Intervention Title:
Increasing Interpretation through Policy Change, Seattle Children’s Hospital, Seattle, Wash.

Goal:
Assure the highest quality care for all patients regardless of language needs. 

Innovation: 
Incorporated language services metrics into the hospital dashboard and changed hospital policy to require interpretation two times a day for patients.

Result:
Electronic measures showing if patients receive required language services and improvement in use of interpreters.

Institution:
Seattle Children's Hospital
4800 Sand Point Way, NE
Seattle, WA 98105
P: (206) 987-2000

From the C-Suite: 

“By measuring the use of interpretation against patients’ language needs, we ensure that our patients are able to communicate with providers from the beginning. Assuring interpretation means we are giving our staff the tools they need to do their job right the first time. We are providing safer care, are reducing waits and inefficiencies from miscommunication.”

Pat Hagan
President and Chief Operating Officer

Profile:
250-bed hospital and pediatric referral center for Washington, Alaska, Montana and Idaho.

Clinical areas affected:

• Interpreter services
• Knowledge Management Department 

Staff involved: 

• Data analysts
• Nurses
• Physicians
• Statisticians 

Timeline: 
One year was spent to ensure language needs were accurately documented in the registration system and that the electronic orders set was providing accurate data. Then a hospital policy change was implemented requiring an interpreter twice a day for all non-English-speaking patients. An electronic report was also developed to measure the standard of care for patients using phone and in-person interpreters. Moving forward, the next step is to determine if patients are more satisfied and if fewer serious adverse events occur because of the increased use of interpreters.

Contact:
Sarah Rafton, M.S.W.
Director, Center for Diversity and Health Equity
sarah.rafton@seattlechildrens.org                    
P: (206) 987-3881

Innovation implementation: 
In order to better assess the impact of language on patient care and outcomes, the Seattle Children’s Hospital developed metrics to measure quality of care provided to both English-speaking and patients with limited English proficiency (LEP). This new metric will compare patient satisfaction and safety by error rates against language assessment and use of interpreters.

To begin implementing this new measure, the hospital first determined how accurately patients’ language needs were assessed by comparing the frequency with which interpreters were ordered and patients’ identified language needs. This assessment enabled the hospital to identify patients who were listed as English speakers, but for whom interpreters had been ordered.

Initially, the phone line for interpreters was assessed for frequency of use. As part of this process, the hospital subsequently changed its policy to require interpretation two times a day for patients. Now medical records on the phone bill match patients, so that an electronic report can be generated to show frequency of interpretation and how many days the patient spent in the hospital—ensuring that patients are receiving interpretation (either via phone or in-person) an average of two times per day.

Safety and satisfaction rates are being compared to language needs. The process is underway to create an electronic measure to determine if satisfaction and safety improve if patients receive interpreter services two times a day. A monthly bulletin to all nurses shows rates of interpretation by unit, which fosters transparency across the hospital.

Advice and lessons learned:

1. Demonstrate interpreter use. Once nurses and physicians saw data on how frequently interpreters are actually ordered, they realized they were not actually utilizing interpreters as much as they thought they were.
2. Be patient. Partnerships between interpreter services and data and research experts can help demonstrate value and provide objectivity.
3. Use a multidisciplinary approach. Working with different teams across a hospital raises the visibility and buy-in for initiatives evaluating quality and safety.

Cost/benefit estimate:
Improved language assessment from 97 percent to 100 percent and improved rates of interpretation from 100 percent to 109 percent per inpatient day for LEP families. Although formal cost-benefit comparisons have not been made, it seems intuitive that regular communication—including an upfront identification of language needs—will be more cost-effective than infrequent, delayed or nonexistent communication in the appropriate language.