1 / 30

AHRQ's new tools to improve safety for patients with Limited English Proficiency March 14, 2013

AHRQ's new tools to improve safety for patients with Limited English Proficiency March 14, 2013. Cindy Brach Agency for Healthcare Research and Quality Joseph Betancourt Disparities Solutions Center. Melanie Wasserman Abt Associates Alexander Green Disparities Solutions Center.

kirima
Télécharger la présentation

AHRQ's new tools to improve safety for patients with Limited English Proficiency March 14, 2013

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. AHRQ's new tools to improve safety for patients with Limited English Proficiency March 14, 2013

  2. Cindy BrachAgency for Healthcare Research and Quality Joseph BetancourtDisparities Solutions Center Melanie WassermanAbt Associates Alexander Green Disparities Solutions Center

  3. One more collaborator • Emils, born 10/10/2012

  4. Presentation goals • Describe development and testing of 2 AHRQ tools to improve LEP patient safety: • TeamSTEPPS Training module • Guide for Hospital Leaders • Describe implementation successes and challenges • Hear from you whether/how you might use the tools

  5. Background • 8.5% of the U.S. population has limited English proficiency (LEP) (US Census Bureau, 2010) • Patient safety events more severe and more often due to communication errors for LEP patients (Divi et al. 2006, Flores 2005)

  6. Background (Cont’d) • LEP patients are safer and have fewer readmissions with professional interpreters (Flores et al. 2003, 2005, Linholm et al. 2012) • Health care providers often try to “get by” without interpreters (Diamond et al. 2009; Ring et al. 2010) • This can cost hospitals millions (Price-Wise 2008; Quan 2010; Carbone et al. 2003) • Even when interpreters are present, they may not be empowered to speak up when they see a patient safety risk (Betancourt et al. 2012)

  7. AHRQ’s response • Commissioned an evidence-based Hospital Guide and TeamSTEPPS training module to improve LEP patient safety • TeamSTEPPs is AHRQ and DoD’s patient safety initiative • These are the first patient safety tools designed for LEP patients

  8. Preliminary Research Questions • How do language barriers and cultural factors contribute to potential patient safety events? • How are hospitals addressing linguistic and cultural sources of error? • Which trainable team behaviors and hospital-level changes can improve LEP patient safety?

  9. Preliminary Research Adverse Events Database Interpreter pilot TeamSTEPPS Module Environmental Scan Qualitative Interviews with Interpreters, Frontline Staff & Hospital Leaders Hospital Guide Town Hall Meeting Background Tool Development

  10. Findings • Environmental scan results reported above • Stratified adverse events database analysis: • Less productive than anticipated due to data challenges: • No standard field for patient language • No field to record interpreter presence/absence • Hospitals at Town Hall meeting reported similar data challenges

  11. Abt Associates Interpreter pilot and qualitative interviews • Common system failures: • Late or wrong identification of patient language needs • Non-qualified or non-use of interpreter • Failure to address interpreter shortages • Failure to integrate interpreter into patient safety team • Many stories about “close calls” or risky situations due to these issues

  12. Abt Associates Late or wrong identification of language needs • Surgery intake in English  latex allergy almost missed, caught by interpreter called in at the last moment • Interpreter present but provider refusing their services • Wrong language used (Spanish/Portuguese, French/Creole) In French, estomac is the stomach, but in Creole, lestomakmwen means, ‘my chest’. Without an interpreter present, a French-speaking provider could incorrectly think a patient was experiencing stomach pain, not chest pain. This is a potentially life-threatening error. — Interpreter

  13. Non-use of interpreter; failure to address shortages “I try to say, ‘The interpreter’s coming.’ I try to stall. But it’s hard when somebody’s pushing and saying, ‘I have to go. My family member has been here waiting with me for the interpreter…’ ” —Nurse Maybe 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 Abt Associates

  14. I have noticed that the patients come back to the hospital, to the same units where they have already been discharged. So you give the paperwork to the patient the day that they are going home. Suppose I did not speak the language. The patient actually said, “yes yesyesyes I understand everything”. And then you find the patient back a few days later, a week later…the same patient. And then, that’s when I find out that every discharge instruction that was given to the patient was totally…it was just…it didn’t work at all. —Nurse

