Articles

Bridging Gaps in Care

by Scott Suckow, FACHE

Imagine you are on an overseas business trip to someplace like Seoul, South Korea. In the middle of the night, you suddenly start feeling very ill. You find your way to a local hospital and check-in at the ER. The clerk doesn’t speak English, and you don’t speak Korean, so communicating the reason for your visit is difficult. The doctor who sees you seems empathetic, but only knows a few English words, like pain, and where. You can’t explain what you are feeling or give any of your health history. The doctor orders labs and an x-ray, later returns, and hands you a bottle of pills. The label is in Korean, and so is the discharge paperwork. You don’t know what the medication is, or how often to take it. You get the idea you are supposed to take two tablets, so you do. You leave and hope for the best.
This kind of scenario happens every day in hospitals across the US. Patients with language barriers often struggle to communicate with care teams, leading to 27% higher rates of readmission, 47% higher rates of returning to an ED, and inpatient stays that average 1.5 days longer. Often these patients are uninsured or under-insured, making any return ED visits and readmissions even more impactful to the hospital. 
Within Colorado and Wyoming, the percentage of individuals with Limited English Proficiency ranges from as low as 2-3% in some areas, to a high of 12-13% in Denver and Aurora, where some 150 different languages are spoken at home. These percentages have increased in recent years.

Fortunately, many hospitals invest in language access resources like video interpretation, telephonic interpretation, in-person interpreters, and bilingual staff. While not reimbursed, these services enable hospitals to comply with legal requirements and accreditation standards. More importantly, they level the playing field for these patients and allow them to fully participate in their care. Patients who are provided language assistance see shorter lengths of stay, return to the ED less, and enjoy better patient experience.
Over the past 20 years, hospitals across the US have made great progress in providing language access. It is now commonplace for care teams to be able to access telephonic or video interpreters in several hundred languages, on-demand, day or night. Many telehealth and virtual care modalities have interpretation resources built-in.
Important barriers still persist, however. The telephone remains the “front door” to hospitals and doctors’ offices for many patients, and those facing a language barrier often have trouble making appointments, canceling them, or inquiring about a family member. Medication labels and discharge instructions are commonly printed in English. Patient portals are available in English and sometimes Spanish, but not other languages. Social determinants of health like transportation, housing and insurance often block access to follow-up care and specialty services.

Recent advances in artificial intelligence bear great promise for these kinds of barriers. As AI solutions spring forward, though, it is important to keep a close eye on the accuracy, cultural context, and legal compliance of the information they provide.
With support from healthcare leaders, new and innovative solutions will emerge that close communication gaps, and enable patients with language barriers to take charge of their healthcare, and reap the benefit of all that our hospitals and clinics have to offer.

Scott Suckow, FACHE - Senior Director, UCHealth Language Services