lines of communication: linguistic competence & interpreter services in healthcare settings...
TRANSCRIPT
Lines of Communication: Linguistic Competence & Interpreter
Services in Healthcare Settings
JOHANNIE RESTO, BSB
MANAGER OF INTERPRETER SERVICES
VANDERBILT MEDICAL CENTER
Covered Topics
I. Why the Provision of Interpreter Services ?II. Compliance Requirements III. Medical Interpreting Overview
OBJECTIVES
I. To increase awareness of the Legal Mandates that guide institutions as it relates to patients who have limited English proficiency
II. Learn the benefits of Interpreter Services
III. Learn techniques that help manage the flow of communication when an interpreter is present.
LIMITED ENGLISH PROFICIENCY (LEP)
A LEP individual is a person who is unable to speak, read, write or understand the English language at a level that permits them to interact effectively with health care providers and social service agencies.
The Top 15 Languages at VUMC FY 2010
1. Spanish2. Arabic3. Somali4. Kurdish5. Chinese6. Vietnamese7. Russian8. Persian (Farsi)9. Korean10. Japanese11. Burmese12. Laotian13. Amharic14. Sign Language
15. Bosnian
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WHY SHOULD WE PROVIDE INTERPRETER SERVICES ?
1) Patient Safety2) Quality Healthcare3) Compliance Requirements
Interpreter Services
Providing Quality Healthcare
Communicating effectively with patients in their language
Clear understanding of symptoms
Ability to communicate their diagnosis, prognosis, explain tests, procedures, discharge instructions, how to take their medicines, follow-up appointments
Recognizing different cultural and religious factors that often impede our ability to perform examinations, recommend treatments, accurate diagnosis, prognosis, and treatment plan
Understanding financial issues
COMPLIANCE REQUIREMENTS
Under Title VI of the Civil Rights Act of 1964 the denial or delay of medical care because of language barriers is discrimination. Any medical facility that receives Medicaid or Medicare must provide language assistance to patients with LEP and take steps to ensure that persons have meaningful access to the health services that they provide.
Title VI of the Civil Rights Act of 1964
“No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”42 U.S.C. Section 2000d42 U.S.C. Section 2000d
Joint Commission on Accreditation of Healthcare Organizations
Requires use of medical interpreters with proven competency (The 1997 Accreditation Manual for Hospitals. SectionR1.1.4. The 2001 Comprehensive Accreditation Manual for Hospitals. Standard R1.1.2.)
Train staff to recognize and respond appropriately to patients with language needs.
National Standards on Culturally and Linguistically Appropriate Services (CLAS) Issued
in March 2001
The national standards issued by the U.S. Department of Health and Human Services’ (HHS) Office of Minority Health (OMH) respond to the need to ensure that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner.
CULTURALLY LINGUISTIC APPROPRIATE STANDARDS (CLAS)
Language Access Services (Standards 4-7)
Standard 4
Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient with limited English proficiency at all points of contact, in a timely manner during all hours of operation.
Standard 5Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.
Standard 6
Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff.
Family and friends should not be used to provide interpretation services
Bilingual providers must demonstrate language proficiency, and adequate knowledge of technical terminology “relevant to the encounter”.
Crash courses or “survival language courses” pose a threat, because clinicians overestimate their fluency.
Minors should NEVER be used.
Standard 7
Translated MaterialsHealth care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.
CASE
Inadequate communication can have tragic consequences
Case 1A high profile case in Florida in 1984 were Spanish-speaking 18-year-old had stumbled into his girlfriend’s home, told her he was “intoxicado,” and collapsed.
When the girlfriend and her mother repeated the term, the non-Spanish-speaking paramedics took it to mean “intoxicated”; the intended meaning was “nauseated.”
After more than 36 hours in the hospital being worked up for a drug overdose, the comatose patient was re-evaluated and given a diagnosis of intra-cerebellar hematoma with brain-stem compression and a subdural hematoma secondary to a ruptured artery.
ConclusionMisinterpretation of a single word led to a patient’s delayed care and preventable quadriplegia.The hospital ended up paying a $71 million malpractice settlement because of one word that was misinterpreted in the Emergency department, causing permanent damage to the patient.
References:The New England Journal of Medicine; Language Barriers to Health Care in the US by Glen Flores,MD. Volume355:229-231 July 20, 2006 number 3(Harsham.P. - A misinterpreted word worth $71 million. Med Econ 1984; June:289-292.)
