Now, let's see what our audience members and our other faculty members have on their minds and let's dive into our final case studies. All right, so exploring case one, the hospital endoscopy unit director and nurse manager notice that their colonoscopy prep scores of Boston Brow prep score averages about 6.2 and the number of colonoscopies that need to be repeated due to inadequate prep, it's about 8.7% are worse when they're compared to their affiliated ASCs, which have a Boston Brow prep score average of about 8.1 and repeat colonoscopies as a 2.4%. What do we think should be done in this situation? I might throw this out first to TR and see thoughts there. I mean, I think I'm going to guess that the patients in the hospital unit may be a little less affluent than the patients in the ASC and they may have less social support and less other things. So really trying, you know, it might be an opportunity to introduce navigation or, you know, it doesn't have to be a licensed person who kind of works with those patients to help them complete their prep. It could be somebody ideally, probably racially or ethnically important with the patients that you're serving. I think you can build trust with that community and really with a little bit of training, just really understand why it's so important for people to have a good prep. I think you could, so really just having somebody in charge of really educating the patients, letting them know kind of what is an acceptable prep and why the prep is so important and what they can do to salvage a prep if it's not going well. I think those things are all probably good. I mean, Rachel Osaka and Fred Hutch did some interesting work with the kind of unhoused community in Seattle and in low income communities, there's just so many barriers to access to a bathroom, being able to take a time off from work to kind of take the prep on the day prior to the procedure. All those things are really challenging. So I'm trying to do some navigation, I think, to see if you can improve those scores. I think one of the things that was discussed in some of the questions were also about the literature we use in terms of the patient handouts regarding bowel preps. And I want to say that one of the things that, you know, there was a discussion in one of the questions about, do you have the ability to make sure that it's at the reading level that's appropriate for all patients? And one of the great resources that we've used at our endoscopy suite is we have a enterprise resource where they will actually look at your bowel prep letters. And we actually have been in the process, Mary Rose Rose and Shanshan know about this, to revamp those bowel preps so that they have more pictures, that they are written at the level of a fourth or fifth grader to understand. Because I agree, there can be a lot of various barriers to getting your bowel prep right. But one of the first things we want to do is not hand out patient education that is not easy to read, user friendly, and that the patient can actually use and navigate to help them get their colonoscopy. I see you unmuted, Rosa, did you have any further comments? No, recently when we had our director of patient education review, he also made a comment about the font size needing to be larger for just visually impaired patients and also like to go along with, you know, the American Disabilities Act. So, you know, he, you know, he taught us to do it quickly. That's a great point. I mentioned our custodian who, part of our team who went out and took his time to counsel a patient. He actually was so grateful for the patient's expression of gratitude towards him, reaching out to him and showing him pictures of how the bowel prep should work, that we actually incorporated many of his ideas into the patient prep instruction. So, this first case is actually a case involving our own institution. So, this is one of the things that we did. It's a great example of, you know, you don't need to have a nursing license or a medical license to be able to help connect with patients and reassure them or advise them about how important it is to have a good prep for their colonoscopy. Absolutely. So, why don't we go ahead and move then to case two. So, case two. A Spanish-speaking patient arrived at the endoscopy unit for a screening colonoscopy accompanied by a family member who also did not speak English. Registration associate did not speak Spanish and was unaware of how to communicate with the patient and our family member. What should be done to remedy this situation in the present and for the future? Any thoughts from our panel? We encounter this frequently in California, as you can imagine. I mean, there's telephone-based translation services, and then we also have mobile iPads on a stand that connects us to a video interpretation service. So, those are two ways that we've used to try and facilitate communication with our patients. Yeah. Also, I'll say that some of our staff are actually fluent in other languages, and they can go through the process of getting certified as the actual translator. And so, sometimes when you're trying to remedy a situation kind of at the front desk and you don't know what to do and you're getting your iPad going, if you do have a member of your staff that's credentialed to give translation, there's nothing better than a person saying, you know, in their native tongue, speaking face-to-face with the person, please allow us a little time. We want to make sure that we get a translator on the line and to help navigate. And so, identifying people in your unit, that can be a real resource in a pinch, but not only for Spanish, but other languages is important. And that's one of the reasons why we always say, if you speak another language, we need you to get certified and get the okay from the hospital so that we can use you as a translator in the future with our patients. System, those people actually get paid, their hourly rate is higher if they're bilingual certified. So, there's some incentive to come forward and take on those extra tasks. Yeah. Great point. One of the things that we do here in our endoscopy suite, and I'm sure you're aware, Dr. Abdi, we do have those resources as well here, but we try because we're a large unit and we have a lot of diversity here and many folks who are multilingual. So, what we will do is we'll match folks that speak their language in PrEP, procedure room recovery, and CRNAs. And what we find is that really puts the patient at ease because they have someone there that they can touch, hold their hand, and communicate fluently and not through the iPad. Because it's very scary to go back into procedure rooms where all the equipment is once you're finished the consenting portion. And so, that's one of the things that I can say that we're blessed to have that maybe other institutions do not. I wanted to add one more thing about the discharge. We have discharge instructions that our patients sign and we do have them in Spanish. And then through the hospital patient education system, you can also print in various languages, such as Arabic, Italian, and so it's called EMI. So, that's a really great resource also. Thank you, Rosa. And Mary Rose, I love the idea of being proactive. I like the idea of saying if we know the patient's schedule and we understand that a patient speaks a particular language, we can, you know, adjust staff who may speak their language. That's a great pearl for us to all take home and emulate.

colonoscopy preparation

communication challenges

non-English speaking patients

translation services

patient care