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Is your ED in compliance with federal regulations for care of non-English-speaking patients and their families? You are required to provide language assistance to patients in your ED, and penalties for failure to comply are severe, including exclusion from participation in Medicare and Medicaid and possible criminal charges.
In addition, standards from the Joint Commission on Accreditation of Healthcare Organizations require that you find effective ways to communicate medical information to patients who don’t speak English. The agency also requires you to address how staff interact with patients from different cultures.
Here are effective strategies to comply:
• Provide trained and competent interpreters.
Federal regulations mandate that to receive federal funds, health care organizations must offer and provide language assistance services to patients with limited English proficiency in a timely manner, says Mary Jo Webb, RN, MSN, director of emergency nursing at San Francisco General Hospital and Medical Center.1 Solutions include hiring bilingual staff members and staff interpreters, enlisting the help of community volunteers, or contracting with a telephone interpreter service, she adds.
Health care providers are banned from requiring patients to use family and friends as interpreters, Webb cautions. "We do not encourage family or friends to interpret because of confidentiality concerns and the risk of misinterpretation," Webb says. Family or friends may not understand medical terminology, and this can cause problems, she explains. "The wrong question with the wrong answer could affect the treatment plan," she says.
San Francisco General Hospital and Medical Center’s ED uses the facility’s translation department, which is capable of interpreting 10 languages/24 hours a day, and it also contracts with the Portland, OR-based Pacific Interpreters for telephone translation, Webb says. The language spoken by the patient is documented on the triage sheet, and translation services are provided from that point on, explains Webb.
• Use a closed-circuit TV with interpreter.
At Genesys Regional Medical Center in Grand Blanc, MI, the ED sees very few non-English-speaking patients, says Jackie Sage, RN, former ED nurse manager. "This puts us in a minor crisis when we do have a need for interpreters," she says. Although Genesee County provides the ED with a list of local translators to access, there is often a delay in their arrival, and the cost is $35 per hour, she adds.
To address these problems of quick access and cost, a closed-circuit TV is brought into the patient’s room for videoconferencing, a service provided by Flint, MI-based Communication Access Center, which costs about $20 per contact, she reports. "We place it at the end of the bed, and we can have three-way conversations with a live interpreter," Sage says.
The patient, triage nurse, primary nurse, physician, and social worker can participate in the communication, says Sage. "This process has worked great for us so far," she says. "The downside is that the interpreters are not available 24 hours a day at this time, but we are progressing to that coverage."
• Hire bilingual staff.
Webb hires multilingual staff whenever possible. "We have nurses, physicians, and ancillary staff who are multilingual," she says. Approximately 40% of the ED staff speak a foreign language, mostly Spanish, says Webb. "It is not a criteria for hiring, but we prefer bilingual staff," she says.
• Give staff incentives for multilingual status.
Staff members who are multilingual frequently go to other areas of the hospital to help interpret if needed, Webb explains. "Our staff receive interpreter pay if they are credentialed," she says.
ED staff can take a language exam given through the facility’s human resource department, she explains. "It does not cost the employees anything, but if they want to be paid for interpreting, they have to pass the test," Webb explains. "If they pass, they are credentialed that they are qualified to interpret, and get an additional $25 per week," she explains.
Several ED nurses receive tuition reimbursement for taking adult education Spanish courses, Webb says. "The staff realize the significance of this, since a large part of our population speaks Spanish," she says. Consider reimbursing staff for language classes, Webb recommends. "Our staff can get reimbursement through their educational fund if they opt to use the money for that purpose," she says.
• Give patients written materials in their native language.
Federal guidelines recommend that you should offer written materials for each group of non-English-speaking patients constituting 5% of your ED’s patient volume.1
All forms and signs in San Francisco General’s ED are printed in four languages because of the diverse patient population, says Webb. Forms are sent out to the San Francisco Department of Public Health to be translated into Spanish, Russian, and Chinese, she says.
• Give staff diversity training.
Cultural and diversity training are given to all ED staff by the clinical educator and clinical nurse specialist, with frequent classes offered, reports Webb. "We stress cultural differences and beliefs that may affect the patient’s care," she says. The health department supplies all the training materials, she says. In addition, the county health department provides cultural diversity training several times a year, says Webb. "We send staff to be trainers, and they, in turn, train staff in the department," she says.
Additional diversity training is provided during the ED’s annual competency day, Webb says. The clinical nurse specialist prepares the materials from a variety of sources, she says. "We also utilize our equal employment opportunity department to provide individual training if needed," she says.
1. 67 Fed Reg. 41455 (June 18, 2002).
For more information on care of non-English-speaking patients, contact:
• Mary Jo Webb, RN, MSN, Director, Emergency Nursing, San Francisco General Hospital and Medical Center, 1001 Potrero Ave., San Francisco, CA 94110. Telephone: (415) 206-4097. Fax: (415) 206-5818. E-mail: Mary.Jo.Webb@sfdph.org.
For resources on non-English-speaking patients, contact:
• The Office for Civil Rights of the Department of Health and Human Services document titled Policy Guidance on the Title VI Prohibition Against National Origin Discrimination as It Affects Persons With Limited English Proficiency is available at no charge at www.hhs.gov/ocr/lep.
• The Care Notes System is a patient education tool written at the sixth- to eighth-grade reading level, with 3,000 titles available in English and Spanish. For more information, contact Micromedex, 6200 S. Syracuse Way, Suite 300, Greenwood Village, CO 80111-4740. Telephone: (800) 525-9083 or (303) 486-6444. Fax: (303) 486-6464. E-mail: email@example.com. Web: www.micromedex.com/products/healthcare. Click on "Patient Education," and "Care Notes System."
• Communication Access Center provides interpreters on site and via videoconferencing. For more information, contact Communication Access Center, 1631 Miller Road, Flint, MI 48503. Telephone: (810) 239-3112. Fax: (810) 239-1606. E-mail: firstname.lastname@example.org. Web: www.cacdhh.org.
• Pacific Interpreters provides telephone translation services in more than 130 languages. A per-minute rate is charged, based on volume and other factors. For more information, contact Pacific Interpreters, 520 S. W. Yamhill, Suite 320, Portland, OR 97204. Telephone: (800) 311-1232. Fax: (503) 445-5502. E-mail: email@example.com. Web: www.pacificinterpreters.com.
• Medical Spanish for the Emergency Room, a web site that was developed by Matthew Kopf, MS, and Julie McGowan, PhD, from the Burlington-based Vermont Initiative for Rural Health Information and Telemedicine. It assists medical professionals with patient history and physical examination if translation resources are unavailable or delayed. Web: www.vtmednet.org/medspanish.
• Language Assistance provides videoconferencing services with medically trained and certified interpreters for Spanish-speaking and hearing impaired patients. For more information, contact Language Assistance, 7227 Fannin St., Suite 103, Houston, TX 77030. Telephone: (888) 466-8255 or (713) 790-1295. Fax: (713) 790-1253. E-mail: firstname.lastname@example.org. Web: www.languageassistance.com.