Cut LOS for your patients who don't speak English
Immediate contact is 'tremendous anxiety reducer'
(Editor's note: This is the first story in a two-part series on caring for non-English-speaking patients in the ED. This month, we give strategies to reduce delays and improve care. Next month, we'll cover liability risks for emergency nurses.)
When a Spanish-speaking man approached ED nurses at Methodist LeBonheur Healthcare in Memphis, TN, pointing to his chest, nurses immediately called for translation services, but the interpreter was tied up with another patient elsewhere in the hospital.
"The patient needed a cardiac catheterization, but we couldn't have him sign the informed consent without translation," says Marianne Fournie, RN, BSN, MBA, corporate director for system ED services. There was a delay of more than 30 minutes before they could move him to the catheterization lab, she recalls. "We watched the clock the entire time while we waited."
ED nurses nationwide report caring for increasing numbers of non-English-speaking patients. "There is a great problem in our ED with health care providers being unable to communicate effectively with their patients," says Fournie. "This can affect access to care, delays in care, the efficiency of care, quality of care and, most importantly, the safety of care."
Pediatric LOS is longer
Length of stay (LOS) is longer for non-English-speaking children coming to EDs, says a recently published study.1 Researchers looked at 48,497 visits in one year in a Toronto pediatric ED and compared length of stay for 6,051 English-, 628 Spanish-, 486 Cantonese-, 486 Mandarin-, and 417 Tamil-speaking families. The average length of stay was 3.86 hours for English-speaking patients, and 3.95 hours for non-English-speaking patients.
"I think the implications for emergency nurses are significant," says Ran Goldman, MD, the study's lead author. "ED nurses are the first to communicate with parents of sick children, and the language barrier can be challenging."
In the past, the ED used family members as interpreters since this method was the fastest to communicate with the patient, says Fournie. "We found that it is often inappropriate for the family member to be interpreting, due to patient confidentiality and especially in circumstances such as children interpreting for their parents," she says.
Using interpretive telephone services is not ideal because the translators sometimes do not understand medical terminology, and interpreters coming to the ED aren't always available to come immediately, says Fournie.
The Joint Commission requires EDs provide interpretive services for non-English-speaking patients and patients with limited English proficiency as necessary, although the standards are not specific about who can translate or how quickly the translation must be provided. "We are required to provide language assistance to ensure equal access for programs and services," says Fournie. "These services cannot be of lower quality or delay delivery of care due to language barriers."
Methodist Le Bonheur Healthcare's ED is using a phone service with trained medical interpreters from Cyracom using "dual-headset" telephones that plug into any phone line in the ED. The price of the service and what it includes depends on the provider's contract, but one may be able to negotiate a price that includes the phone or be able to negotiate a leasing fee for the phones. All contracts include a price per minute for use of the phone lines. Methodist LeBonheur pays about $1.95 per minute for use of the service at six hospitals in its system.
It's determined which language is needed by the patient pointing it out on a card supplied by the service or by asking a family member.
Then the nurse picks up a headset, presses a button, and states which language is needed. Within minutes, an interpreter is available on the phone, and the patient picks up the other headset, which allows the ED nurse and patient to speak to each other through a trained medical interpreter.
"It can be used as soon as the patient enters the ED, so there are no delays in care," Fournie says. The translators are not only medically versed, they also are knowledgeable of cultural and ethnic nuances, she says. "We are able to provide clear communication without language barriers," Fournie says.
At Inova Healthplex in Alexandria, VA, the ED contacts qualified interpreters within the hospital when needed, and uses a phone service (Language Line Services; Monterey, CA) when these individuals are not available. "Our biggest challenge is the wide variety of languages that we encounter: Spanish, Vietnamese, Farsi, Amharic, and different African dialects, to name a few," reports Margaret Gaskins, RN, BSN, assistant management coordinator for the ED. "However, our nursing staff does share this demographic."
To save time, bilingual ED nurses are encouraged to seek certification through the hospital's cultural diversity department, in conjunction with the Alexandria-based Northern Virginia Area Health Education Center, to become qualified medical interpreters. Currently, two ED nurses are certified interpreters, one in Amharic and one in Tagalog. "We also have four staff members from radiology and registration certified in Spanish," says Gaskins. ED staff complete a verbal and written pretest to ensure fluency in the language before being accepted into the program, followed by five eight-hour classes over one month, ending with testing to receive final certification.
Using ED staff as interpreters saves time, because only two portable phones are available to use for interpretation; also, it takes a couple of minutes to be connected by phone to the appropriate representative, says Gaskins. "It also provides the patient with immediate face-to-face contact with someone who speaks their language," she says. "That is a tremendous anxiety reducer."
Reference
- Goldman RD, Amin P, Macpherson A. Language and length of stay in the pediatric emergency department. Ped Emerg Care 2006; 22:640-643.
Sources/Resources
For more information on reducing delays in caring for non-English-speaking patients, contact:
- Marianne Fournie, RN, BSN, MBA, Corporate Director, System ED Services, Methodist Healthcare, 251 S. Claybrook Suite, A218, Memphis, TN 38104. Phone: (901) 516-2357. Fax: (901) 516-2676. E-mail: [email protected].
- Margaret Gaskins, RN, BSN, Assistant Management Coordinator, Emergency Department, Inova Healthplex, 6355 Walker Lane, Alexandria, VA 22310. Phone: (703) 797-6819. E-mail: [email protected].
- Ran D. Goldman, MD, Associate Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Toronto, 555 University Ave., Toronto, ON M5G 1X8. Phone: (416) 813-7654, ext. 1486. Fax: (416) 813-5043.
- A telephone service with trained medical interpreters is available using dual-headset telephones that plug into any telephone line in the ED. For more information, contact: CyraCom International, 5780 N. Swan Road, Tucson, AZ 85718. Phone: (520) 745-9447. Fax: (520) 745-9022. E-mail: [email protected]. Web: www.cyracom.com.
- Telephone translation services are available from Language Line Services. For more information, contact Language Line Services, One Lower Ragsdale Drive, Building Two, Monterey, CA 93940. Phone: (877) 886-3885. E-mail: [email protected]. Web: www.languageline.com.
- "I Speak" cards can be downloaded free of charge on the Northern Virginia Area Health Education Center (NVAHEC) web site in the following languages: Amharic, Arabic, Bantu, Bosnian, Croatian, Farsi, French, Russian, Serbian, Soomaali, Tigrigna, Urdu, and Vietnamese. Go to www.nvahec.org/ispeak.html and click on "I Speak Cards/Charts." Scroll to the bottom of the document to click on the language name. Laminated "I Speak" cards or charts in additional languages can be purchased, with cost depending on the languages and number of charts ordered, and shipping varying by location. For more information, contact the NVAHEC, 3131-A Mount Vernon Ave., Alexandria, VA 22305. Phone: (703) 549-7060. Fax: (703) 549-7002. E-mail: [email protected].
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