New Program Improves Access to On-Call Clinicians for Patients with Limited English Proficiency
When patients call a clinic at night or on the weekend, they are connected with a phone operator who serves as a bridge between the patient and on-call provider. But most operators are not trained to assist a caller who speaks a language other than English. Reaching a member of the Brigham’s on-staff medical interpreters at night or over the weekend can take longer than during normal business hours, when most interpreters work.
To address this gap, teams from the Department of Quality and Safety and Interpreter Services collaborated with Telecommunications and OB-GYN/Midwifery to better support patients with limited English proficiency (LEP). Led by Yilu Ma, MS, MA, CMI, director of Interpreter Services, the group worked with a third-party vendor to design a program, called DirectResponse, that supports phone operators with non-emergency interpreter needs outside of normal business hours.
Prior to the program’s implementation, Brigham operators who received calls from patients speaking languages other than English during off-business hours often had difficulty obtaining information and relaying it accurately to on-call teams, according to Ma. The operator had to first identify the patient’s language and then put the patient on hold to contact an outside interpreter vendor to assist, which can involve extended wait times.
Now, LEP patients who need after-hours assistance from an on-call OB-GYN provider can more easily access those services. They can connect with an interpreter of their language within seconds. When patients call the program’s designated number from home during off-business hours, they are prompted to select their language by a pre-recorded instruction in that language. Since the patient and provider each contact the interpreter before connecting with each other, the interpreter is already on the line and ready to assist with translation.
“Our partnership with this vendor has decreased miscommunication and allowed patients’ voices to be heard,” said Nicole Sczekan, MSN, CNM, FACNM, director of Midwifery. “Prior to implementing this program, we had reports of patient calls not being appropriately transferred to us. That was distressing for the patient and family, as well as for clinicians. It’s imperative that patients call us with concerns and warning signs in order to provide safe care. Since the start of the program, these complaints have stopped and LEP patients now have peace of mind that they didn’t have beforehand.”
After a successful pilot in the Department of Obstetrics and Gynecology (OB-GYN), DirectResponse will be rolled out to all 28 Brigham clinical services that have on-call services. The program provides interpreter services in nine languages: Arabic, Cantonese, Cape Verdean, Haitian Creole, Mandarin, Portuguese, Russian, Spanish and Vietnamese.
“This is one of our inclusivity initiatives that allows our LEP community to communicate directly with their providers from their homes, independent of assistance from English-speaking family members or friends to translate on their behalf,” said Pamela Brown Linzer, PhD, RN, NEA-BC, associate chief nursing officer of Medicine and the Center for Nursing Excellence, who oversees Interpreter Services and Spiritual Care Services.
Robert Barbieri, MD, FACP, FACOG, interim chief of Obstetrics, agreed. “Interpreter services are so important in health care, so this program is really vital,” he said. “Rapidly accessible interpreter services are critical to providing equitable and high-quality clinical care to patients with limited English proficiency. This project is a testament to the Brigham’s work in continually improving our available interpreter services, and Yilu’s leadership was critical to the success of the program.”
Deborah Darveau, RN, senior patient safety specialist in the Department of Quality and Safety, described the program as an important step in improving the patient experience and advancing health equity.
“All patients deserve to be treated with the utmost respect and to be able to communicate with providers in their native languages,” she said.
“For our operators, particularly the after-hours team, the program has been an invaluable resource in providing customer service,” commented Aaron McDonald, evening supervisor of Operator Services. “The ability to so conveniently connect with another team that is dedicated to providing excellent service has proven itself to be nothing but a boon for accommodating callers in need of patient care.”