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Use of Professional Interpreters for Surgical Consent

South Eastern Sydney Local Health District
Project Added:
30 November 2015
Last updated:
3 December 2015

Use of Professional Interpreters for Surgical Consent

Summary

This project aims to reduce barriers in using professional interpreters for surgical consent, including the availability of interpreters, staff knowledge, skill and confidence, patient knowledge and service systems. 

View a poster from the Centre for Healthcare Redesign graduation, December 2015.

Use of Professional Interpreters for Surgical Consent poster

Aim

To increase the use of professional interpreters for patients with limited English proficiency, when giving informed consent for surgical procedures.

Benefits 

  • Improves patient safety.
  • Improves patient satisfaction.
  • Reduces delays to theatre and cancellations on day of surgery.
  • Reduces medical errors and exposure to associated medico-legal action.

Project Status

Key dates

  • Project start:  February 2015
  • Project finish: December 2016

Status

Implementation - The initiative is currently being implemented.

Background

SESLHD undertakes around 30,000 surgical procedures each year. It is likely that an interpreter will be required to gain informed consent for 10-20% of these procedures.

NSW Health policy requires that professional interpreters are used to obtain informed consent for surgery or medical procedures from patients for culturally and linguistically diverse backgrounds who have limited English proficiency. NSW Health has a stretch target of 100% by December 2015.

Family and friends or bilingual staff cannot be used as interpreters as their language ability can be variable, they may lack the required skills in medical terminology and they may omit important information. The use of professional interpreters reduces the risk of adverse events, improves patient experiences and patient compliance, and is associated with better health outcomes.

A 2015 court case found in the favour of a patient, where an interpreter was not used and they had an adverse health outcome. They received $330,000 in damages.

Baseline compliance rates in 2014 at the designated Prince of Wales Hospital and St George Hospital units were 19% and 47% respectively. This exposes SESLHD to a range of potential risks in relation to the target group including increased risks of:

  • adverse events
  • poorer patient experience and compliance
  • higher readmission rate
  • delays to theatre
  • medico-legal action and associated costs.

Implementation

Phase 1

Solution 1: Improving access to telephone interpreter services

  • Providing education and resources to secretarial staff of specialists in private rooms (30 secretaries).
  • Providing dual handset telephones in key locations in designated sites (24 handsets).
  • Providing education and demonstrations to staff in the use of phones (over 40 staff).
  • Developing and installing appropriate signage regarding preferred interpreter services in key locations (installed in over 100 locations).

Solution 2: Improving patient and carer knowledge regarding the right to a professional interpreter

  • Providing information and resources to community members regarding patients’ rights to professional interpreter services within public hospitals (over 200 community members).
  • Developing and distributing resources to support patients that request professional interpreters, including multilingual banners, posters, postcards and interpreter business cards in key locations.
  • Patient letters to include translated information about access to interpreters (anticipated completion date December 2015).

Phase 2

Solution 3: Improving the efficiency of face to face interpreter services

  • Working with the Sydney Health Care Interpreter Service Governance Committee to introduce new technologies that address inefficiencies in the use of interpreter service resources (anticipated completion date June 2016).

Solution 4: Developing new business rules regarding the use of professional interpreters

  • Co-designing process with senior surgeons and senior management to respond to Recommendations for Admissions (RFAs) without interpreter use identified where required (anticipated completion date June 2016)
  • Providing education and support during introduction of new business rules (anticipated completion date December 2016).

Implementation sites

  • Perioperative Unit at Prince of Wales Hospital
  • Upper Gastrointestinal Tract and Breast/Endocrine surgical sub-specialties at St George Hospital

Partnership

  • Sydney Health Care Interpreter Service
Banner asking consumers if they need an interpreter in several languages

Evaluation

  • Phase 1 audit at Prince of Wales Hospital demonstrated an increase from 19% to 36% in the use of professional interpreters for patients with limited English proficiency, based on audits of surgical patient medical records.
  • Audits at St George Hospital are currently in progress.
  • Planning for Phase 2 of the project is currently underway.

Lessons Learnt

  • Don’t assume that the underlying systems are working well for English speaking patients.
  • A district-wide, rather than an individual hospital approach, is required to change systems that impact on acceptance and flow of surgical referrals.
  • The use of committee-based engagement strategies for surgeons was not effective and alternative mechanisms such as formal, front-end engagement of a surgical clinical lead may be more effective.

Further Reading

  • Flores G et al. Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters. Annals of Emergency Medicine 2012; 60(5): 545-553.
  • Garrett P. Healthcare interpreter policy: policy determinants and current issues in the Australian context. Interpreting & Translation 2009; 1(2): 44-54.
  • Johnstone M, Kanitsaki O. Culture, language, and patient safety: making the link. International Journal of Quality in Health Care 2006; 18(5): 383-388.
  • Lindholm M, Hargraves JL, Ferguson WJ, Reed G. Professional language interpretation and inpatient length of stay and readmission rates. Journal General Internal Medicine 2012; 27(10): 1294-9.

Project Team

  • Lisa Woodland, Multicultural Health Service
  • Vivianne Challita-Ajaka, St George Hospital
  • Jo Lewis, Prince of Wales Hospital
  • Dianna Jagers, Sydney Health Care Interpreter Service

Contact

Lisa Woodland
Manager, Multicultural Health Service
South Eastern Sydney Local Health District
Phone: 02 9382 8676
lisa.woodland@sesiahs.health.nsw.gov.au

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