Improving the Delivery of Care to Limited English Proficiency Patients

Abstract

Poster Presentation Purpose for the Program Limited English proficiency (LEP) creates challenges for effective communication, affects health outcomes, and exacerbates health disparities. A survey of postpartum women at this facility indicated that 41% of LEP patients reported an unmet need for an interpreter and wide use of unqualified interpreters during their stays. Proposed Change By October 2013, to achieve a 50% reduction in the number of postpartum LEP women who reported an unmet need for a qualified medical interpreter (MI) during their hospital stay. Implementation, Outcomes, and Evaluation A Lean Six Sigma (LSS) project was initiated to improve the quality and safety of care for women with LEP during their labor and delivery hospitalizations. Utilizing LSS concepts, a multidisciplinary team embraced the define, measure, analyze, improve, and control (DMAIC) process. Focus groups and surveys were conducted to elicit the voice of the customer from patients, nurses, and providers. Findings from a postpartum survey served as the baseline of measure for unmet needs for an interpreter in LEP patients. The number of patients with a completed “preferred language” field in the patient registration and billing system (PRBS) as well as use of qualified interpreters (in person and telephonic) were tracked. A standardized process (script) for soliciting the patient's preferred language was established and education on race, ethnicity, and language was provided. Obstetric providers received training on the use of language services and effective communication. After training, there was a 25% increase in completed preferred language fields in PRBS. There was a significant increase (34%) in the use of qualified medical interpreters (p Implications for Nursing Practice Effective communication is critical to the delivery of safe, high‐quality care. Identifying and delivering safe, high‐quality care to patients with LEP can be challenging. Failure to address language barriers inadvertently affects health outcomes. National efforts are underway to address disparities in care. As direct care providers, nurses must appreciate the importance of providing culturally sensitive care to avoid miscommunication and misunderstanding. Nursing administrators need to recognize the challenges associated with caring for the LEP patient and advocate for appropriate support and resources to meet the needs of LEP patients and health care providers.