IMIA International Conference on Medical Interpreting

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COMMUNICATION - KEY TO PATIENT SAFETY

• IMIA International Conference on Medical
  Interpreting
• Pioneering Healthy Alliances
• Boston, Massachusetts
• Oct. 5 7, 2007

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Presented by

• Sandra Sanchez, M.S.,
• Director, Multi-Cultural Affairs
• Grady Health System, Atlanta
• and
• Linda Joyce, M.S.,
• Language Access Consultant
• Interpreter

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Objectives of the Presentation

• Understand patient safety issues
• Recognize the relevance of language and culture
  in patient safety
• Discuss some of the strategies that have worked
• Show how collaborating will lead to better health
  outcomes for all, including culturally and
  linguistically diverse patients

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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 patients illness or underlying condition.

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Why the focus on patient safety?
Joint Commission, Dec., 2006
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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

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Joint Commission - Dec. 2006
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2007 National Patient Safety Goals

• Patient Identification
• Improve communication
• Medication Safety
• Reconcile Medications
• Patient involvement
• Focused risk assessment

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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

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WHO (World Health Organization) Patient Safety
Solutions

• Patient identification
• Communication
• Assuring medication accuracy
• Look-alike, sound-alike medication names

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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

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Language and culture 101

• Basic considerations to improve patient safety
• Primary/preferred Language
• Cultural Background
• Health Literacy Levels

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Cases to consider

• 10 month old baby with iron-deficiency anemia
• 3-year old child with abdominal pain
• Girl falling from bicycle
• Intoxicado
• Hysterectomy
• Hmong child with epilepsy

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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

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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
  patients
• Communication 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
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Adverse event type characteristics for English
speaking and LEP patients
Adverse event characteristic English speaking N () Limited English proficient N () P-value
Communication 299 (35.9) 130 (52.4) lt0.001
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) lt0.001
Patient 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 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.
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Hospitals, Language and Culture A Snapshot of
the Nation

• Quality controlled translations
• Qualified interpreters and cultural brokers
• Education on cultural competency
• Avoid stereotyping
• Discuss impact of language and culture on patient
  safety
• Expand Joint Commission Natl Safety Goals
• Better data and research effect of language and
  culture in adverse events

Joint commission - Wilson-Stokes
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CLAS, OCR and The Joint Commission

• Effective and understandable communication
• Written information in patients 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

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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

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Interdepartmental Collaboration at Grady Health
System

• Patient Safety
• Risk Management
• Customer service / Patient Advocacy
• Training and Development
• Nurse Residency Program
• Facilities Management
• Public Relations
• Human Resources

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The Goal Patient-centered care

• Assessing language and cultural needs
• Listening to the patient
• Asking the patient what they are doing to address
  their health issues
• Involving the patient and families at all
  transitions
• Using teach-back or show-back techniques

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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?

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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

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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

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Thank You!