Patient Safety: Risk of Errors for Patients During Hospital Stay

This report examines the risks to patient safety, particularly those arising from communication errors and language barriers in hospital settings. The report begins by presenting a case study of a patient with limited English proficiency and outlines the potential risks she faces, including communication errors and adverse events. It then poses a research question about factors increasing patient safety events in hospitalized patients with limited English proficiency. The report details a search strategy using the PubMed database and specifies inclusion criteria for relevant articles. Five articles are reviewed, each addressing the impact of language barriers on patient safety, including medication errors, prolonged hospital stays, misdiagnosis, and poor understanding of treatment. The articles highlight the importance of language concordance, access to interpreters, and effective communication to prevent complications and improve patient outcomes. The report concludes by emphasizing the need to address communication barriers to ensure patient safety and quality of care.

Running head: PATIENT SAFETY
Patient safety:
Name of the student:
Name of the University:
Author’s note

1PATIENT SAFETY
Risk of errors for patient during hospital stay:
Druhi Neupane is a 48 year old lady who does not speak much English and her family
also have minimal knowledge of English. They have migrated to Australia from Nepal. Druhi is
at risk of communication errors and adverse events due to lack of proficiency in English
language and this can increase the likelihood of negative outcomes for patient. This is said
because language gap delays interaction with patient and lead to misinterpretation of patient’s
concern. Research study shows great association between language, serious adverse events and
length of stay is seen for patient with ethnic and language differences. A research done
regarding the evaluation of risk for adverse events among hospitalized children according to race
and language revealed that adverse event is high particularly in patients speaking other language.
In the study, the patients whose family spoke Spanish language were found to have significantly
longer hospital stays compared to those whose family spoke English (Lion et al. 2013). Hence, as
Druhi’s family also do not speak in English, Druhi is at risk of longer hospital stay.
Patients with limited English language proficiency (LEP) are more likely to be associated
with patient safety issues because language gap increases communication gaps and result in
misinterpretation of patient’s information. van Rosse et al. (2016) argues that language barrier
threatens quality of hospital care and the key situations where language barrier threatens patient
safety includes medication administration, pain management, fluid balance and patient-physician
interaction. Relatives of patient function as interpreter in case patient does not speak English.
However, this is also not possible for the care of Drugi. Hence, Druhi Neupane is at risk of
medication errors and adverse events because of communication error.

2PATIENT SAFETY
Search strategy:
Research question:
Based on the review of possible risk for Ms. Druhi during hospital stay, it has been
identified that patient safety risk and adverse events increase in such patient due to language gap
and communication errors. The research that can help to extract more details:
What factors increase risk of patient safety events in hospitalized patients with limited English
language proficiency?
Search strategy:
To find out relevant articles regarding the cause behind adverse event in patients with
English language knowledge, one data base that will help to retrieve relevant articles related to
the research question include the PubMed database. The key search terms that will help in
literature search includes ‘patient safety risk’, ‘communication error’, ‘adverse event’, ‘adverse
event in patient with LEP’ and ‘communication gap in patient with LEP’. The first strategy
would be to retrieve relevant papers using the basic search terms mentioned above. However,
advanced search will also be used by the use of Boolean operators like ‘AND’ and ‘OR’. The
search terms that has been developed using the Boolean operators are as follows:
 Adverse event AND patient with LEP
 Communication error AND patient with LEP
 Medication error AND patient with LEP

3PATIENT SAFETY
Apart from the search, the following inclusion criteria would ensure that relevant papers were
retrieved relevant to the research question:
 All the papers must be published within 2010 to 2019
 All papers must be discussing about any patient safety events
 All papers must have patient with LEP as the main research subject
Five articles relevant to the research question:
The following article has been found relevant to address the research question:
1. The article by de Moissac and Bowen (2018) provides an overview of impact of language
barriers on minority Francophones in Canada. This is relevant with the Druhi’s case
because it conducts study with Francophones who have limited English language just like
Druhi. It is a journal article that has explored experience of minority Francophones in
accessing health care service. By using online and paper based survey with patient and
interpreters, the study discussed about the impact of language concordance on effective
communication process. The study revealed that common patient safety risk seen in
patient with low LEP includes medication error, prolonged hospital stay and
readmissions. As Druhi lacks English language, hence this kind of risk is possible for her
too. In accordance with the research question, the articles give answers to the cause
behind patient safety risk in patients with LEP. The article mentions that language
concordance is affected due to language gap between care provider and patient and this
has an imppct on disease management process. The study gave examples of situation

