The Mount Sinai Hospital in New York is one of America’s largest and most respected medical facilities, acclaimed internationally for excellence in clinical care. In the 2017-2018 “Best Hospitals” issue of U.S. News and World Report, Mount Sinai was nationally ranked in 10 specialties, and its pediatric center was listed among the country’s best children’s hospitals in six out of 10 areas of care.
Located in Manhattan, Mount Sinai serves one of the most diverse populations in the world, helping patients who speak 150 different languages. Providing optimal care to non-English speakers is a priority for the hospital’s leadership. In that pursuit, Mount Sinai was willing to innovate. After adopting LanguageLine InSight video interpreting in 2016, they became a beta user of the InSight for Smartphone mobile application when it was released in February.
We recently conducted a question-and-answer with Language Assistance Program Associate Director Silvina de la Iglesia, CMI-Spanish, on the ways in which InSight for Smartphone has changed language access at Mount Sinai, as well as lessons learned that can be implemented by future users of the application.
Q: At last count, there were an estimated 192 languages spoken at home in the New York metro area. Which of those languages are most frequently spoken by patients at The Mount Sinai Hospital?
A: Spanish is the most popular, followed by Mandarin, Cantonese, and Bengali. Given our reputation as a top hospital for numerous specialties, we also have a lot of international patients coming to us from all over the world. The bottom line is that we are in the business of delivering health care in multiple languages. We have to be prepared to communicate with all patients who come through our doors.
Q: What challenge did you face prior to implementing LanguageLine InSight for Smartphone?
A: One of the things we discovered early last year was that it was difficult for medical and nursing staff to use existing telephonic interpretation services when performing some of their briefer patient interactions. As a result, staff needed a more convenient and rapid means of fully explaining important information to their limited-English-proficient (LEP) patients. With the use of the smartphone app, this has gotten much better.
Q: How did the use of InSight compare with traditional over-the-phone interpreting?
A: InSight was a much improved experience. In any medical setting, there tends to be a lot of background noise – machines, beeping sounds, other people. Interpreters would often ask for more repetition. When we use InSight on the iPad or smartphone, it captures audio extremely well, and of course the video aspect makes it much more evident to the interpreter who is speaking.
Q: What was the genesis of your implementation of InSight for Smartphone?
A: We needed quick access to interpreters for parents on our pediatric ward. We did an in-service with staff, residents, nurses, social workers, and child specialists. We ended up providing them with an Interpreter on Wheels on every floor. We activated InSight on our staff’s existing iPads, as well. That was a very positive experience and went a long way toward enhancing the patient experience for children and their parents.
Our hospital leadership has been very focused on enhancing communication with LEP patients. That has been a priority. Our leadership learned that we could take the power and technology of InSight and put it in our users’ pockets through the smartphone application. Our president was actually the one who suggested we give the smartphone app to our hospitalists. (Hospitalists are dedicated inpatient physicians who work exclusively in the hospital.) The mobility enhancement was very appealing, and we were able to identify areas where this technology could be helpful right away.
Q: How are you currently deploying InSight for Smartphone?
A: We activated 58 smartphones beginning in February. The app is primarily used by hospitalists doing rounds, usually early in the morning, and by physician assistants in the emergency room. These encounters are typically short and concentrated. We believed this group would be a logical place to test the technology. We’ve used the smartphone app for audio and video calls.
In addition to these physicians, we also gave it to our patient liaisons and patient representatives who perform customer-service functions. They can use it when they assist LEP patients with complaints and interpretation services are immediately required. If a face-to-face interpreter is not readily available, they can use the smartphone app.
Q: Have you noticed a correlation between increased use of the smartphone application and increased patient satisfaction?
A: Yes, definitely. Based on the surveys that we give patients, we have captured a lot of positive comments. We have noticed a great acceptance of the technology by patients.
Q: What about your hospitalists? What has their response been their response to the smartphone application?
A: The ability to get instant access to an interpreter when doing rounds has had a dramatic impact on the ability of our hospitalists to communicate with non-English-speaking patients. This leaves patients with a much more complete understanding of their condition and care, which ultimately leads to better health outcomes. The mobility aspect of the smartphone app provides incredible flexibility and having language access on their phones keeps the service top-of-mind.
Q: How have you blended the use of the smartphone application with live, onsite interpreters?
A: As I said, the smartphone application is ideal for personnel who are up, moving, and making rounds. They don’t necessarily have outpatient appointments. Otherwise, we use InSight for last-minute requests and as a backup when a live interpreter cannot be found.
In terms of evaluating whether to use a live interpreter or video remote interpreting (VRI) for a pre-planned medical appointment, we first try to understand the purpose of the encounter. If it’s a sensitive conversation, a group discussion, a traumatic case, or a conversation with a child or elderly person, we would probably try to have a live interpreter if at all possible.
It’s also important to find out how long the appointment is going to last. If it is going to last more than an hour, we will attempt to bring in a live interpreter, because it becomes more affordable than a video interpreter at that point.
Q: What have you learned from your implementation of the smartphone – and VRI in general – that would be useful to another healthcare organization?
A: Our first objective when we implemented VRI was to cover every point of entry at the hospital – essentially emergency rooms and admissions – and to make sure staff knew how to locate and use the device. We also made sure it was available on our inpatient units. Initially these were the departments we thought would benefit the most from VRI based on the types of encounters they have. We eventually supplemented the InSight VRI solution with the smartphone app.
In terms of quantifying the app’s impact, we have had to actively solicit this information from our patients through end-of-stay surveys.
One area where we are trying to improve our processes is at registration, where we are increasing efforts to identify whether or not a patient is limited English proficient. This will give us a clearer understanding of language needs and resources planning going into the future.
Q: What do you see as the next steps for your rollout of the smartphone app?
A: Our next step will probably be to give it to our social workers. They are like our hospitalists in that they are up and moving. They are not in a single location, in other words. The smartphone app is ideal for this sort of personnel.
Beyond that, some of the other hospitals in our system know about our use of the smartphone app and are eager to give it a try.