A Survey of Language Diversity and Communication in Indian Academic Emergency Departments

Background Communication in the Emergency Department (ED) is particularly important given the acuity of patients and lack of prior medical history. In India, patient care is further complicated by the many spoken languages, the regional differentiation in language and the fact that medical training is primarily delivered in English. Our objective was to document language diversity among clinicians in Indian EDs linked to an international training program and explore issues related to clinician-clinician and clinician-patient communication. Methodology A cross-sectional survey of ED clinicians was conducted from May to July 2017. Survey participants were recruited via convenience sampling by a researcher at 6 ED training sites in Kerala and Karnataka. Doctors were also sent an email link to the survey. ANOVA and binary logistic regression were used to perform subgroup analysis. Results 106 clinicians completed the survey including 42 doctors (9 consultants and 33 residents), 45 nurses and 19 paramedics. On average, clinicians spoke 3. 75 languages. Fluency in the majority language at the hospital was reported by 93% of doctors, 84% of nurses and 95% of paramedics. Fluency in English was reported by 100% of doctors, 71% of nurses and 63% of paramedics. Type of clinician, age, gender, and time in clinical practice did not predict number of languages spoken or fluency in the majority language. Doctors were more likely to report fluency in English, compared to other providers (p \u3c 0. 003). 70% of clinicians reported that they used a non-English language to speak to their fellow providers most of the time. 64% felt that information was lost or changed when English medical knowledge was explained in a different language. 53% reported at least one critical incident over the last year where poor communication played a part. Time constraints, language and differences in medical knowledge were the most frequently identified barriers in these incidents. Conclusions Our study is the first to document language diversity in Indian EDs. Important findings include the common use of non-English language in clinician-clinician communication and the frequent perceived loss of information in clinician-patient communication. The reported rates of critical incidents linked to poor communication are higher than reported in comparable studies and warrant further research and action