4PATIENT SAFETY
where LEP contribute to inadequate health assessment, misdiagnosis, delayed treatment
and poor understanding of treatment. All this have an impact on quality of care.
2. The study by Lion et al. (2013) is relevant as it investigated about adverse event and
hospital stay in Spanish speaking family. As the research participants include those with
no knowledge of English, the article is relevant to the scenario of Druhi. By the analysis
of association between adverse event and length of hospital stay in Spanish children, the
study answered the research question by showing that communication is a risk factor for
serious adverse event and hospitalized Spanish speaking patients increased
communication gap in care. The study explained that length of hospital stay increase for
LWP patient as they wait longer for an interpreter. Hence, the study suggested addressing
communication barrier a necessary component for overall patient safety. The same
applies for Druhi too.
3. The analysis of Druhi’s case scenario revealed that communication gap is the main risk
factor of adverse event for patient. The reason for this is explained by a population based
cohort study done by Okrainec et al. (2015) which revealed that language barrier
increases risk of complication for patient. This was explained by showing that patients
with language barriers are more likely to experience avoidable emergency department
visit or hospitalization for complication. The study indicated access to language
concordance physicians, use of family members and professional interpreters as
necessary part of patient safety and preventing complication. However, all these elements
were lacking in the case of Druhi indicating risk of patient safety issues for her.
4. The study by Karliner, Pérez-Stable and Gregorich (2017) is relevant to the research
question because it deals with the subject of communication barrier and experience of

5PATIENT SAFETY
patient with LEP. By using experimental based study design, the study revealed that
quality of care for patient with LEP is compromised because of language barrier as it
leads to decreased comprehension of diagnosis, lower satisfaction with care, increase in
medication complication and poor adherence to treatment. Hence, these factors explain
why Druhi is likely to experience risk of patient safety and complications during hospital
stay.
5. The significance of the study by Nápoles et al. (2015) is that it aimed to address the issue
of poor quality of care for LEP patient. As Druhi also comes under the category of LEP
patient, this article is significant. The examination of errors in Spanish speaking Latino
patients revealed that diversity of language increase challenges for clinicians and they are
dependent on interpreters for interaction with patient thus comprising the quality of
communication. Hence, prevalence of poorer quality of care in LEP patient is mostly
seen because of communication errors that occur because of worse comprehension of
patient’s health and reduction in transmission of correct information to concern multi-
professional health care team. Therefore, the clinical significance of inadequate
interpretation is understood from this study and this gives the idea regarding why lack of
structure of meet language needs of Druhi can increase the likelihood of communication
errors and negative outcomes like adverse event and poor satisfaction with care.

6PATIENT SAFETY
References:
de Moissac, D. & Bowen, S., 2018, ‘Impact of language barriers on quality of care and patient
safety for official language minority Francophones in Canada’, Journal of Patient Experience,
p.2374373518769008.
Karliner, L.S., Pérez-Stable, E.J. & Gregorich, S.E., 2017, ‘Convenient access to professional
interpreters in the hospital decreases readmission rates and estimated hospital expenditures for
patients with limited English proficiency’, Medical care, Vol. 55, no. 3, p.199.
Lion, K.C., Rafton, S.A., Shafii, J., Brownstein, D., Michel, E., Tolman, M. & Ebel, B.E., 2013,
‘Association between language, serious adverse events, and length of stay among hospitalized
children’, Hospital pediatrics, Vol.3, no. 3, pp.219-225.
Nápoles, A.M., Santoyo-Olsson, J., Karliner, L.S., Gregorich, S.E. & Pérez-Stable, E.J., 2015,
‘Inaccurate language interpretation and its clinical significance in the medical encounters of
Spanish-speaking Latinos’, Medical care, Vol 53, no. 11, p.940.
Okrainec, K., Booth, G.L., Hollands, S. & Bell, C.M., 2015, ‘Impact of language barriers on
complications and mortality among immigrants with diabetes: a population-based cohort study’,
Diabetes Care, Vol. 38, no. 2, pp.189-196.
van Rosse, F., de Bruijne, M., Suurmond, J., Essink-Bot, M.L. & Wagner, C., 2016, ‘Language
barriers and patient safety risks in hospital care. A mixed methods study’, International journal
of nursing studies, Vol. 54, pp.45-53.