  15. “I’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 “The role of the interpreter is what we call black box. The role…is to render the words only” — Patient safety leader Failure to integrate interpreter into patient safety team Abt Associates

  16. Hospital Guide Goals Improve LEP safety by helping hospital leaders to: • Foster a Supportive Culture for Safety of Diverse Patient Populations. • Adapt Current Systems To Better Identify Medical Errors Among LEP Patients. • Improve Reporting of Medical Errors for LEP Patients. • Routinely Monitor Patient Safety for LEP Patients. • Address Root Causes To Prevent Medical Errors Among LEP Patients Abt Associates

  17. Hospital Guide Content • What we know about LEP and patient safety • Strategies and tools to improve patient safety systems • Team behaviors to improve LEP patient safety • Additional resources and case examples Abt Associates

  18. Hospital Guide Testing • Shared with leaders in quality and safety at 9 hospitals • Leaders shared with their implementation teams (eg: interpreter leads, nursing leads) • Structured 30 mn interviews with leaders about content, usability, ease of implementation, and overall design and structure • Qualitative data analysis to identify key themes and implications for hospital guide • Edits made accordingly Abt Associates

  19. Module Goals and Content • Goals: help hospital staff to improve LEP safety by: • Understanding risks to LEP patients • If LEP  calling a professional medical interpreter • Identifying and raising patient communication issues • Content: • Customizable PowerPoint slides, videos, exercises • Structured communication tools • Evaluation guide

  20. Process Map Exercise Abt Associates

  21. Stop the Line: Use CUS Words • Structured communication tool to flag patient safety risks • Empowers everyone on the team to stop the line • Cues everyone on the team to pay attention if these words are used Abt Associates

  22. Check-Back Tool Abt Associates

  23. Field Test • Case study design • ToT, 5 month follow-up, field visit • Requirements to participate: • No $ incentive • Send 2 trainers to ToT • Implement in at least 1 unit • Train the entire team • Evaluate

  24. Successes • Module implemented 3 hospitals • Hospital #1: L&D • Hospital #2: ED, OB/Gyn • Hospital #3: Pediatric primary care • Focus of interventions: • Hospital #1: Use of qualified communicator • Hospital #2: Capturing patient preferred language • Hospital #3: Use of phone-interpreters • 268 staff members trained including doctors, nurses, interpreters, registration staff

  25. Quantitative Results Hospital #1 • Pre-test convinced leadership  no post-test Hospital #2 • High satisfaction (2.94 on 3-pt scale) • Significant increase in knowledge (up 28 points on 100-pt scale) • Race/ Ethnicity/Language (R/E/L) data quality issues  behavior data unusable Hospital #3 • High satisfaction (3 on 3-pt scale) • Increase in knowledge scores (up 17.6 points on 100-pt scale) • More phone interpreter minutes used but no LEP denominator

  26. Qualitative Results • Recognition of interpreter as cultural broker • Willingness to include interpreter in care team • Reliance on CUS words/other techniques • Increased use of phone line (Hospital #3) • Institutional changes • Reallocation of interpreter resources (Hospital #1 & #3) • Plans to update hospital interpreter policy • Clarification of bilingual certification guidelines (Hospital #1)

  27. Challenges • Time/cost concerns • Competing quality initiatives • Limited interpreter resources • Staff turnover • Equipment loss • Data quality for evaluation • Scale-up after the pilot

  28. Practical advice • Implement the Guide and module to improve LEP safety • May be helpful to implement Joint Commission standards on patient-centered communication • Use creative scheduling and persistence to overcome barriers of time, cost and competing initiatives • Use interpreter resource reallocation as a stopgap until shortages are addressed • Check data availability/quality before finalizing evaluation plan

  29. Take-home tools • Hospital Guide and Module available here: http://www.ahrq.gov/legacy/teamsteppstools/lep/

  30. Thank you!

More Related