TeamSTEPPS: LEP Safety: Success

Summary

This transcript highlights the importance of using interpreters in medical settings to ensure clear communication and patient safety, especially for patients with Limited English Proficiency (LEP). The scenario presented involves Rafael Hernandez, who speaks Spanish, and a healthcare team navigating his language needs while addressing symptoms of shortness of breath, which turn out to be serious. The use of interpreters ensures the accurate understanding of medical terms and instructions, preventing potential complications due to language barriers.

Highlights

• Interpreters play a crucial role in understanding medical symptoms and ensuring accurate treatment. 🎧
• The term 'fatiga' was initially misunderstood, showcasing the importance of language precision. 🔍
• The healthcare team's adaptability ensured Rafael Hernandez received the correct diagnosis and treatment. 🤝
• Clear communication led to the discovery of a contrast dye allergy, preventing potential complications. 💉
• The teamwork between medical staff and interpreters effectively supported patient safety and care. 🏅

Key Takeaways

• Always use professional interpreters when dealing with LEP patients to avoid misunderstandings. 📞
• Language nuances can greatly affect patient safety and treatment outcomes. 🌐
• Effective communication is crucial in medical settings to tailor proper care. 🏥
• Be aware that some terms can have dual meanings in different languages. 🌍
• Patient comfort and understanding should always be checked and prioritized during interactions. ✅

Overview

In this enlightening and educational scenario, we learn about Rafael Hernandez, a patient with Limited English Proficiency, whose experience with the healthcare system highlights the critical role of interpreters. As he visits a medical facility due to shortness of breath, communication quickly becomes a focal point. Initially, the term 'fatiga' is misinterpreted by the nurse, which could have led to a dangerous oversight had an interpreter not intervened to clarify that Rafael's symptoms were more aligned with shortness of breath rather than general tiredness.

Fortunately, the situation is remedied with the help of an interpreter, Ms. Vega, who ensures that both the patient and the healthcare team are on the same page. This leads to the crucial discovery that Mr. Hernandez is suffering from a myocardial infarction, and expedites his treatment with an angioplasty. This scenario underscores the essential role of interpreters in bridging language gaps, ensuring patient understanding, and preventing medical mishaps.

The story concludes on a successful note, with the medical procedure being carried out efficiently and effectively, thanks to the quick actions and precise communication facilitated by interpreters. The episode serves as a compelling reminder of the importance of language services in healthcare settings, not just for patient comfort, but also as a matter of safety and care accuracy. The narrative paints a clear picture of how collaboration and communication are at the heart of successful medical outcomes.

