Modifying the Registration System to Accurately and Efficiently Capture Patient Language Preference

Beaumont Hospitals, Royal Oak Campus, Michigan

Accurately and efficiently capture information on a patient’s language preference.

Changed hospital registration and record-keeping system so that they do not automatically input English as the default language for the patient.

Through audits of patient records the hospital reports a 95 percent accuracy rate for patient language preference data.

Beaumont Hospitals, Royal Oak Campus
3601 W. 13 Mile Road
Royal Oak, MI 42073
Ph: (248) 423-2640

From the Experts:
"The simple removal of a default language in our registration system is allowing us to provide the highest-quality of care to all of our patients by ensuring accurate collection of their language preferences from the beginning. By ensuring this data is correct we are in a better position to know what our patients’ needs are; which helps us provide them with the safer and more culturally competent care that they deserve."

Lauren Hill
Corporate Director, Diversity

Beaumont Hospital is a 1,067 bed inpatient and outpatient tertiary hospital.

Clinical areas affected:

  • Emergency Department
  • Cardiology Progressive Care Unit

Staff involved:

  • Medical Staff
  • Nursing Staff
  • Administrative staff
  • IT department

Implementing the registration system change was extremely simple but took many weeks to implement between training and education of registration staff on the importance of capturing accurate language information.

Lauren Hill
Corporate Director, Diversity
Ph: (248) 423-2640

Innovation Implementation:
Documenting a patient’s preferred spoken and written language for communications is an important step in the intake process. It allows the hospital to provide patients with interpreter services when needed and gives patients a critical voice in their health care journey, ensuring that they receive the same high-quality care as English speaking patients. Documenting this information is also an important part of a hospital’s data collection process, allowing them to track and address the needs of their patients as well as tackle any racial and ethnic disparities that might appear.

Examining the state of their registration system, the team at Beaumont Hospitals recognized some serious shortcomings in its ability to accurately and consistently capture the information. Because of the way it was set up, the system allowed the registration staff to easily pass over important patient details. For example, the team noticed that English was the default language in the electronic registration system allowing staff to skip this field rather than ask what they felt was a sensitive question. If the patient did not request an interpreter—or appear to need one by observation, the registrars left the language as English. This caused a number of miscommunications between doctors and patients who were not given the language services that they needed and lowered the quality of care that many were receiving.

Looking for ways to improve the process, the team at Royal Oak realized that a simple solution lay in not allowing a default in the language field. Doing this, the registration would be more likely forced to accurately note a patient’s language preference instead of moving past the language question and then falling back on the default selection.

To implement the change, the registration staff worked with the hospital IT department to disable the default selection in the language screening process and then ran a pilot group to refresh registration staff training. They were reminded of the importance of recording a patient’s language preference as well as where and how in the system they were to record it.

A handful of staff led the trainings and went around the hospital with “training documents” to teach staff members one-on-one. Each staff member was given a start date for recording patient’s language preferences and were then audited by the trainers. Staff found not to be in compliance were retrained.

One important decision for the Royal Oak Hospital was that they chose not to make the filling in the language field a “stop sign” in the process—staff would still have the ability to skip over the language field if necessary. This was done because too many stop signs in a record can lead to various complications, the most important of which being that if a clinical person needs timely access the person’s record and the field is incomplete, they would be stopped. It was decided that the stop signs cause too many problems throughout the system and instead Royal Oak decided to do electronic audits of the staff’s work to catch problems and constantly improve processes. Audits are conducted weekly to determine accuracy with completing written and spoken language fields and show that the hospital has achieved a 95 percent success rate.

Advice and lessons learned:

  1. Get IT on board early. Making changes to hospital computer systems requires the help of the IT department and their impact cannot be understated. For Royal Oak, it took a long time to make minimal changes, so they needed to be active from the get go.
  2. Education is key. As new staff come on board, it’s important to train them on the importance of providing interpreters and the new system - as well as invite existing staff to participate in a refresher. These sessions will also allow you to revisit the system and make sure that it is working properly.
  3. Get people involved early. It may take time for everyone to become acquainted with the new system. Change occurs over time and patience on everyone’s part will help ensure success with any new idea. Don’t take staff errors as stubborn resistance, though do expect some push back.

Cost/benefit estimate:
Costs were extremely minimal compared to the benefits of accurately collecting all patient language preference data. Implementing the change added only 15 minutes of training for each person while no staff were taken off the job to learn. As a result of more accurate information and greater staff awareness, Royal Oak expects interpreter use to increase causing an increase in cost for services.