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EDs are using new video tool instead of interpreters
Nurses 'see the patient's face light up'
A 40-year-old man approached triage nurses at Marion (OH) General Hospital's ED clutching his chest, but he didn't speak a word of English.
"We thought he was having chest pain, so we were going to treat him as such," recalls Erin Hansen, RN, the nurse who cared for the patient.
Instead, nurses were able to access a translator in seconds using a portable video device, and they discovered the man actually had shortness of breath. This determination saved the man, who was discharged from the ED with a diagnosis of pneumonia, from undergoing a needless electrocardiogram (ECG), blood work, and oxygen.
"We put in the IVs and did chest X-rays but did not go down the cardiac pathway," says Hansen.
The system is MARTI, which is an acronym for My Accessible Real-Time Trusted Interpreter, and it was developed by Columbus, OH-based Language Access Network. MARTI is a portable two-way, battery-operated, wireless video conference service with an adjustable camera. It looks like a TV screen on a wheeled stand. Nurses can use it anywhere in the ED to access interpreters in 150 languages.
Marion's ED has a large Spanish-speaking population who sometimes bring in their own interpreters, but the policy is to use the MARTI regardless, to ensure accurate and impartial translations. "Finding an interpreter who is certified who we can legally use takes a lot of time," says Hansen. "With a click of a button, we can be communicating effectively."
At Los Angeles-based Olympia Medical Center's ED, the system has bridged the language barrier for patients who speak Russian, Korean, and Farsi. Gerald Gabriel, RN, charge nurse in the ED, says in the past, they had access to translators, but sometimes waited hours with devastating effect. "If the patient comes in and you don't know where they are hurting, you can get more information through the [MARTI] interpreter," Gabriel says. "As a result, you may end up doing an ECG and find out they are having a mild heart attack. This may well have saved their life."
Similarly, you may learn that a patient has been double-dosing on digoxin, and that dosage is causing an adverse cardiac reaction. "Otherwise, we'd have to run a battery of tests to find out exactly what is going on, and we would have to wait for those tests to come back," says Gabriel.
At Boston Medical Center, ED nurses "care for a huge number of non-English-speaking people, which makes everything harder from start to finish," says Martha Eldessoky, RN, an ED nurse at the hospital.
Using MARTI, patients are treated much more efficiently with less frustration, says Eldessoky. "This in turn has a long-term affect," she says. "Patients are more likely to seek treatment, knowing that they can communicate their needs, problems, and concerns."
MARTI also has improved care of deaf patients, says Eldessoky. In the past, nurses called a service and an American Sign Language interpreter came to the ED, which took up to several hours.
"In the meantime, the stable patient waited, sometimes unable to make their problem or complaint known, much less receive treatment for it," she says. In one case, nurses were unable to fully assess the complaint of a deaf man until an interpreter showed up. As a result, a full work-up was done, including lab work, starting an intravenous line, and an abdominal computerized tomography scan — an expensive and time-consuming process, says Eldessoky. "When the interpreter arrived, it became apparent that his pain briefly felt better after eating, was worse when lying down at night, and was aggravated by certain foods," says Eldessoky. "This is a classic description of gastroesophageal reflux disease, which required no emergent work-up and is fairly simple to treat."
ED nurses set up the equipment; initiate the call; and coordinate the patient, physician, and translator, says Eldessoky. However, because only two rooms in the ED are wired for MARTI, this coordination involves the cooperation of other nurses, the movement of patients out of these rooms, and physicians being available when it all comes together, she says. "This occasionally doesn't go as smoothly as we'd like, but it is still a big improvement," says Eldessoky.
With the MARTI, the language barrier is bridged even if the patient speaks a language you have never heard of, says Gabriel. "It's scary enough to go to an ED, but not being able to communicate can be emotionally taxing," he says. "You can see the patient's face light up when they are able to talk with somebody in their native tongue."
For more information on using video interpretive services in the ED, contact: