Center for Diversity and Health Equity

Sarah Rafton, MSWDiversity RxOctober 20, 2010

Assuring Daily Interpretation in a Pediatric Hospital

Center for Diversity and Health Equity

Korean 2%

Amharic 2%

Cantonese 3%

Russian 4%

Somali 7%

Vietnamese 7%

Spanish 62%

Seattle Children’s Hospital

• Specialty tertiary medical center

serving Washington, Alaska,

Montana and Idaho

• Culture of continuous performance

improvement

• 49% pediatric patients are poor

(Medicaid or state-funded health

insurance)

• 15% of patients with limited English

proficiency (LEP)

Center for Diversity and Health Equity

The Joint Commission

New Patient-Centered Communication Standards

The hospital effectively communicates with patients when providing care, treatment and services.

1. The hospital identifies the patient’s oral and written communication needs, including the patient’s preferred language for discussing health care.

2. The hospital communicates with the patient during the provision of care, treatment, and services, in a manner that meets the patient’s oral and written communication needs.

Center for Diversity and Health Equity

Speaking Together Collaborative (RWJF)

10 hospital collaborative to develop language service quality measures

Center for Diversity and Health Equity

Speaking Together Goals

Develop and track metrics for improving interpretation

1. Consistently screen every patient/family for language need

2. Provide interpretation upon admission for each LEP patient/family

3. Measure efficiency of interpretation delivery

Center for Diversity and Health Equity

• Unreliable system for identifying which families needed interpretation

• Request for interpretation made in multiple and duplicative ways

• Difficult to track interpretation provided

• Unable to examine hospital quality metrics by language spoken

Where we started

Center for Diversity and Health Equity

“Big Wins”

• Registration asking every family about language need

• On-line order for interpreters

• “SPEAK” phone line—x77325

• Strengthened hospital policy, 2x per day inpatient interpretation SPEAK (7-7325)

To request an interpreter in less than one business day, place order in CIS

To get an interpreter on the phone or to call Interpreter Services, dial:

SPEAK (7-7325)Your 3-digit department code: ICU

Language Line 1-800-874-9426 (alternative line)

Client ID: 00043Personal Code: Name / Phone Extension Number.Language needed:

SPEAK (7-7325)To request an interpreter in less than one

business day, place order in CIS To get an interpreter on the phone or to

call Interpreter Services, dial: SPEAK (7-7325)

Your 3-digit department code: ICU

Language Line 1-800-874-9426 (alternative line)

Client ID: 00043Personal Code: Name / Phone Extension Number.Language needed:

Center for Diversity and Health Equity

“Big Wins”

TELEPHONIC INTERPRETATION

_____________________________

1. Press A

2. Department code: (4 digit)

3. NEW! Medical Record Number

4. Once the interpreter is on the

line, ask the patient/guardian

to pick up the receiver of their

bed-side phone.

______________________________

Quick

Dial

A B C

TELEPHONIC INTERPRETATION

_____________________________

1. Press A

2. Department code: (4 digit)

3. NEW! Medical Record Number

4. Once the interpreter is on the

line, ask the patient/guardian

to pick up the receiver of their

bed-side phone.

______________________________

Quick

Dial

A B C

• Enhanced phone interpretation:

– Toll-free family phone line– Bedside one-touch phones in all inpatient and day surgery

rooms

Center for Diversity and Health Equity

“Big Wins”

• Electronic order entry, and soliciting medical record number when using telephonic interpretation, facilitated tracking quality indicators by language need• Length of stay

• Satisfaction

• Pain scores

• Dedicated regional interpreters with strategic deployment• ED

• Day surgery

• Inpatient units

• Hired additional staff interpreters

Center for Diversity and Health Equity

→ Cultivate strong partners in registration

→ Use data to continuously inform improvements

• Language field 98% complete (Dec. 2006)

- But was it accurate?

- Were we screening every family?

• Audits of call center and ED find inconsistent screening (2007)

• Partnered with registration to adapt script

• Electronic report identifies failure to screen (2008)- 90% accurate in inpatient- 99% accurate in outpatient (call center screening)

• Inpatient accuracy now 93% (2009-2010)

• Educate registration HOW data they collect improves patient care

Example: Screening for language need

Center for Diversity and Health Equity

Enhanced Phone Interpretation

Center for Diversity and Health Equity

Interpretation per patient-day

0.99 0.91

0.150.48

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

Period 1 (Nov06 - Mar08) Period 2 (Dec08 - Aug09)

Inte

rpre

tatio

ns

per

day

Telephonic

In-person

Improved interpretation for LEP patients with cardiac conditions

Inpatient Interpretation per Day

Center for Diversity and Health Equity

Family Initiated Telephonic Interpretation

0

200

400

600

800

1000

1200

calls

per

mon

th

Center for Diversity and Health Equity

Key ingredients to success

• Use data to inform decisions and improve care• Support from highest levels of leadership• Multidisciplinary team of champions

– Nurse manager– Research faculty– Interpreter– Bicultural RA– MPH-trained data analyst

• Stay with it! Continuing to progress since 2006

Center for Diversity and Health Equity

Remaining Challenges

• Family constellation in pediatrics: assessing interpreter need for all caregivers

• Screening consistently; nurse and provider responsibility for screening

• Overcoming provider resistance to phone interpretation• Providers with some level of Spanish proficiency• Documenting interpreter use