Chapters

• 00:00 - 00:30: Rafael's Initial Symptoms Rafael is experiencing fatigue, primarily in the mornings, and he communicates this to a nurse. Despite the language barrier, Rafael insists he understands English well enough to communicate.
• 00:30 - 01:00: Interpreter Joins the Conversation This chapter depicts a conversation involving a nurse, patient Mr. Hernandez, and an interpreter. The nurse insists on using an interpreter to ensure effective communication despite Mr. Hernandez's initial hesitance. Revealing his dominant language as Spanish, Mr. Hernandez begins to describe his symptoms, starting with fatigue that occurs in the morning.
• 01:00 - 01:30: Clarifying 'Fatiga' In this chapter, a nurse is attending to a patient, Mr. Hernandez, who reports feeling 'fatiga' since the morning. The nurse initially interprets this as fatigue or tiredness. However, the interpreter steps in to clarify the meaning, pointing out that 'fatiga' might also refer to shortness of breath in Spanish. The interpreter then checks back with the patient to confirm what he means by 'fatiga'.
• 01:30 - 02:00: Correct Understanding: Shortness of Breath The chapter explores the correct understanding of the phrase 'shortness of breath' in a medical context, particularly highlighting the potential for misinterpretation when translating from Spanish to English. Rafael, a patient, initially conveys his symptom as 'Me falta el aire,' which is correctly interpreted as shortness of breath by the interpreter, rather than fatigue. The medical team acknowledges the importance of accurate interpretation to identify serious health conditions accurately, such as those involving the lungs and heart. This interaction underscores the critical role of interpreters in healthcare settings to ensure patients' symptoms are correctly understood and addressed.
• 02:00 - 02:30: Dr. Desai's Briefing Dr. Desai meets with the medical team to discuss a 55-year-old male patient experiencing shortness of breath and mild chest pressure. The patient's EKG results indicate a myocardial infarction, and consent has been obtained for a balloon angioplasty procedure. The team moves forward with collecting pre-operative information, and the interpreter is advised to ask questions for clarity as needed.
• 02:30 - 03:00: Introduction of Medical Team In this chapter, the medical team is introduced to Mr. Hernandez, the patient, during a meeting. Dr. Desai, along with interpreter Ms. Vega and nurse Lansky, ensure that Mr. Hernandez understands the conversation. The interpreter, Ms. Vega, facilitates communication in Spanish, reinforcing the team's commitment to make sure the patient feels comfortable to ask questions if there's anything unclear.
• 03:00 - 03:30: Procedure Explanation: Balloon Angioplasty Chapter Title: Procedure Explanation: Balloon Angioplasty The chapter involves a conversation between a doctor and Rafael Hernandez, with the assistance of an interpreter. The doctor explains the upcoming procedure called balloon angioplasty, which is intended to open an artery in Mr. Hernandez's heart. Before proceeding, they need to confirm if Mr. Hernandez has any allergies to IV contrast dye, which is critical for the procedure.
• 03:30 - 04:00: Clarifying Contrast Dye Allergy In this chapter titled "Clarifying Contrast Dye Allergy," a conversation takes place primarily revolving around whether a patient, Rafael, is allergic to contrast dye used in medical procedures, which is administered intravenously. There seems to be some confusion and concern from an interpreter regarding whether Rafael fully understands what is being asked of him concerning the contrast dye, despite Rafael stating he's not allergic. The interpreter expresses discomfort, suggesting that Rafael may not have fully grasped the term "contrast" or "dye," indicating possible language or communication barriers in the medical context.
• 04:00 - 04:30: Interpreter's Concern and Plain Language The chapter discusses the importance of using plain language for clarity, especially in medical settings. An example is provided where a doctor explains a procedure involving the injection of a liquid for better visualization of the heart, also utilized in CAT scans and x-rays. The interpreter translates this explanation into Spanish, illustrating the need to convey medical information in understandable terms.
• 04:30 - 05:00: Discovery of Past Contrast Reaction The chapter discusses a patient's past allergic reaction to a medical procedure involving radiology. EVA recounts how in their home country, a similar incident nearly caused the patient to die after an X-ray was performed. The doctor suggests that the patient might have a serious contrast allergy and recommends premedicating with prednisone and Benadryl while closely monitoring the patient during future procedures. The chapter ends with the doctor inquiring if Mr. Hernandez has any questions about his treatment.
• 05:00 - 05:30: Ensuring Patient's Understanding The chapter titled 'Ensuring Patient's Understanding' centers around confirming the patient's comprehension of the information shared by the healthcare team. The interpreter asks Mr. Hernandez if he has any questions, to which he responds that he does not have any. Dr. Desai thanks the interpreter, Ms. Vega, for her assistance, while the nurse acknowledges the interpreter's awareness of a dye allergy.
• 05:30 - 06:00: Successful Angioplasty and Positive Outcome Successful Angioplasty and Positive Outcome - In this chapter, a nurse informs Mrs. Hernandez that her husband's angioplasty procedure went well after he suffered a serious heart attack. The procedure was performed promptly, offering a significant chance of preserving much of his heart muscle. An interpreter is present to ensure Mrs. Hernandez receives the information in her native language, providing reassurance about the successful outcome of the medical intervention.

