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In the middle of a busy evening shift in the Bridgeport Hospital (Conn.) emergency department, a Korean woman gestured frantically that she had abdominal pain. The patient did not speak English, so the staff asked her husband where it hurt, when it started, and what her medical history was.

As he struggled to answer in his few words of English, the patient's face twisted with frustration, anxiety, and pain. Then Dawn Loehn, LPN, activated the MARTTI, a two-way live videoconferencing language service. A qualified medical interpreter appeared on the screen and began translating the staff's questions into Korean and the patient's answers into English.

"The patient's whole demeanor changed," says Loehn. "She felt understood." The patient began to describe her gynecological problems in detail, tests were conducted, and treatment began promptly.

According to the U.S. Census Bureau, 56,000 Bridgeport-area residents speak a language other than English.

Lynn Charbonneau, director of patient relations at BH, says the main languages spoken by patients are Spanish, Portuguese, and Polish. However, it is not unusual for the staff to communicate with patients who speak Mandarin Chinese, Italian, Laotian, Creole, Arabic, Bengali, or one of the 71 other languages spoken around Bridgeport. There also are many patients who are deaf or hard-of-hearing and communicate with American Sign Language (ASL).

All hospitals need a combination of interpretation methods and devices to keep up with the burgeoning need to provide quality care to diverse patient populations. In addition to telephonic interpretation and in-person interpreters, BH contracted with Language Access Network (LAN) to provide 24/7 interpretation services in any language and ASL via a HIPAA-compliant network. BH is piloting the use of three MARTTI units in the ED and projects access throughout the hospital by the end of 2008.

Advantages for nurses

Loehn says the telephonic interpreter system is not always reliable because of connection problems and interpreter availability. Using family members or hospital staff to interpret brings up problems with reliability and privacy.

Loehn is particularly concerned about patients who are deaf or hard-of-hearing. The staff has had to call an outside organization to send a certified ASL interpreter to the ED, often resulting in a wait of up to two hours. They resorted to pencil and paper if the situation was urgent.

Loehn says, "Now as soon as I see the hard-of-hearing or language barrier notation on a patient's chart, I start the LAN service right away."

Ken Forte, ED nurse educator, highlights the advantages of the MARTTI system.

"The most important thing about having someone use a translation device is speed," he says. MARTTI takes three minutes to activate, saving valuable time in assessing a patient, making the correct diagnosis, and initiating treatment. The nurses use MARTTI for both complicated situations and shorter educational sessions. The interpreter can convey the list of symptoms to report, the way to test blood glucose levels, or the procedure to change a bandage that the nurse is teaching the patient.

The second advantage is the personal touch of interacting with a person on screen who can see the patient and providers. The interpreter can watch the physician palpate an area and ask precise questions. Interpreters are trained in cultural aspects of medical interpretation, so they can explain words the nurse might use that are not common in the patient's primary language.

In addition to being critical for patients who do not speak English, MARTTI is ideal for people who can get by in English at home but lack vocabulary for medical problems. Loehn says using the videoconferencing system in those situations is more comfortable for the patient while assuring the staff they are working with reliable information. Staff learn the LAN system after one training session. The device is simple to operate — the nurse pushes a button to connect to a triage operator, who then dispatches the call to a medical interpreter on the screen who is ready to interact with the patient and providers.

Staff as interpreters

BH has implemented Spanish proficiency testing and training programs for staff members to become qualified medical interpreters. Thirty employees have passed the first step language proficiency test. Then eight of those people were trained to be medical interpreters in a formal program.

In 2009, BH plans to hold two 40-hour courses for employees who have passed the language proficiency exam. Graduates will serve as volunteer interpreters.

Connecticut hospitals cannot bill patients or Medicaid for interpreter services, but new policies are being proposed. To help BH defray costs, Charbonneau was awarded a $100,000 grant from the Connecticut Health and Education Facilities Authority.

Forte concludes, "The only complaint we have is that we want more MARTTIs. This method has really helped patients and staff."

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Janet M. Cromer, RN, MA, LMHC, is a freelance writer. To comment, e-mail editorNE@nursingspectrum.com.

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