center for diversity and health equity sarah rafton, msw diversity rx october 20, 2010 assuring...
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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