COVINGTON, KY. – Basing an interpreter directly inside inpatient units shaved roughly 30 minutes off a nearly 1-hour delay in discharge times for patients from Spanish-speaking families at Childrens Hospital Los Angeles.
"We have a thousand discharges per month and 60%-70% require a translator, so it made a big difference," Dr. Ara Balkian, chief medical director of inpatient operations and associate chair of inpatient pediatrics, said at the Pediatric Hospital Medicine 2012 meeting.
Dr. Ara Balkian
Prior to the intervention, interpreters were centralized in a single office away from the units and were deployed as requests were submitted. In the fourth quarter of 2010, however, a Spanish-language interpreter was stationed on one of the medical-surgical floors for 4-6 hours per day during peak weekday discharge times to assist with discharge instructions.
Between the third quarters of 2009 and 2010, there was a statistically significant difference of 41 minutes in mean discharge times between English- and Spanish-speaking families, he said. The average time between the discharge order and the patient’s actually being discharged was 2 hours 25 minutes for English-speaking families and 3 hours 6 minutes for Spanish-speaking families.
During the intervention period, the difference decreased to 23 minutes in the fourth quarter of 2010 and to 27 minutes in the first quarter of 2011, and was no longer significant, he said.
As for why times lagged for Spanish-speaking families compared with English speakers, Dr. Balkian said the investigators hypothesize that many discharge components – such as instructions, or the interpretation of pharmacy directions – all require more time to convert to the parent’s or guardian’s primary language. The findings were based on the preferred language of the adults, even if the child spoke perfect English, Dr. Balkian explained.
He said it’s possible that interpreters were spending more time educating Spanish-speaking families, who according to previously published studies may have disparities in health literacy, compared with English speakers. In addition, the use of the unit-based interpreters during discharge and rounds identified more errors in the medication reconciliation and discharge instructions of Spanish-speaking patients. This may have been the result of miscommunication with non–Spanish-speaking providers while the components of the discharge were being prepared.
As fate would have it, funding for the project dried up and the interpreters were pulled off the units in the second quarter of 2011. Once again, the disparity in discharge times between Spanish speakers and English speakers increased significantly, this time to 48 minutes, Dr. Balkian said. The team also required more translators with increased hours on the units to meet the discharge demands in a consistent way.
Based on the results and longer response times resulting from the centralized interpreter office’s move to a location farther away from the inpatient units, funding has been restored and interpreters are again based in the units.
"Anecdotally, the nurses and interpreters do believe the discharge times have improved for Spanish-speaking patients," he said.
The investigators are currently collecting data on discharge times since the second quarter of 2011, and may expand the scope of their research to other non–English-speaking patients.
In a separate study presented at the meeting, interventions to improve awareness of, access to, and accountability for interpreter usage doubled the use of interpreters in a medical unit, compared with the rest of the hospital, to about three interpreter encounters per limited English-proficiency patient-day.
Interventions included staff education, inclusion of language needs in the emergency department admissions request, instructions in how to access face-to-face interpreter services, placement of interpreter phones in all rooms at all time, and providing for documentation of interpreter usage for attending notes.
Increased interpreter usage has been sustained, compared with other inpatient units, although multiple clinical encounters still occur without interpreters, reported Dr. Padmaja Pavuluri, a pediatric hospitalist at Children’s National Medical Center in Washington, D.C.
Dr. Balkian and Dr. Pavuluri reported having no relevant conflicts of interest.