Language Barriers Identified as Potential Factor in Maryland Hospital Safety Incidents

Medical mistakes in Maryland hospitals increased by 5% in fiscal 2023, according to the state health department's annual Hospital Patient Safety Program report released September 12. The report documented 808 serious level 1 incidents, with 49 resulting in patient deaths. Most serious injuries stemmed from falls and pressure injuries like bedsores. While the report attributes some increase to pandemic after-effects and staffing shortages, it overlooks potential communication barriers as a contributing factor.

Approximately 50,000 foreign nationals work in Maryland's healthcare system, representing about 26% of the state's healthcare workforce according to data from the U.S. Census Bureau's American Community Survey. This estimate, derived from 2021 data and adjusted for 2023 employment trends showing about 7,400 annual job gains in healthcare and social assistance sectors, suggests significant linguistic diversity within medical facilities. The same percentage applies to Johns Hopkins Hospital in Baltimore, where approximately one-quarter of staff may speak English as a second language.

A patient who underwent extensive open heart surgery at Johns Hopkins Hospital observed communication challenges during a 51-day hospitalization. While acknowledging excellent overall care and successful medical outcomes, the patient noted instances where medical instructions from physicians were misinterpreted by nursing staff. Several situations required clarification with doctors to prevent potential medication errors or incorrect procedures. The patient emphasizes that these observations are not criticisms of foreign-born healthcare workers' medical competence, but rather highlight the critical importance of clear communication in patient safety.

The need for effective communication extends beyond nursing staff to physicians who received medical training outside the United States. When English serves as a second language for both issuing and receiving medical instructions, the potential for misunderstanding increases significantly. Maryland's healthcare system relies heavily on foreign-born workers to address staffing shortages, making communication proficiency an essential component of patient safety protocols. The state health department's investigation into root causes of medical errors would benefit from examining language barriers as a potential contributing factor to the documented increase in safety incidents.