In this issue of Stronger Together we will focus on interpreter collaboration with inpatient nurses and inpatient nurse managers. Both of these collaborations involve rounding, but the rounding involves different groups and serves different purposes.
Interpreter rounds on inpatients:
First, let’s look at systematically scheduling interpreters to round twice a day on every language need patient with the floor nurses, to make sure that the patients and families understand the plan for the day and have all concerns and questions about care answered. Children’s hospitals around the country are very advanced in this practice. Some, including Seattle Children’s Hospital, have a policy that requires every inpatient to have at least one interpreted encounter with the care team every 12-hour shift. The frequency and consistency of these interpreted twice-daily sessions support the parents in learning how to care for their child when they finally take the child home. In the description of this practice, below, also note that the interpreters themselves document these interpreted encounters and their documentation becomes adjunct to the nursing notes. Here is a description of the practice at Children’s Hospital of Wisconsin, shared with us by Kristin Neitzel, Manager, Patient Amenities and Family Services:
In 2014 Children’s created a nursing education entitled Safe Discharge of a Non-English-Speaking Patient. Language Services participated in that educational development. As this education rolled out, Language Services began a rounding process 2 times a day. We rounded in the morning to set the stage for first shift and once again in the early evening to set the stage overnight. We do not round on 3rd shift as most of our patients are sleeping during that time. Each hospitalized LEP patient is visited. The goal of this rounding is to talk with the family and the nurse, answer any questions that the family may have and ensure communication was planned for related to any other treatment or services for that day. The Language Services representative would also ask the family through an interpreter (themselves or a phone interpreter) to ask if the family was comfortable with daily cares being done without an interpreter present. We have found that most families understand hourly cares well and do not have a need for an interpreter at those times. The interpreter then would document their rounding discussion. This documentation would support the nursing activity for hourly cares. All other treatment and services would require a consult [request] for the interpreter to return at the desired time. This rounding and related education to nursing has increased our documentation compliance for the hospitalized patients by 36% in 4 years.
– Kristin Neitzel, Manager, Patient Amenities and Family Services, Children’s Hospital of Wisconsin
Rounding by Inpatient Nurse Managers:
Daily rounding on every inpatient by the Inpatient Nurse Manager is practiced more and more widely. The purpose of this rounding is to increase Patient Satisfaction and to provide quality of care oversight. This rounding is incidentally very beneficial for the non-English-speaking patients, particularly with coaching and support from the Language Program Manager.
In the past, Nurse Managers were very busy with administrative matters related to room allocation, care processes, infrastructure, and staff management. They would interact with patients only when there was a specific problem to be solved. Enter HCAHPS (the Hospital Consumer Assessment of Healthcare Providers and Systems), a government program to identify hospitals which are providing best or worst inpatient quality of service. Hospitals are now paid according to their high or low HCAHPS profile. Administrators push very hard on inpatient floor leadership to increase patient satisfaction and reduce complaints. In other words, patient satisfaction surveys about the care they receive can significantly reduce or boost the Medicare compensation to the hospital.
This financial pressure to raise patient satisfaction has created a new work process for Nurse Managers, in which they check in directly with every patient on the floor every day. Some nurse managers must report the number and percentage of their patients that they round on every single day. This rounding process requires the nurse manager to have easy access to an interpreter in each of the languages represented in her patient base each day. Each interaction with patients is brief. This is the perfect application for use of a remote interpreting modality. The nurse manager can wheel a VRI stand down the hall, or carry a speakerphone, and connect with language support in each successive patient room.
The Language Program Manager can guide the Nurse Manager to offer patient education materials in the patient’s language, to ask if cultural requirements are being met, and to ask if the patient feels that her questions are being answered by providers and staff.
In one hospital which sends out its HCAHPS patient satisfaction surveys in Spanish, they discovered something which is instructive for all hospitals: Patients recorded a fairly high satisfaction with their hospital stay overall but reported a significantly lower satisfaction with their interaction with their doctors. This hospital tended to schedule in-person interpreters only for the nurse discharge teaching. Doctor rounds were supported only with remote interpretation, regardless of factors such as patient vision, hearing, and mental or physical ability to interact with phone or video modality.
Special thanks to our contributor Kristin Neitzel.
Kristin Neitzel is a Manager in Patient Amenities and Family Services at Children’s Hospital of Wisconsin (CHW) and holds the LEP Officer title for Civil Rights Compliance. Kristin is the manager for the Language Services team and also manages the Welcome Center team, Patient Transport, Surgery Family Waiting, Accommodations and has regulatory responsibilities related to The Joint Commission. She has been with Children’s for 21 years and in her current role for 12. Kristin has been instrumental in improving access to language support for families by leveraging technology and contract partnerships. She has also increased quality of service and reduced overall cost of language support within CHW. Kristin has over 30 years of leadership experience in various industries including health care, human resources, banking and temporary help. Kristin holds a Bachelor’s Degree in Business Management and is currently pursuing her MBA.