A multidisciplinary exploration of misunderstanding in ad hoc interpreter mediated Emergency Department consultations

Emergency medicine is a predominantly oral activity in which medical errors often result from poor communication. Despite the fact that Emergency Departments (EDs) are becoming increasingly linguistically diverse, professional interpreters remain underused. Hospital staff mainly rely on ad hoc interpreters who tend to make more errors than professional interpreters do. So far, the literature on language barriers in the ED has mainly focussed on health outcomes in the presence of language barriers, and the impact of interventions such as interpreting on these outcomes. This study aims to contribute to the existing knowledge by analysing the process underlying these outcomes with a view to identifying targeted communication strategies that can be integrated in clinician training programs.
We audio-recorded ad hoc mediated consultations in a linguistically diverse ED and collected the corresponding contextual information via ethnographic participant observation (including note taking and after action interviews with clinicians). The consultations were transcribed, translated, and analysed by a multidisciplinary research team of applied linguists and clinicians.
In a first phase, linguists analysed the causes of misunderstandings. In a second phase, clinicians assessed the misunderstandings with regard to their clinical relevance. In a third phase, we played back our analysis to the clinicians in question with the purpose of member checking and eliciting feedback.
We identified a set of recurrent communication patterns that lead to misunderstanding. Based on these, we developed a taxonomy of the causes of misunderstandings in translations and role confusions between the clinician, patient, and ad hoc interpreter that lead to communication problems of clinical significance.
Highlighting misunderstandings and the underlying communication patterns can be an eyeopener for clinicians as many misunderstandings pass unnoticed. It is a first step in developing successful communication strategies to interact with patients and ad hoc interpreters in a multilingual ED.