LEP Patient Engagement

T EAM STEPPS 05.2 Mod Page 2 TeamSTEPPS 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)

T EAM STEPPS 05.2 Mod Page 3 TeamSTEPPS Abt Associates 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 Misunderstandings are common and can be serious

T EAM STEPPS 05.2 Mod Page 4 TeamSTEPPS 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

T EAM STEPPS 05.2 Mod Page 5 TeamSTEPPS High-Risk Settings and Situations Consider starting here: ED Labor and Delivery Surgery Transitions in care, including intake and discharge Medication reconciliation

T EAM STEPPS 05.2 Mod Page 6 TeamSTEPPS 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

T EAM STEPPS 05.2 Mod Page 7 TeamSTEPPS Module preview: process map

T EAM STEPPS 05.2 Mod Page 8 TeamSTEPPS Tools Assemble the team CUS Two Challenge Rule Brief Psychological Safety Check-Back Teach Back

T EAM STEPPS 05.2 Mod Page 9 TeamSTEPPS Stop the Line: CUS (insert video clip of CUS here)

T EAM STEPPS 05.2 Mod Page 10 TeamSTEPPS 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

T EAM STEPPS 05.2 Mod Page 11 TeamSTEPPS Field test findings

T EAM STEPPS 05.2 Mod Page 12 TeamSTEPPS 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

T EAM STEPPS 05.2 Mod Page 13 TeamSTEPPS 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

T EAM STEPPS 05.2 Mod Page 14 TeamSTEPPS Next steps Module available early Fall Sign up today for a copy