Impact of Communication on Patient Outcomes

Introduction:

It has been determined that communication is a major factor regarding health care and spiritual care among our patients/customers. Cone Health in Greensboro, North Carolina boasts the tenth busiest emergency department (ED)in the country. Patients accessing Cone Health speak a variety of languages other than English. Currently, 23 different cultures side with the city limits of Greensboro. Staff and patients often times find it necessary to access interpretive services. However, many times, particularly in the ED, patient care is control by time- restraints and those interpretative services are not access appropriately.

The problem identified, is that while Cone Health experiences diversity, as practitioners, providers of care often experience difficulty in communicating with patients who speak languages other than English. Thus, either communication is truncated or other nonconventional interventions are used. This communication misstep often occurs not because Cone Health does not have the necessary resources for translation/interpretation services, but oftentimes because of education or awareness and access to said services. The initial question regarding this project is: Will offering an Educational HLC on Interpretive Services improve the compliance in utilizing these services for our customers/patients/families? The burning question was triggered by observations of three tragic circumstances where interpretive services should/could have been initiated. The three instances are as follows: One, a teenage shot in the mouth having to interpret for his parents. Two, patient’s deaf wife was whaling loudly after her husband had passed away in the during a procedure. The family was hearing impaired and were utilizing minor children for interpret services (ASL Interpreter called to comfort her, but it was a 2-hour delay in providing appropriate interpretative services). Finally, children who spoke English over heard the request for an interpreter to communicate that their mother had died.

The three instances that trigged this study identified areas for improvements in utilizing interpretative services during opportunities in crisis situations/interventions.  In the case of the hearing-impaired family, the mobile device could have been accessed when the family arrived and prepared prior to. The staff did not know such a device was available until the chaplain arrived and suggested it be borrowed from another department. The device itself was easy to navigate and once the ASL interpreter appeared on screen and introduced herself, the loud whaling stopped and all seemed to be intently listening with their eyes and ears.

This type of intervention is easily applied when proper knowledge and education exists to assist staff in accessing interpretative services. Even though, this happened on a weekend, it is feasible to imply that this event could have occurred at any time of day. Every employee and volunteer of Cone Health need to be made aware of the legal ramifications and potential negative patient/customers outcomes. Cone Health must stress the importance of knowing the procedure on how to access needed interpretive services for patients and families in crisis at any time.

Background

Approximately 57 million people, or 20% of the US population, speak a language other than

English at home, and approximately 25 million, or 8.6% of the U.S. population are defined as Limited English Proficiency (LEP).  The Pew Research Center reported that approximately 50% of the newly insured will be minorities, and less likely to speak English. It should be noted that LEP have Longer Hospital Stays, greater risk for surgical delays due to lack understanding surgical instructions, and greater risk for readmission due to not understanding discharge instructions. It is important to remember that there are also legal requirements of hospitals to provide access to interpretive services. Title VI of the Civil rights Act mandates the interpreter services be provided for patients with limited English proficiency who need this service despite the lack of reimbursement. Thus, when staff does not initiate the use of interpretive services there can be legal liability and impacts to patient health.

Our goal for this quasi-longitudinal study was to identify if offering an Educational HLC on Interpretive Services would improve the compliance in utilizing these services for our customers/patients/families?”

 Methods

A survey monkey was utilize to identify any gaps in knowledge about the process Cone employee and volunteers assess interpretive services for non-English speaking patients, clients or guardians. Staff were contacted via email to participate in a survey about interpretive services. After reviewing the results, an educational power point, which contained the official Cone policy, was devised to address any gaps in knowledge. A post survey was delivered via email to assess any changes in practice.

The pre-survey consisted of fourteen questions. A total of 1778 employees and volunteers completed the pre-survey. Four demographic questions were used to identify roles, departments and campus location.  The survey contain questions requesting the employees and volunteers to share their purpose for using interpretive services and how frequently. Based on a Likert scale, staff was asked about how comfortable were they requesting interpretive services. The roles or position a staff member is placed will highly affects this question. Employees were asked to identify the appropriate situations for requesting interpretive services and provide any barriers that affected their request.

After ( weeks) an educational PowerPoint was delivered via email to all the staff and volunteer personnel at Cone hospital. The power point explained everyone roles for communicating with Non-English speaking patients. The power point identified the official resources that are to be used for interpretive services such as face-to face interpreters that have completed the requirements designated by Cone Hospital, language line telephone service, and/or mobile notepad/screen. Family members and co-workers are not acceptable replacement for interpretive services. A patient may choose to decline interpretive services by signing a waiver, which is placed in the patient’s chart. The patient may decide at any time to use interpretive services in the future if they chose. The location of the official policy for Cone Health hospital was also available in the power point.

The post survey composed of ten questions which was delivered via email (? week after the educational power point. The post survey was developed to explore any practice changes throughout the hospital. The survey inquired about any barriers the employees and volunteers may have encountered while accessing volunteer services. How comfortable staff felt about contacting interpretive services for the patient, guardian or visitor. Since the pre-survey how many times did that staff member or volunteer utilized interpretive services. The final question was used to identify any recurrent responders.

Results:

A total of 1778 employees and volunteers completed the pre survey within a two weeks span. About 65% percent of the respondents were using interpretive services for direct patient care.  Face to face interpreters was the most common type of interpretive services used by staff and volunteers at 73.36%. 88% of the Cone health members felt comfortable utilizing interpretive services. 92 percent of the respondents are aware that any employee or volunteer can request an interpreter if services are needed. Over 97 percent of the respondents will consider using interpretive services for any patient that does not speak English.  There was an increase of 2% of the respondents that recognize that any role/position is at liberty to contact interpretive services.  85% of the respondents stated that family and co-workers are not acceptable forms on interpretive services.

There were many barriers voiced by staff and volunteers that made it difficult to provide interpretive services to their clients. Most respondents determined the length of the time to obtain an interpreter was the greatest barrier. Some languages, such as Vietnamese, various African dialects and Montagnard dialects were not languages offered within the facility services. Many staff members were lacked the information required to access interpretive services. New employees are given badges with the most up-to-date information about interpretive services, but seasoned employees and volunteer workers were not provided with this information annually. The hospital also had a limited number of equipment staff and volunteers could utilize. Locating these devices made it more difficult for the members of the facility to perform their role efficiently.

Discussion/Implications

Effective communication has a profound impact on patient outcomes. As the community demographics changes so does the variety of languages spoken.  Healthcare workers are mandated by title IV of the civil right (Juckett and Unger)to provide medical information to the patient and/or caregivers in the manner in which they comprehend. This study has revealed that employees and volunteers want to provide the best care available but at times encounters barriers that prevent the best method of communication for the patient. Any member of healthcare is responsible for advocating for the patient. The institution should provide the resources the staff need, such as in house interpreters, remote interpreters that can be contacted via phone or streaming devices in addition to a wide variety of language options.

Many staff members felt time was a major drawback to seeking interpretive services.  As healthcare providers, managing one’s time efficiently is paramount, but when short cuts are taken to save time then patient care is compromised. To truly understand, the non-English speaking patients, all efforts must be made to have interpretive services available to assist staff in providing optimal care.

Staff members must also be able to identify the type of interpretive services resources that are available to them. Facilities should require annual update educational sessions to keep staff and volunteers informed about any changes to interpretive services.  The education may include the why, when and how to use interpretive services; the variety of options of resources and locations of the resources.

References:

• Overcoming the challenges of providing care to LEP patients
• Juckett,G. & Under, K. (2014). Appropriate use of medical interpreters. American Family Physician, 90(7), 476-480.