CASE 2An untrained bilingual staff, misinterpreted for a nurse practitioner, told the mother of a seven-year-old girl with otitis media to put (oral) amoxicillin “in the ears”.
Case 3A Spanish-speaking woman told a resident that her two-year old had “hit herself” when she fell off her tricycle; the resident misinterpreted two words, understood the fracture to have resulted from abuse, and contacted the Dept. of Social Services (DSS). DSS sent a worker who, without an interpreter present had the mother sign over custody of her two children. Clearly, Catastrophes can and do result from such
miscommunication.
Reference- The New England Journal of Medicine; Language Barriers to Health Care in the US by Glen Flores,MD. Volume355:229-231 July 20, 2006 number 3
http://content.nejm.org/cgi/content/full/355/3/229
Benefits of Interpreter Services in Healthcare
Medical Interpreting
What is the difference between Interpreting and Translating?
To render messages orally, from one
language into another.
Interpreters are the VOICE!!!!
Interpreting
To render written text from one language to
another.
Translating
What is the Basic purpose of the Medical Interpreter?
Is to facilitate understanding in communication between people who are speaking different languages.
Basic purpose of the medical interpreter
Medical Interpreting
Roles of the Medical Interpreter
Interpreters are the VOICE!!!!
Tips for Effectively Working with an Interpreter
Brief the interpreter before entering the room.
Position yourself to maintain eye contact with the patient.
Address the patient, not the interpreter using “I” and “you”, not “he or she”.
Remember that everything you say will be interpreted.
Avoid highly technical jargon and acronyms.
Check for understanding.
Pause often to allow the interpreter to accurately convey your message
Make short and precise questions or statements
Avoid side conversations
Focus your attention on the patient or family not the interpreter
Avoid asking the interpreter his/her opinion
AVAILABLE RESOURCES VANDERBILT UNIVERSITY MEDICAL CENTER
15 full-time interpreters (13 Spanish, 2 Arabic)
35 plus temporary interpreters (Spanish, Arabic, Bosnian, Burmese, Chinese, Kurdish, Russian, Somali, Swahili, Farsi, Japanese, Portuguese, Vietnamese, Amharic, Urdu, Harraric)
Interpreters are assessed, trained, follow National Standards for Healthcare interpreters and Code of Ethics
Telephonic Interpreter line 24/7 “OPI” Staff calls 1-877-746-4674 Patient calls 1-866-675-2040 (If pt needs to call VUMC)
After hours (message center) has a list of the VTS temporary interpreters 2-7378
After hours Spanish interpreter available Monday thru Friday from 4:30pm to 8:00am . Saturday and Sunday 24 hour coverage. Please page 835-0507 and leave numeric message
Services for the Hard of Hearing and the Deaf (615-248-8828) staff calls directly
TTY/TDD phones available for the deaf and hard of hearing . TTY stands for telephone typewriter, teletypewriter or text, TDD stands for Telecommunications Device for the Deaf. TTY/TDD stands for a group of telecommunication devices that make it easier for deaf and/or mute people to talk over telephone lines. TDDY phones for the Hard of Hearing.
Signage assuring the patients that they are entitled to interpreters at no cost
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On-site interpreters 2-SERVE (2-7378)
Interpretive Services Policy Communications OP 10-50.01 (will be updated)
Documents are translated by professional translators e-mail documents to: http://www.vanderbilthealth.com/main/23115
NEVER use Babble fish or any other translation system via the Internet
Interpreter Services website address: www.mc.vanderbilt.edu/interpreterhttp://www.vanderbiltchildrens.org/interpreter
Questions
Articles of Interest/References
National Council on Interpreting in Health Care (NCIHC) http://www.ncihc.org/
Common cross-cultural communication challengeshttp://www.wwcd.org/action/ampu/crosscult.html#COMMUN
OCR list of “vital” Documents. www.hhs.gov/ocr/lep
Office of Minority Health CLAS standards Final Report http://www.omhrc.gov/assets/pdf/checked/finalreport.pdf
Addressing Language Barriers in Health Care: What’s at Stake, by Robert Wood Johnson Foundation . March 2007
Navigating Language Barriers under difficult circumstances Annals of Internal Medicine- American College of Physicians by Yael Schenker, MC,;Bernard Lo, MD; Katharine M. Ettinger, JD; and Alicia Fernandez, MD
Language Barriers to Health Care in the United States by Glenn Flores, MD.