LEP Patient Engagement

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Slide 1

LEP Patient Engagement

Slide 2

Why engage patients with limited English proficiency?

• LEP patients = 8.6% of U.S. population.
• Patient safety events more severe and more often due to communication errors (Divi et al. 2006, Flores 2005).
• LEP patients are safer and have fewer readmissions with professional interpreters (Flores et al. 2003, 2008, Linholm et al. 2012).

Slide 3

Misunderstandings are common and can be serious.

• One misunderstood word, "intoxicado" → quadriplegic teen, $71 million settlement.
• Heard during our initial research:

  "In French, estomac is the stomach, but in Creole, lestomak mwen means, 'my chest'. Without an interpreter present, a French-speaking provider could incorrectly think a [Haitian] patient was experiencing stomach pain, not chest pain. This is a potentially life-threatening error."

  — Interpreter

Slide 4

• Yet interpreters are rarely integrated into the patient safety team (Diamond et al. 2009; Ring et al. 2010; Betancourt et al., forthcoming)
• Often not called at all because of delays.

  Maybe somebody else requires that bed. So that's when we do our discharge. I would like to see the doctor's face if I go over there, and say, 'you know, I really can't discharge this patient because he doesn't really understand anything''--Nurse

• Or ignored when they are present.

  I've seen interpreters try, for example, to intervene when a provider insists on speaking a language they're not fluent in. And there's a big power struggle and the interpreters feel intimidated. But it'd be nice for them to be able to really recognize situations that are really critical, to be able to call time outs.

  — Interpreter Services leader

Slide 5

High-Risk Settings and Situations

• Consider starting here:
  • ED.
  • Labor and Delivery.
  • Surgery.
  • Transitions in care, including intake and discharge.
  • Medication reconciliation.

Slide 6

How the LEP module can help

• 1.5 hour staff training module and 4-hour train-the-trainer program so unit staff and interpreters can:
  • Understand the risks to LEP patients.
  • Assemble the right team (call an interpreter!).
  • Identify and raise patient communication issues.
• Also includes a guide for hospital leaders:
  • To identify/ implement needed system changes ahead of training.

Slide 7

Module preview: process map

Slide 8

Tools

• Assemble the team.
• CUS.
• Two Challenge Rule.
• Brief.
• Psychological Safety.
• Check-Back.
• Teach Back.

Slide 9

Stop the Line: CUS

C—I am Concerned!
Image: A penguin in a green shirt looks concerned.
U—I am Uncomfortable!
Image: A penguin in a white shirt looks embarrassed.
S—This is a Safety Issue!
Image: A penguin in a blue shirt says "Stop!" and emphatically holds up crossed wings.

Slide 10

Field-test findings

• Module can be implemented various ways in various settings:
  • TeamSTEPPS/non-TeamSTEPPS hospital.
  • Hospital units (ED, L&D, OB), or primary care.
  • Stand-alone or part of overall TeamSTEPPS.

Slide 11

Field test findings

• Focus for each hospital was different:
  • Use of a qualified communicator.
  • Briefs with interpreters.
  • Phone interpreter use if no in-person interpreter.
• Catalyst for institutional changes
  • Reorganize/reallocate interpreters.
  • Clarify interpreter use policies.
  • Bilingual provider training/certification.

Slide 12

Results

• Qualitative results:
  • Clinical staff more aware of need to call interpreter.
  • Interpreters more empowered to raise and address communication issues with clinical team.
• Quantitative results:
  • Hospital 1: pre-test convinced leadership → no post-test.
  • Hospital 2: High satisfaction, increase in knowledge.
  • R/E/L data quality issues → interpreter use data unusable.
  • Hospital 3: High satisfaction, increase in knowledge scores, R/E/L data quality issues → interpreter use data unusable.

Slide 13

Conclusions

• Module can be implemented in a variety of settings:
  • TeamSTEPPS/non-TeamSTEPPS.
  • Hospital/ primary care clinic.
• Catalyst for change.
• R/E/L data Collection/use still a barrier to formal evaluation.

Slide 14

Next steps

• Module available early Fall:
  • Sign up today for a copy.