IMPROVING ACCESS TO CARE IMPROVING ACCESS TO CARE FOR SPANISH SPEAKING FOR SPANISH SPEAKING

PATIENTSPATIENTS

IMPROVISAR AXESOS HA IMPROVISAR AXESOS HA CUIDADOS PARA PACIENTES CUIDADOS PARA PACIENTES

QUE HABLAN ESPANOLQUE HABLAN ESPANOL

PEDIATRIC PRACTICE TEAM PEDIATRIC PRACTICE TEAM MEMBERSMEMBERS

MYRNA ENRIQUEZ, JENNIFER MYRNA ENRIQUEZ, JENNIFER COLLIER, ANNEMARIE LALLY, GINA COLLIER, ANNEMARIE LALLY, GINA MARZULLO, MARY HOFFMAN RN, MARZULLO, MARY HOFFMAN RN, KATHY LENZ, JEROLD STIRLING MD, KATHY LENZ, JEROLD STIRLING MD, LAURA BELLING LAURA BELLING

OPPORTUNITY STATEMENTOPPORTUNITY STATEMENT In the pediatric practice, it was noted that In the pediatric practice, it was noted that

many Spanish speaking patients accessed care many Spanish speaking patients accessed care in person rather than by phonein person rather than by phone

Baseline data gathered over 2 weeks showed Baseline data gathered over 2 weeks showed that 83% of walk in patients were Spanish that 83% of walk in patients were Spanish speakingspeaking

GOAL:GOAL:Implement a system to improve access to care Implement a system to improve access to care

for Spanish speaking patients for Spanish speaking patients To decrease walk in rate for Spanish speaking To decrease walk in rate for Spanish speaking

patientspatients

MOST LIKELY CAUSESMOST LIKELY CAUSESLanguage Barriers Language Barriers No bilingual triage staffNo bilingual triage staff Triage phone prompts Triage phone prompts

only in Englishonly in English Spanish speaking patients Spanish speaking patients

reluctant to leave reluctant to leave messages in Spanish messages in Spanish despite instructions by despite instructions by bilingual clerical staffbilingual clerical staff

Patient’s inability to Patient’s inability to communicate with English communicate with English speaking MD’s without speaking MD’s without the assistance of a the assistance of a translatortranslator

Patient Knowledge:Patient Knowledge: Unaware of triage lineUnaware of triage line Unaware that Unaware that

appointments are appointments are necessary for clinic necessary for clinic visitsvisits

Patient Preference:Patient Preference: Patients know there is Patients know there is

bilingual staff at the bilingual staff at the front desk that will front desk that will help themhelp them

SOLUTIONS IMPLEMENTEDSOLUTIONS IMPLEMENTED

Added a Spanish option to the Nurse Phone Added a Spanish option to the Nurse Phone Triage line to promote phone access and Triage line to promote phone access and triage for Spanish speaking patients:triage for Spanish speaking patients:

Redesigned phone triage tree and recorded the Redesigned phone triage tree and recorded the Spanish optionSpanish option

Spanish messages answered and translated by Spanish messages answered and translated by bilingual clerical staff bilingual clerical staff

Promoted Spanish option during clinic visits and Promoted Spanish option during clinic visits and the quarterly patient newsletterthe quarterly patient newsletter

SOLUTIONS IMPLEMENTEDSOLUTIONS IMPLEMENTEDImplemented use of the AT&T language line to Implemented use of the AT&T language line to

facilitate phone communication with non-English facilitate phone communication with non-English speaking patientsspeaking patients

Staff educationStaff education Established staff expectations for use of the language line Established staff expectations for use of the language line

and monitored utilizationand monitored utilization

Expanded use of the AT&T language line to clinic Expanded use of the AT&T language line to clinic visits visits

Purchased a portable phone for interpretation in the Purchased a portable phone for interpretation in the exam roomsexam rooms

Established expectations for use by faculty and staffEstablished expectations for use by faculty and staff

Spanish Speaking Patient Walk In Rate

83.3%

6.6%

0.0%0%

20%

40%

60%

80%

100%

Nov 03 Jan 04 Mar 04

Perc

en

t o

f P

ts

No Walk-ins

Spanish Speaking Calls to Phone Triage Line

6.3%

29.3%

37.0%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Nov 03 Jan 04 Mar 04

Per

cen

t of P

ts

RESULTS & ANALYSISRESULTS & ANALYSIS

The Spanish speaking patient walk in rate The Spanish speaking patient walk in rate decreased dramatically with decreased dramatically with implementation of new access to care implementation of new access to care processes for this patient populationprocesses for this patient population

The percent of Spanish speaking triage The percent of Spanish speaking triage calls increased with the implementation of calls increased with the implementation of the Spanish phone optionthe Spanish phone option

Clinical care has improved through Clinical care has improved through effective translation services for both effective translation services for both phone triage and clinic visitsphone triage and clinic visits

NEXT STEPSNEXT STEPS

Establish a routing system for Spanish Establish a routing system for Spanish speaking calls to allow for effective triagespeaking calls to allow for effective triage

Monitor portable phone utilization during Monitor portable phone utilization during clinic visitsclinic visits

Develop Spanish patient education tool to Develop Spanish patient education tool to instruct patients how to access careinstruct patients how to access care

Explore opportunities for on site certified Explore opportunities for on site certified medical translatorsmedical translators

Continue efforts to hire bilingual staffContinue efforts to hire bilingual staff