TeamSTEPPS: LEP Safety: Success Transcription

• 00:00 - 00:30 RAFAEL: I have...fatiga...you know? How you say in English...fatiga? NURSE: Okay, how long have you been fatigued? RAFAEL: I have fatiga -- very much. It happen in the morning. NURSE: Ok. I'd like to call an interpreter to help us understand each other. RAFAEL: No, I understand English. No problem.
• 00:30 - 01:00 NURSE: Mr. Hernandez, I'm sure you do, ...but its our policy to use interpreters just to make sure we're not missing anything. Now, what language do you speak best - Spanish, Portuguese, or some other language? RAFAEL: Es-spanish. NURSE: OK, so tell me again about your symptoms? INTERPRETER: `Bueno, podra otra vez describir cules son sus sintomas? RAFAEL: I have fatiga. Very much. It happen in the morning.
• 01:00 - 01:30 NURSE: OK, so you have been tired since this morning. Do you have any other symptoms? Any fevers or chills? INTERPRETER: I'm sorry. Can I stop you for a minute? I need to clarify something. He's saying fatiga... ...and you're taking that to mean that he's tired, ...but he may mean hes feeling short of breath. Do you mind if I check-back with Mr. Hernandez just to clarify? NURSE: Yes, please do. INTERPRETER: Cuando usted dice "fatiga", quiere decir que est cansado o que le falta el aire?
• 01:30 - 02:00 RAFAEL: Me falta el aire. INTERPRETER: Okay, o sea que siente como que le falta el aire. RAFAEL: S. INTERPRETER: Hes actually having shortness of breath, not tiredness. The word fatiga can mean either one. NURSE: Thank you, that is very helpful. Mr. Hernandez, shortness of breath... ...can be a sign of some serious conditions. Im going to need to ask you a few more questions... ...and to do some examinations of your lungs and your heart. INTERPRETER: Hi, I'm Luz Vega. I am the interpreter for Mr. Hernandez.
• 02:00 - 02:30 DOCTOR: Dr. Desai. Nice to meet you. DOCTOR: OK, let's brief. This is a 55 year-old man here for shortness of breath... ...who just started having some mild chest pressure. Weve already told him that his EKG shows that he is having a myocardial infarction, ...and weve gotten consent for a balloon angioplasty. Now we need to get some pre-op information from him. INTERPRETER: Okay, thanks -- is there anything else I should know? DOCTOR: Nothing comes to mind, ...but stop us any time and let me know if anything is unclear...
• 02:30 - 03:00 ...or there's anything I should know about him that Im not getting. DOCTOR: Hi Mr. Hernandez. Im Dr. Desai. And, you know the interpreter, Ms. Vega, and nurse Lansky. INTERPRETER: Hola, Señor Hernandez. Soy la doctora Desai. Usted ya conoce a la interpreter, la seora Vega, y a la enfermera Lansky. La doctora Desai quiere asegurarse de que usted entienda... ...todo lo que le explicamos, as que, sintase en libertad de interrumpirnos... ...si hay algo que no entiende, est bien?
• 03:00 - 03:30 RAFAEL: S. DOCTOR: Mr. Hernndez, ...as you know, you are going to have a procedure called balloon angioplasty to open the artery in your heart. INTERPRETER: Señor Hernandez, como sabe, a usted se le va a realizar un procedimiento, llamado angioplasta de globo... ...para abrir la arteria en su corazn. DOCTOR: First of all, we need to make sure that you don't have any allergies to IV contrast. Do you have any allergy to IV contrast dye? INTERPRETER: Lo primero que tenemos que hacer es asegurarnos de que usted no tenga alergia al...
• 03:30 - 04:00 ...al... ...al tinte de contraste que le introducen va intravenosa. Tiene usted alergia al tinte de contraste? RAFAEL: Nono creo. INTERPRETER: I'm... I'm sorry...I'm concerned. He may not understand what you mean when you say contrast or dye. DOCTOR: He just said hes not allergic. INTERPRETER: Im sorry, Im a bit uncomfortable; I dont think he understood.
• 04:00 - 04:30 It think you may be safer if you say it in plain language. DOCTOR: Of course. Of course. For this procedure, we inject a liquid into the blood so that we can see the heart better. The same liquid is used for CAT scans, x? rays, and some other tests. INTERPRETER: Para este procedimiento, necesitamos inyectarle un lquido a su sangre -- tal que... ...podamos ver mejor su corazn. Ese lquido es el mismo que se usa cuando le... ...hacen una CAT scan, rayos equis y unas otras pruebas.
• 04:30 - 05:00 EVA: A l le hicieron algo parecido en nuestro pas, ...hace mucho tiempo ya, ...cuando le hicieron una prueba de radiologa. Casi se muere. INTERPRETER: He had something like that back home a long time ago... ...when they gave him an x-ray. He almost died. DOCTOR: It sounds like he may have a serious contrast allergy. Well need to pre-medicate him with prednisone and Benadryl... ...and keep a close eye on him during the procedure. DOCTOR: Mr. Hernandez, what questions do you have about any of this?
• 05:00 - 05:30 INTERPRETER: Señor Hernandez, que preguntas tiene de lo que le hemos explicado? RAFAEL: No, no tengo preguntas. INTERPRETER; No I dont have any questions, thank you. Dr. Desai, anything else youd like to ask... ...or mention to Mr. Hernandez? DOCTOR: No, thats it. Ms. Vega, thank you very much for your help today. NURSE: Yes. And great catch on the dye allergy.
• 05:30 - 06:00 NURSE: Good news Mrs. Hernandez. The procedure went very well. Your husband had a serious heart attack, ...but we got him the angioplasty quickly, ...so there is a good chance we saved most of his heart muscle. INTERPRETER: Buena noticia, Seora Hernandez El procedimiento sali muy bien. Su esposo tuvo un ataque al corazon muy serio, ...pero le hizimos la angioplastia a tiempo, ...o sea que hay alta probabilidad de que se salve bastante del tejido muscular del corazon.