Plan required to offer interpreter services

Make sure staff receives training once plan is set

Every medical facility needs to have a plan in place for accessing qualified medical interpreters when a patient has limited English proficiency. There are many ways to make sure there is good communication between medical staff and patients or family members with limited English proficiency.

At Wellspan Health in York, PA, there are four full- time and two part-time Spanish interpreters employed to provide services 24 hours a day, seven days a week, says Christine Hess, MEd, patient and family education coordinator. The AT&T Language Line is used for other languages, and there is a resource list of staff members who may be able to help with some languages in certain situations, she adds.

"Hispanics are the largest group in our community needing the interpretation services," states Hess.

The policy is specific about requirements. It reads:

"If a patient, designated family member or significant other of a patient participating in treatment discussions and decision-making for the patient is unable to effectively communicate except for using sign, or foreign language interpreter, all medical and psychiatric evaluations or discussions regarding a patient's symptoms, treatment, diagnosis, progress, and prognosis in which that person takes part must be communicated through the use of a qualified sign or foreign language interpreter.

Additional situations in which an interpreter is involved include, but are not limited to: Obtaining informed consent or permission for treatment; discharge planning; explaining and discussing advance directives; explaining the administration and side effects of medication; explaining follow-up treatment; and discussing billing and insurance matters."

The "Communication Assistance Policy" at Cincinnati (OH) Children's Hospital Medical Center, specifies that any time medical information is exchanged with a family or patient with limited English proficiency, an interpreter must be present. Staff is required to arrange for interpreters in advance of a scheduled appointment or encounter, as well.

Although the health care institution has bilingual providers on staff from more than 60 countries, they are not allowed to act as an interpreter. Fluency in a language is not enough to qualify as an interpreter, explains Mariel J. Broadus, director of guest services at Cincinnati Children's Hospital.

"I know a lot of hospitals do allow for bilingual providers, but that is something we chose not to condone. Part of the reason for that is because we currently don't have any assessment in place for anyone who identifies themselves as bilingual," says Broadus.

To assist with communication, the children's hospital employs eight full-time Spanish speaking interpreters and has three more on call. Three local agencies are used to provide interpreters for other languages, and also there is a contract with an agency for American Sign Language. A telephonic interpreting service is also available to staff.

Training essential

Although it is important to have policy in place, that alone is not enough. There must be ongoing staff education to make sure everyone understands how to comply with the policy.

Broadus constantly works with department heads and managers to make sure they can train their staff on the appropriate use of interpreters.

Also, when someone calls guest services with a question about policy concerning interpreters, Broadus has staff suggest someone from the department follow-up with a short in-service at a staff meeting. Information covered might include an overview of working with a medical interpreter, going through a mock encounter, and the steps for requesting an interpreter.

"One of the most important messages we try and give everyone is that interpreters are not just here for patients and families -- they are here for providers, as well," says Broadus.

She helps providers learn how to politely tell parents who do not want an interpreter that they want one present in order to make sure everything said is communicated appropriately.

Interpreters on staff are also taught how to politely refuse to leave when a physician states that he or she can handle the encounter since they speak the language. Often, the physicians realize the patient does not understand and it is an opportunity for the interpreter to step in and clarify. It's a great teaching opportunity for providers, says Broadus.

At most health care facilities, the preferred method of communication is assessed at admission. At Cincinnati Children's Hospital, upon registration, parents or guardians are asked their preferred spoken and written method of communication, and patients are also asked.

Information on the electronic medical record can be flagged, and every time a patient or family is identified with limited English proficiency, the information is flagged. In that way, anyone who accesses the medical record will see the flag, says Broadus.

Currently, additional methods for notifying providers are being considered, such as creating a magnet for the door of the patient's room, she adds.

Education about the importance of using medical interpreters is an ongoing effort, says Broadus.

SOURCES

For more information about creating policy and training on the use of medical interpreters within your health care system, contact:

• Mariel J. Broadus, Director of Guest Services, Cincinnati Children's Hospital Medical Center, MLC 2019, 3333 Burnet Ave., Cincinnati, OH 45229-3039. Telephone: (513) 636-0701. E-mail: Mariel.Broadus@cchmc.org.

• Christine Hess, MEd, Patient and Family Education Coordinator, Wellspan Health, York, PA. Telephone: (717) 851-5859. E-mail: chess@wellspan.org.