Effective Communication In Patient Care: Language Access Considerations.pdf

1. During the screening visit, patients need to understand the plan and that history is accurate, so interpreters should be used without shortcuts, especially during a crisis. Reinforce that all interpreters are bound by patient confidentiality at the start of the patient interview. Do not rely on family members or friends to interpret.

2. Interpreted conversations are often less patient-centered, so be sure to ask about patient concerns and feasibility of recommendations. Specifically, ask:
a) What have you heard about this illness? Dispel rumors.
b) What else are you taking for this illness? Any other medicines or herbs or treatments?
c) What are your worries? Who lives at home with you? Are you caring for a high-risk person?

3. Highlight that public charge is suspended for COVID-19 testing and treatment. Encourage all patients to spread the word broadly in their communities, as seeking testing or care for COVID-19 concerns will not impact patient ability to get a green card.

4. Ensure written communication, patient guidance, and education for symptomatic patients, and telemedicine workflows include language access considerations, particularly for threshold languages in your system.

For admitted patients:
5. Ensure hospitalized patients with language barriers (or their families for intubated/severely ill patients) have an opportunity to ask questions via a phone/video interpreter at least once a day with a physician and once per shift with nurses.

6. Address barriers to patient-initiated communication with nurses.

7. LEP admitted patients are even more isolated without family. Make case-by-case decisions on having one family member present. Facilitate remote connection via phone or videos with loved ones.

8. Promote access to health information. Help meet social needs.

9. Fight stigma and promote connection. We are all at risk, and we can take care of one another.

10. Immigrants may be low-wage workers. Offer and advocate for community resources addressing social determinants of health, such as food or housing insecurity. Unaccompanied immigrant youth are at particular risk with school closures.

Resources:
COVID-19 Education:
- General information (COVID epidemiology/prognosis, prevention of COVID)
- Repository of resources in 50+ languages
- COVID19 health literacy project (in 35+ languages; includes children’s books)
- In multiple languages from trustworthy sources
- FAQ sheets from Coronavirus Support Network (English, Spanish, Portuguese)
- Basic information on coronavirus from the CDC (Spanish)
- Basic information on coronavirus from Hesperian Health Guides (Bahasa Indonesian, Bengali, Chinese, Filipino, French, Hindi, Sindhi, Spanish, Portuguese, Telegu, Urdu, Vietnamese, and others)

Infographics/Posters:
- From Washington State Dept of Health (10+ languages)
- Flyer on coronavirus prevention from the CDC (Spanish)
- Infographic on coronavirus from LA County Public Health (Spanish)
- Social distancing posters from Boston Medical Center (Spanish, Haitian Creole, Portuguese, Mandarin, Vietnamese)
- Children’s books about COVID (Spanish, Italian, Portuguese, French, Polish, Hebrew, Indonesian, German, Turkish, Russian, Arabic, Romanian, Hungarian, Greek, Danish, Serbian, Welsh, Croatian, Japanese)
- Information on importance of handwashing from CDC (not COVID-19 specific) (Spanish)
- COVID - 5 tips from Boston Medical Center (Armenian, Bahasa Indonesian, Bengali, Chinese, Czech, Dutch, French, German, Hindi, Macedonian Cyrillic + Latin, Persian, Portuguese, Russian, Serbian Cyrillic, Spanish, Tami, Turkish, Ukranian, Urdu, Vietnamese and growing)

Isolation instructions:
- COVID - awaiting test results from Boston Medical Center (infographic) (Spanish, Czech)
- COVID - positive test from Boston Medical Center (infographic) (Spanish, Czech)
- From Washington State Dept of Health (Arabic, Farsi, French, Indian, Japanese, Korean, Russian, Dari, Spanish, Thai, Ukrainian, Vietnamese)
- From San Francisco Department of Public Health (Spanish, Chinese, Tagalog, Vietnamese, Russian)

For undocumented patients:
- Undocumented workers’ rights in CA
- Undocumented Fund in Sonoma County
- List of resources
- 24-hour phone hotline for Bay Area

Social Needs:
- Northern California
- Free food in Oakland
- Free breakfast and lunch in SF
- SF Dept. of Public Health information in multiple languages
- Cease executions of evictions in Alameda County
- Bay Area community resources and up-to-date health information
- San Francisco Unified District Free Meals
- A variety of community resources
- Boston
- Fact sheet, infection prevention, and meals (in Boston): English, Spanish, Chinese, Vietnamese, Portuguese, Haitian Creole, Russian, Arabic, Somali, Cape Verdean Creole, Farsi

For clinicians/health systems:
- A work in progress, there are a number of good poster resources below. Will try to start depositing workflows/adaptations that clinicians/systems can use specific to immigrant + LEP patients as they become available
- Telehealth
- UCSF Health workflows includes:
- including interpreters in phone or video visits
- patient instructions for Zoom meetings in Spanish and Chinese
- UCSF Center for Vulnerable Populations Telehealth Resources