The following is excerpted from our recent webinar, “Onsite and Video Remote Interpreting: Choosing the Right Modality.” To listen to the entire webinar, please click here.
To use an onsite interpreter or not to use an onsite interpreter?
This is a frequent question in healthcare settings when tending to patients who are limited English proficient (LEP), deaf, or hard-of-hearing. The advent of over-the-phone (OPI) interpreting and video remote interpreting (VRI) has given healthcare providers multiple options when it comes to providing these patients with the language access to which they are legally entitled through Title VI of the Civil Rights Act and the Americans with Disabilities Act. (Title VI of the Civil Rights Act and the Americans with Disabilities Act Section 1557 resulted in mandates aimed at ensuring patients with limited English proficiency receive meaningful access to care.)
However, there are certain instances in which – whenever possible – an onsite interpreter is recommended.
These situations include:
- Sensitive or end-of-life conversations: Hospitals and doctors’ offices are the settings for some of the most personal moments of our lives. When a healthcare provider is able to foresee that a conversation will involve a serious diagnosis, worsening medical condition, or other highly emotional communication, it is recommended that an onsite interpreter be scheduled in advance.
- Group discussions: OPI and VRI work best when the participants in the meeting are confined to a few, namely the doctor, patient, and perhaps a family member. As this audience grows and turn-taking becomes less structured, it becomes increasingly difficult for the remote interpreter to understand who is speaking. Likewise, the greater the background noise, the more difficult it is for the remote interpreter to listen and focus. For larger meetings, family conferences, or group-therapy sessions, it is best to schedule an onsite interpreter.
- Lengthy procedures or consultations: From a cost perspective, a remote interpreter becomes more expensive than a comparable onsite one after approximately 60 minutes. From the patient’s point of view, it is preferable to have an interpreter present over the course of an extended procedure or series of continuous conversations. For example, if labor is being induced, there are many variables involved and it is likely a patient would prefer an interpreter to be present when the physician or other medical professionals are in the room. Generally speaking, onsite is more cost-effective when there is a long procedure in which a patient’s constant feedback is required. These include surgeries with conscious sedation; a person’s first chemotherapy appointment where the provider continuously monitors any potential reactions to treatment; and cases of a long consultation with continuous conversation (i.e., psychotherapy, a first physical therapy appointment or evaluation, and family meetings).
- Conversations with young children and the elderly: Children age three and younger are still developing their language skills. They tend to use idiosyncratic language patterns, meaning their words have private meanings or make sense to a restricted few. Young children benefit from having an interpreter onsite to work with them on conveying and receiving information at an age-appropriate level. On the other end of the age spectrum, elderly patients with declining cognitive or hearing abilities typically benefit from having their interpreter physically present.
- Educational Environments: Often times in healthcare settings, there is patient education that requires hands-on instruction and demonstration. Written or visual materials are frequently distributed. In these instances it is preferable to have an onsite interpreter who can see what the patient is seeing. This applies to physical therapy, occupational therapy, speech therapy, and inpatient rehabilitation – all of which are often educational in nature.
- Mental-health instances: OPI and VRI work best when the patient is situated in one place and focused on communication. However, onsite interpreters are most effective on those occasions where the patient is mentally ill, combative, confused, or has experienced some sort of head trauma.
- Visual impairment: There is obviously a visual component to VRI. The patient benefits from seeing the interpreter, and being seen in return. If the person is visually impaired, it will be difficult for her or him to see facial expressions or use visual cues. In cases where the patient is visually impaired, an onsite (or phone) interpreter is likely preferred.
- Traumatic cases: In cases of traumatic injury, it is recommended to work with an onsite interpreter when possible, given that a patient’s ability to communicate via phone or video may be impaired. Also, in traumatic cases of assault or abuse, the patient may prefer an onsite interpreter given the personal nature of the information being conveyed.
Blending OPI and VRI
When an onsite interpreter is not available for any reason, an alternative modality like OPI or VRI can be utilized rather than rescheduling for a later date in order to ensure compliance and provide quality care.
Additional instances in which OPI and VRI are effectively utilized include:
- Follow-up phone calls
- Short appointments
- Emergency room settings
- Hospital registration
- Short engagements with overnight patients (for example, giving a patient needed medication in the middle of the night)
- Unanticipated inbound calls from LEP patients
- Unanticipated languages must be interpreted
LanguageLine supports facilities that have an ongoing need for dependable onsite interpretation in American Sign Language and spoken languages. We provide fully trained, professional interpreters; convenient scheduling by phone, email, and secure online portal; and the ability to view the up-to-the-minute status of assignments online, with full reporting to facilitate language-access management.