Overcoming Communication Barriers to Improve Patient Safety for American Sign Language Users Who Are Deaf or Hard of Hearing

In the United States, approximately 3.6% of the population-about 11 million individuals-are deaf or hard of hearing 1 and about 1 million adults who are deaf or hard of hearing use American Sign Language (ASL) to communicate. 2 Patients who use ASL can encounter communication-related patient safety challenges in various healthcare settings. [3][4]4][5][6] While some of these patients can use alternatives to ASL to communicate, such as lipreading or written communication methods, 3,7 these are considered inferior to using ASL interpreters. 7,8For example, lip-readers may only understand part of a conversation 7,9 and written communication could be limited by other factors, such as education and literacy challenges. 10Addressing these communication challenges can improve confidence in care provided, patient understanding, and-ultimately-patient safety.Reports recently submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) highlight communication challenges faced by deaf or hard-of-hearing patients and the healthcare workers serving them, emphasizing that inadequate or delayed interpreter availability could lead to serious patient safety events.For example, one report described a delay in emergency department triage due to an inability to obtain an ASL interpreter and having to resort to written communication to triage a patient who was deaf.Another report described a patient who was restrained due to movement during necessary scans that resulted in the patient becoming agitated and experiencing a skin tear trying to remove the straps; this patient was deaf and may have been unable to communicate while restrained.Additionally, a patient who had limited eyesight in addition to being deaf required an in-person ASL interpreter, but only video remote interpretation (VRI) was available.