exceptional care. remarkable services. extraordinary grady. imia international conference on medical...

Exceptional Care. Remarkable Services. Extraordinary Grady.

IMIA International Conference on Medical Interpreting“Pioneering Healthy Alliances”

Boston, MassachusettsOct. 5 – 7, 2007

COMMUNICATION -KEY TO PATIENT SAFETY


Presented by:

Sandra Sanchez, M.S.,

Director, Multi-Cultural Affairs

Grady Health System, Atlanta

and

Linda Joyce, M.S.,

Language Access Consultant

Interpreter


Objectives of the Presentation

Understand patient safety issuesRecognize the relevance of language and

culture in patient safetyDiscuss some of the strategies that have

worked Show how collaborating will lead to better

health outcomes for all, including culturally and linguistically diverse patients


Patient Safety Definitions

Adverse Event/ Occurrence:

Any unintended harm to the patient by an act of commission or omission rather than by the underlying disease or condition of the patient.

Near Miss/Close call:

A potential injury that did not happen to the patient.Sentinel Event:

An unanticipated death or major loss of function, not related to the natural course of the patient’s illness or underlying condition.


Why the focus on patient safety?

Joint Commission, Dec., 2006


Is it safe to go to the hospital?

An average of 195,000 people in the USA died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a 2004 study of 37 million patient records

HealthGrades Patient Safety in American Hospital Study


Joint Commission - Dec. 2006


2007 National Patient Safety Goals

Patient IdentificationImprove communicationMedication SafetyReconcile MedicationsPatient involvementFocused risk assessment


“Effective Communication”

U. S. Department of Health and Human Services initiative to strengthen language access

Along with the Office of Civil Rights, collaborating with hospital associations in nine states

Assessment includes looking at the needs of small, rural hospitals


WHO (World Health Organization) Patient Safety Solutions Patient identificationCommunicationAssuring medication accuracyLook-alike, sound-alike medication

names


We are part of a mosaic: There are more than 6 categories for race and about 2.5% of

the population identified themselves as having 2 or more races About 12% of the US population is foreign born About 18% of the US population speak a language other than

English at home (Approx. 47 million) About 8.1% of the population 5 Years and Over Speak

English Less Than “Very Well” (Approx. 21 million) US Census Bureau

Federal and Accreditation Mandates


Language and culture 101

Basic considerations to improve patient safety

Primary/preferred LanguageCultural BackgroundHealth Literacy Levels


Cases to consider

10 month old baby with iron-deficiency anemia

3-year old child with abdominal painGirl falling from bicycle“Intoxicado”HysterectomyHmong child with epilepsy


Your real time examples

Experiences that you have had in your health care setting where communication has been, or could have been the cause of incidents

Experiences where cultural considerations have led, or could have led to incidents


“Language proficiency and adverse events in U.S. hospitals: a pilot study”

Adverse events involving some physical harm Almost half (49.1%) of LEP patients vs.Almost a third (29.5%) of patients who speak English Patients with moderate temporary harm to death:46.8% of the LEP vs. 24.4% of English speaking

patientsCommunication errors:52.4% of the LEPs vs. 35.9% of the English speaking patients

Joint Commission - Chandra Divi, Richard G. Koss, Stephen P. Schmaltz and Jerod M. Loeb


Adverse event type characteristics for English speaking and LEP patients

Adverse event characteristic English speaking N (%) Limited English proficient N (%) P-value

CommunicationCommunication 299 (35.9) 130 (52.4) <0.001

Inaccurate/incomplete information 132 (15.9) 39 (15.5) 0.44

Questionable advice/interpretation 29 (3.5) 28 (11.2) 0.002

Questionable consent process 10 (1.2) 7 (2.8) 0.33

Questionable disclosure process 7 (0.8) 8 (3.2) 0.042

Questionable documentation 171 (20.6) 59 (23.5) 0.77

Questionable assessment of patient needs 53 (6.4) 37 (14.7) <0.001

Patient managementPatient management 467 (56.1) 133 (53.0) 0.12

Questionable delegation 14 (1.7) 10 (4.0) 0.69

Questionable tracking and follow-up 182 (21.9) 61 (24.3) 0.30

Questionable use of resources 257 (30.9) 60 (23.9) 0.18

Clinical performanceClinical performance 154 (18.5) 36 (14.3) 0.47

Correct diagnosis questionable intervention 152 (18.3) 32 (12.8) 0.77

Joint Commission – C.Divi et al.


Hospitals, Language and Culture: A Snapshot of the Nation

Quality controlled translationsQualified interpreters and cultural brokersEducation on cultural competencyAvoid stereotypingDiscuss impact of language and culture on patient

safety Expand Joint Commission Nat’l Safety GoalsBetter data and research effect of language and

culture in adverse eventsJoint commission - Wilson-Stokes


CLAS, OCR and The Joint Commission Effective and understandable communication Written information in patient’s language Interpretation and translation services Staff competence (Qualified interpreters and translators) Cultural, linguistic and learning needs Records of communication with patients Patient involvement Hospitals provide services in accordance to laws and

regulations Patients with comparable needs receive same standard of

care


Grady Health SystemDepartment of Multicultural Affairs

Language Interpretive Services (LIS) Qualified professional interpreters and translators Continuous education sessions for interpreters Language Proficiency Assessments

Multicultural Programs Outreach and education Community Partnerships Cultural Competency Training

International Medical Center (IMC) Primary care – Patient centered (one-stop shop) Bilingual and culturally sensitive staff and providers Education in waiting room


Interdepartmental Collaboration at Grady Health System

Patient SafetyRisk ManagementCustomer service / Patient Advocacy Training and Development Nurse Residency ProgramFacilities ManagementPublic Relations Human Resources


The Goal: Patient-centered careAssessing language and cultural needsListening to the patientAsking the patient what they are doing to

address their health issuesInvolving the patient and families at all

transitionsUsing “teach-back” or “show-back”

techniques


What can we do together?

What can health care systems do to include language and culture in its patient safety plan?

What can language service departments do?

What can interpreters do?What can providers and patients do?


Conclusions

Language and culture have to be considered to achieve all the National Patient Safety Goals for 2007.

Organizational collaboration is key to preventing communication errors.

To reduce the risks to patient safety related to language and cultural barriers, always: Use qualified medical interpreters Collect data on preferred language Document use of medical interpreters Confirm understanding with “teach back” or “show back” approach Learn about practices and customs of the patient population in the

service area Attend cultural competency trainings when possible


References

www.jointcommission.org Hospitals, Language and Culture: A Snapshot of the Nation What did the doctor say? Improving Health Literacy to Protect Patient

Safety National Patient Safety Goals

www.LEP.gov www.omhrc.gov

National Standards for Culturally and Linguistically Appropriate Services

www.census.gov www.hhs.gov/ocr www.publimed.org


Thank You!

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Documents

patient safety slide

extraordinary grady

remarkable services

exceptional care

patient safety issues

american hospital study

human services initiative

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