.

“Health providers and hospitals need to do a better job of helping non-English-speaking patients speak and ask questions safely,” said the lead author of the study, a pediatrician at Boston Children’s Hospital. Alisa Khan said.

For some researchers, the size of the inequality was alarming — and it could be even greater.

“I thought it was a conservative estimate because I had to fill out a questionnaire myself to complete the survey,” said Francesca Ganny, MD, Memorial Sloan Doctor and Head of Immigrant Health Cancer Disparity Service. Says. Kettering Cancer Center. Gany, who was not involved in the study, said the study design meant that the results could have excluded “people with even more difficult and lower literacy levels.”

Kahn said the findings were of particular concern given that clinicians did not consistently call for interpreters. Interpreters can help patients feel and hear in the clinic.

“In most cases, healthcare providers and hospitals don’t use interpreters when they need them, including those at very high risk, such as medications and procedure consents,” Khan said.

Under Federal law, Hospitals need to provide translators or interpreters free of charge to people with limited English proficiency. However, even if this obligation is adhered to, patients are not always treated the same in the routine care part, such as the daily “morning rounds” that take place during the midnight takeover between shifts. Not limited.

In pediatrics, these rounds are also called family-centric rounds because they take place in the children’s room. With the family.

“When I was a resident, we tended to have morning rounds in a conference room completely away from the patient’s bedside,” said Boston Children’s Hospital General Pediatric Director and Senior Author of the Study. One Christopher Landrigan said. Currently, he is involving his parents by having his parents start and end each morning round, avoiding medical terminology, and asking the family to summarize the discussions taking place between the care teams. increase.

However, patients and their families are not always consulted this way when an interpreter is needed, Khan said. Instead, some clinicians in these cases “skip the family-centric rounds and round outside the room,” she said, before giving the interpreter a high-level summary to the family. This may be because it is more convenient to request an interpreter for a longer time, or because the iPad used to call the interpreter in the video is limited.

Broadly speaking, experts said there was growing interest in both closing the care gap due to language access issues and family involvement in the morning round.

Nancy Specter, Physician and Senior Vice Dean of Drexel University, said: “Physicians can’t and shouldn’t be focused. They must be a group team that is truly patient-focused,” added Specter, senior author of the study.

Within a year, the team will publish another paper on health outcome data collected with patient and family surveys. And since their studies only included people who understood Spanish, Chinese, and Arabic, they want to work in additional languages ​​as well.

Both Kahn and Specter Cultural humility It will be a bigger aspect of care.

“The language itself is like the tip of the iceberg when thinking about working with people from other backgrounds and cultures,” Specter said. She raised an example where her grandfather, who was not involved in the round, was found to be influencing the patient’s mother to withhold medication. She was confused by the child’s ongoing illness and knew only on a detour that the child was not taking medicine.

In the meantime, experts say it is important to encourage families to ask if they need an interpreter before much more is done to reduce the language barrier in health care. “I tell my family that it’s your right to hire this interpreter. Ask for it,” Khan said. “Don’t hesitate.”

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