The Impact of Language Barriers on Patient Safety in Pennsylvania: A Review of 336 Patient Safety Events

Christine E. Sanchez (chrsanchez@pa.gov) is a research scientist on the Data Science & Research team at the Patient Safety Authority. She is responsible for utilizing patient safety data, combined with relevant literature, to develop strategies aimed at improving patient safety in Pennsylvania.

In Pennsylvania, over half a million residents have limited English proficiency. Language barriers can pose a risk to patient safety. We aimed to investigate how language barriers impact healthcare facilities and patients in Pennsylvania.

We queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) database to identify reports related to a language barrier that were submitted between January 1, 2024, and December 31, 2024. Reports were manually reviewed to identify patient language, interpretation or translation challenges, clinical process issues, and impacts on patients related to a language barrier.

A total of 336 relevant reports were identified for analysis. Two languages, Spanish and Nepali, were most frequently reported to encounter a language barrier. An interpretation challenge was identified in 82.4% (277 of 336) of reports. Over half (57.0%; 158 of 277) of reports indicated that interpretation was not used because a certified interpreter was not available. Nepali was associated with 24.1% (38 of 158) of events where interpretation was not available, with a large proportion of these events concentrated in two contiguous Pennsylvania counties: Dauphin and Cumberland. The two most frequently reported issues related to translated materials were that they were not available (31.8%; 7 of 22) and the translation was incorrect or incomplete (31.8%; 7 of 22). The most commonly reported clinical process issue was a provider being unable to communicate diagnosis and/or treatment or care plan (57.9%; 33 of 57). The most frequently reported impact on the patient was missed or delayed patient care (55.8%; 53 of 95).

This analysis provides insights into language barriers and how they impact patient safety in Pennsylvania facilities. Despite previous research and current policies requiring the provision of certified interpreters and translated materials, language barriers still pose a risk to patient safety. By investigating these events we are able to provide strategies to supplement existing practices and policies to overcome language barriers and improve patient safety.

Communication during a medical encounter can be challenging, even when both the patient and their healthcare provider speak the same native language. So, imagine the added difficulty of discussing symptoms, diagnoses, and treatment when there’s a language barrier. Research shows that such communication issues can lead to longer hospital stays, greater risk of falls, delayed diagnosis and treatment, medication errors, and even death. An analysis of safety events reported in Pennsylvania—where more than 1.4 million residents speak a non-English language at home and more than 500,000 have limited English proficiency—reveals that language barriers continue to pose a risk to patient safety, despite policies requiring certified interpreters and translated materials be available to patients who need them.

Patient Safety Authority researchers identified 336 events reported to the Pennsylvania Patient Safety Reporting System (PA-PSRS) in 2024 relating to language barriers. The two languages most commonly involved in these reports were Spanish and Nepali, with issues including the lack of a certified interpreter, the lack of translated materials, and materials with inaccurate or incomplete translations. This study closely examines the interpretation and translation challenges faced by Pennsylvania patients and providers, and how they affect patient safety. It also provides strategies and recommendations for facilities to supplement available language services, such as hiring staff bilingual in English and the common languages of the service area and explaining common procedures with visual aids and pre-translated materials.

Keywords: interpretation, translation, dialect, Engglish, non-English speaking