Intervention Title:
Creating a Documentation System for Meeting Inpatient Language Needs – Regions Hospital; St. Paul, Minn.

Goal:
Create systems that ensure documentation of when language services are needed and how they are provided.

Innovation:
Staff augmented the electronic medical records used by nurses and other frontline staff to indicate how and when interpreters offered their services during critical points in care.

Result:
In some key units, the percentage of patients receiving the appropriate language services at admission and discharge have gone from near zero to as high as 70 percent.

Institution:
Regions Hospital
640 Jackson Street
St. Paul, MN 55101

From the experts:
“Very early we realized that providers hold the key to the success of the documentation process. Care providers are ultimately responsible for meeting the language needs of their patients—not interpreters—so they are the ones who should be documenting how language needs are met. They also have consistent access to medical records, the logical place for such documentation. We developed a simple tool to document how patients' language needs are being met and built it into the nursing providers' routine workflow so that it is not an extra process. We used the results to show them why planning for language services at key critical junctures is necessary. Now the nurses are as interested in the results of the monthly documentation as we are.”

Sidney Van Dyke, M.A.
Director, Interpreter Services

Profile:
Regions Hospital is a full-service, 427-bed, nonprofit, private hospital in St. Paul, Minn.

Clinical areas affected:

• Inpatient clinical care

Staff involved:

• Interpreter Services
• Quality Improvement
• Information Technology
• Nurses and other frontline providers

Timeline:
Staff created the systems over one month; utilization began in earnest in January 2007.

Contact:
Sidney Van Dyke, M.A.
Director, Interpreter Services
640 Jackson Street
St. Paul, MN 55101
P: (651) 254-3067
sidney.e.vandyke@healthpartners.com

Innovation implementation:
Many hospitals struggle to accurately determine patient demand for language services and identify how that demand is met. Most organizations use the number of interpreted patient encounters as a key measure, but this only reveals how many patients were served through the Interpreter Services Department, and does not capture the number of patients who were not served at all.

Regions Hospital instituted new policies in 2007 to track how interpretation was being provided to patients in order to accurately assess demand for services at critical points of care and determine how the demand was being met. To make it easy for staff to track this information, Regions worked with its Information Technology (IT) staff to add two questions to the electronic medical record used by nurses:

1. What is the encounter (e.g., admission, discharge, informed consent, tests or procedures, etc.)?
2. How was the need for interpretation met (e.g., family member, non-interpreter staff, telephone interpreter, staff interpreter, contract interpreter, none used, etc.)?

Regions focused first on honest documentation, without discussing what should be done in a given instance. Not surprisingly, they discovered that interpreters were not being used during many pivotal points in patient care. They also discovered that family members and other staff were frequently providing interpretation.

The data provided the gateway for change. The Interpreter Services staff began educating providers about the need to involve interpreters at pivotal points in care – especially admission and discharge. They explained that using family members or other untrained staff was not best practice. Thanks to help from the IT Department, interpreters now receive a daily list of patients who prefer to speak in a language other than English. Interpreters make daily rounds to check on these patients and work with their providers to schedule interpretation at critical junctures in care.

Advice and lessons learned:

1. Providers are key. Regions knew that providers would be instrumental in identifying the need for interpretation – and whether or not the need was met.
2. Collaborate, collaborate, collaborate. Working with nurse managers and IT staff, Regions designed a simple enhancement to the electronic medical record that made recording the information effortless.
3. No judgments. No one “got in trouble” for recording that interpretation was not provided, or if a family member provided it. Regions wanted honest information that they could use to improve their services.
4. Reward success. A monthly report is shared with all staff and providers, and interpreters share in the results. Small celebrations mark moments of success and enhance buy-in among staff.

Cost/benefit estimate:
Since it was a simple addition to the existing electronic medical record, the cost of developing the data collection system was minimal. Regions staff credit the new system with enabling them to significantly improve the quality and timeliness of their language services. As many as 70 percent of patients in key units who need interpreters have one for admission and discharge. While the goal is 100 percent, this shift marks a significant improvement in a short period of time.