Language Services for Limited English Proficient Patient Quality and Safety Dashboard and Data Driven Process Improvement
Background Statement
Professional Interpreter Services are critical to ensuring patients with Limited English Proficiency (LEP) receive safe and effective care at D-H. Without professional interpreters, LEP patients encounter numerous barriers in accessing healthcare and experience higher risk in healthcare outcomes. Without documentation and measurement of LEP patient encounters and interpreter utilization, improvement efforts are challenged
Descriptive Statistics of LEP persons in the United States, New Hampshire, Vermont and Dartmouth Health
o 67.8 million people (22%) of the US population report speaking a language other than English at home. 1
o 25 million people (8%) of the US population report speaking English less than very well. 1
o 103,568 people in NH (7.8%) and 33,457 people in VT (5.4%) speak a language other than English at home.2
o 31,086 people in NH (2.3%) and 7,462 people in VT (1.2%) speak English less than very well.2
o Greater than 20% of residents in New Hampshire’s two largest cities (Manchester and Nashua) speak a language other than English at home.3
General Descriptive Stats of DH LEP Patients (10.1.15 – 8.31.24) – Data represents DH Lebanon, Manchester, Nashua, Concord and Keene sites4.
o Total number of LEP patients at D-HH: 15,242
o Total number of non-English Languages: 124
o Spanish comprises 43.7% of LEP speakers.
o 35,330 patients have language listed as: unknown, unavailable or unlisted
Risks to Limited English Proficient (LEP) and Deaf patients5
o Longer hospital stays when professional interpreters were not used at admissions/discharge
o Greater Risk of line infections, surgical infections, falls, pressure ulcers and surgical delays
o Greater chance of readmissions for certain chronic conditions due to difficulty understanding care
Typical failures known to Occur:
o Use of family members, friends, or nonqualified staff as interpreters
o Provider use of basic language skills to “get by”
o Misunderstanding of cultural beliefs and traditions that affect care delivery, such as expression of pain, respecting authority, gender roles, and class biases.
Organizational Risk4
The safety risks associated with LEP patient care also extend to organizational risk. Several areas of risk management that require quality planning, include:
o Patient comprehension of medical condition, treatment plan, transitions, complications and continuity of care.
o Additional areas requiring proactive attention include accuracy of the medical record, medication reconciliation, informed consent, preparation for tests and procedures, and urgent, emergency and surgical care.
Objective of data driven work
o If we don’t document, we can’t measure and we won’t be able to improve…
o Prevent risk of being out of compliance
o Prevent patients falling through cracks
o Prevent Unsafe care, waste, inefficient care
Interventions
1)Changed how we Identify language needs
2)Will document interpreter utilization in EMR
3)Dashboard to measure LEP patient encounters and interpreter utilization
Impacts of Dashboard and Data Driven Process Improvement
•Current tracking of stratified distribution and prevalence, refreshes monthly
•Ability to have a centralized bird’s eye view of big picture statistics
•More targeted and cost effective interpreter and translation resources allocation
•Understand where gaps are, to inform targeted interventions
