LEP Patient Engagement. T EAM STEPPS 05.2 Mod 1 05.2 Page 2 TeamSTEPPS Why engage patients with...

LEP Patient Engagement

TEAMSTEPPS 05.2Mod 1 05.2 Mod 1 05.2 Page 2

TeamSTEPPS

Why engage patients with limited English proficiency?

LEP patients = 8.6% of U.S. population

Patient safety events more severe and more often due to communication errors (Divi et al. 2006, Flores 2005)

LEP patients are safer and have fewer readmissions with professional interpreters (Flores et al. 2003, 2008, Linholm et al. 2012)


TeamSTEPPS

Abt Associates

One misunderstood word, “intoxicado” -> quadriplegic teen, $71 million settlement

Heard during our initial research:

“In French, estomac is the stomach, but in Creole, lestomak mwen means, ‘my chest’. Without an interpreter present, a French-speaking provider could incorrectly think a [Haitian] patient was experiencing stomach pain, not chest pain. This is a potentially life-threatening error”

— Interpreter

Misunderstandings are common and can be serious


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Yet interpreters are rarely integrated into the patient safety team (Diamond et al. 2009; Ring et al. 2010; Betancourt et al., forthcoming)

Often not called at all because of delaysMaybe somebody else requires that bed. So that’s when we do our discharge. I would like to see the doctor’s face if I go over there, and say, ‘you know, I really can’t discharge this patient because he doesn’t really understand anything’’--Nurse

Or ignored when they are presentI’ve seen interpreters try, for example, to intervene when a provider insists on speaking a language they’re not fluent in. And there’s a big power struggle and the interpreters feel intimidated. But it’d be nice for them to be able to really recognize situations that are really critical, to be able to call time outs. — Interpreter Services leader


TeamSTEPPS

High-Risk Settings and Situations

Consider starting here: ED Labor and Delivery Surgery Transitions in care, including intake and discharge Medication reconciliation


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How the LEP module can help

1.5 hour staff training module and 4-hour train-the-trainer program so unit staff and interpreters can: Understand the risks to LEP patients Assemble the right team (call an interpreter!) Identify and raise patient communication issues

Also includes a guide for hospital leaders To identify/ implement needed system changes

ahead of training


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Module preview: process map


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Tools

Assemble the team CUS Two Challenge Rule Brief Psychological Safety Check-Back Teach Back


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Stop the Line: CUS

(insert video clip of CUS here)


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Field-test findings

Module can be implemented various ways in various settings TeamSTEPPS/non-TeamSTEPPS hospital Hospital units (ED, L&D, OB), or primary care Stand-alone or part of overall TeamSTEPPS


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Field test findings


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Results

Qualitative results: Clinical staff more aware of need to call interpreter Interpreters more empowered to raise and address communication

issues with clinical team

Quantitative results: Hospital 1: pre-test convinced leadership no post-test

Hospital 2: High satisfaction, increase in knowledge, R/E/L data quality issues interpreter use data unusable

Hospital 3: High satisfaction, increase in knowledge scores, R/E/L data quality issues interpreter use data unusable


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Conclusions

Module can be implemented in a variety of settings TeamSTEPPS/non-TeamSTEPPS Hospital/ primary care clinic

Catalyst for change R/E/L data Collection/use still a barrier to formal

evaluation


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Next steps

Module available early Fall Sign up today for a copy

LEP Patient Engagement. T EAM STEPPS 05.2 Mod 1 05.2 Page 2 TeamSTEPPS Why engage patients with...

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