Evidence Summary: Why focus on safety for patients with limited English proficiency?

TeamSTEPPS® Enhancing Safety for Patients With Limited English Proficiency Module

  • Patient safety events that affect limited-English-proficient (LEP) patients tend to be more severe and more frequently due to communication errors compared to English-speaking patients.1,2
  • LEP patients who do not receive professional interpretation at admission and discharge have greater lengths of stay and higher readmission rates compared to patients who receive professional interpretation services.3
  • Hospitals have been held liable for LEP patient safety events caused by poor patient comprehension of their medical condition, treatment plan, discharge instructions, complications, and followup; inaccurate and incomplete medical history; ineffective or improper use of medications or serious medication errors; improper preparation for tests and procedures; and poor or inadequate informed consent.4-6
    • One famous case cost a hospital $71 million.4
    • A malpractice carrier operating in four States found that LEP claims accounted for 2.5 percent of all claims (35 claims total) and cost more than $5 million over a 4-year period.5 Almost all of these claims related to poor communication and failure to provide a competent interpreter.
  • Compared to professional medical interpreters, ad hoc interpreters such as patients' family members or house staff frequently make medical interpretation errors, and these errors are significantly more likely to have potential clinical consequences.7
  • Despite evidence that LEP patients are safer with professional interpreters, health care providers often try to "get by" with their own limited language skills or with ad hoc interpreters.8,9
  • Even when interpreters are present at a medical encounter, they often are not empowered to speak up when they recognize that a patient's safety is at risk.10


  1. Divi C, Koss RG, Schmaltz SP, et al. Language proficiency and adverse events in U.S. hospitals: a pilot study. Intl J Qual Health Care 2006;18:383-8.
  2. Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev 2005;62(3):255-99.
  3. Linholm M, Hargraves JL, Ferguson WJ, et al. Professional language interpretation and inpatient length of stay and readmission rates. J Gen Intern Med 2012 Apr 18 [Epub ahead of print].
  4. Price-Wise G. Language, culture, and medical tragedy: The Case of Willie Ramirez. Health Affairs Blog 2008 Nov 19. Available at: http://healthaffairs.org/blog/2008/11/19/language-culture-and-medical-tragedy-the-case-of-willie-ramirez/.
  5. Quan K. The high costs of language barriers in medical malpractice: Berkeley: University of California School of Public Health; 2010. Available at: http://www.healthlaw.org/images/stories/High_Costs_of_Language_Barriers_in_Malpractice.pdf.
  6. Carbone E, Gorrie J, Oliver R. Without proper language interpretation, sight is lost in Oregon and a $350,000 verdict is reached. Legal Rev Commentary Suppl Healthcare Risk Manage 2003 (May 1-3).
  7. Flores G, Laws MB, Mayo SJ, et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics 2003;111(1):6-14.
  8. Diamond LC, Schenker Y, Curry L, et al. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med 2009;24(2):256-62.
  9. Ring DC, Herndon JH, Meyer GS. Case records of the Massachusetts General Hospital: Case 34-2010: a 65-year-old woman with an incorrect operation on the left hand. N Engl J Med 2010;363(20):1950-7.
  10. Betancourt JR, Renfrew MR, Green AR. Improving patient safety systems for patients with limited English proficiency: a guide for hospitals. Rockville, MD: Agency for Healthcare Research and Quality; 2012. AHRQ Publication No. 12-0041.
Page last reviewed December 2012
Page originally created December 2012
Internet Citation: Evidence Summary: Why focus on safety for patients with limited English proficiency?. Content last reviewed December 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/teamstepps/lep/handouts/lepevidencesum.html