1. Center for Diversity and Health Equity Sarah Rafton, MSW Diversity Rx October 20, 2010 Assuring Daily Interpretation in a Pediatric Hospital

2. Center for Diversity and Health Equity Korean 2% Amharic 2% Cantonese 3% Russian 4% Somali 7% Vietnamese 7% Spanish 62% Seattle Children’s Hospital Specialty tertiary medical center serving Washington, Alaska, Montana and Idaho Culture of continuous performance improvement 49% pediatric patients are poor (Medicaid or state-funded health insurance) 15% of patients with limited English proficiency (LEP)

3. Center for Diversity and Health Equity The Joint Commission New Patient-Centered Communication Standards The hospital effectively communicates with patients when providing care, treatment and services. 1.The hospital identifies the patient’s oral and written communication needs, including the patient’s preferred language for discussing health care. 2. The hospital communicates with the patient during the provision of care, treatment, and services, in a manner that meets the patient’s oral and written communication needs.

4. Center for Diversity and Health Equity Speaking Together Collaborative (RWJF) 10 hospital collaborative to develop language service quality measures

5. Center for Diversity and Health Equity Speaking Together Goals Develop and track metrics for improving interpretation 1.Consistently screen every patient/family for language need 2.Provide interpretation upon admission for each LEP patient/family 3.Measure efficiency of interpretation delivery

6. Center for Diversity and Health Equity Unreliable system for identifying which families needed interpretation Request for interpretation made in multiple and duplicative ways Difficult to track interpretation provided Unable to examine hospital quality metrics by language spoken Where we started

7. Center for Diversity and Health Equity “Big Wins” Registration asking every family about language need On-line order for interpreters “SPEAK” phone line—x77325 Strengthened hospital policy, 2x per day inpatient interpretation

8. Center for Diversity and Health Equity “Big Wins” Enhanced phone interpretation: –Toll-free family phone line –Bedside one-touch phones in all inpatient and day surgery rooms

9. Center for Diversity and Health Equity “Big Wins” Electronic order entry, and soliciting medical record number when using telephonic interpretation, facilitated tracking quality indicators by language need Length of stay Satisfaction Pain scores Dedicated regional interpreters with strategic deployment ED Day surgery Inpatient units Hired additional staff interpreters

10. Center for Diversity and Health Equity → Cultivate strong partners in registration → Use data to continuously inform improvements Language field 98% complete (Dec. 2006) - But was it accurate? - Were we screening every family? Audits of call center and ED find inconsistent screening (2007) Partnered with registration to adapt script Electronic report identifies failure to screen (2008) - 90% accurate in inpatient - 99% accurate in outpatient (call center screening) Inpatient accuracy now 93% (2009-2010) Educate registration HOW data they collect improves patient care Example: Screening for language need

11. Center for Diversity and Health Equity Enhanced Phone Interpretation

12. Center for Diversity and Health Equity Improved interpretation for LEP patients with cardiac conditions Inpatient Interpretation per Day

13. Center for Diversity and Health Equity Family Initiated Telephonic Interpretation

14. Center for Diversity and Health Equity Key ingredients to success Use data to inform decisions and improve care Support from highest levels of leadership Multidisciplinary team of champions –Nurse manager –Research faculty –Interpreter –Bicultural RA –MPH-trained data analyst Stay with it! Continuing to progress since 2006

15. Center for Diversity and Health Equity Remaining Challenges Family constellation in pediatrics: assessing interpreter need for all caregivers Screening consistently; nurse and provider responsibility for screening Overcoming provider resistance to phone interpretation Providers with some level of Spanish proficiency Documenting interpreter use