How Do You Know When to Use Video Remote Interpreting or An On-Site Interpreter?


Site translation by Certified Deaf Interpreter Steven Stubbs. 

To use VRI, or not, that is the question. Sometimes it is the best solution and other times it definitely is not the best choice.

Video Remote Interpreting

Medical providers are often faced with Deaf patients who are offered VRI but demand an on-site interpreter leaving clinicians torn between compliance and patient preference. This can become a heated debate but there are obligations the hospital must abide by and emerging practices in which the Deaf patients must learn to accept. Let’s take a look at two examples that explore the hospital meeting their obligations without compromising patient care and Deaf patients accepting the hospital’s offered interpreting services that stretch their comfort zones, without sacrificing quality communication.

A Deaf patient arrived at the ER with chest pain, shortness of breath, and a dizzy, light headed feeling. The intake nurse met with the patient and brought in the VRI cart with a certified interpreter already on the screen. The patient immediately asked for an on-site interpreter and the nurse said, “Let’s try and work with the VRI cart first and if it looks like this isn’t going to work, we’ll call an on-site for you.” The patient reluctantly agreed and was brought back into the ER. Over the course of the next hour while the patient’s medical history was collected, blood work was taken, an EKG, and other preliminary tests were run, the VRI cart was used during each exchange between the providers and patient. As the results came in, the supervising nurse stopped in to see the patient and inquired if the patient still wanted to use an on-site interpreter. The patient responded that the VRI interpreter was doing a good job and felt the need for an on-site wasn’t necessary.  The patient admitted that he was surprised how easy it was to use VRI in the ER.

On-Site Interpreting

In this circumstance, the Deaf patient wanted an on-site, was not immediately comfortable with the use of VRI, but the hospital was doing its due diligence to provide effective communication with qualified interpreters using reliable technology. Though an on-site may have been preferred because of the long-standing history of on-site interpreters, VRI interpreters can be just as effective and more readily available than an on-site.

However, not every circumstance that starts out with VRI should continue to use VRI. A Deaf patient was brought to the hospital by ambulance after a car accident. The patient was brought in on a stretcher with a neck brace and clear wounds to his face, hands, and upper body. The nurses and doctors secured the patient flat on his back and told him he could not turn his head or move his upper body until x-rays were done to confirm any injuries. The VRI cart was immediately brought in by the nurses and an interpreter was asked to interpret the health history questions.

However, the patient was flat on his back and unable to move or lift his head. The video interpreter was having a difficult time seeing and communicating with the patient and did not want to put him at risk. The hospital staff realized the communication was hindered and called for an on-site interpreter to avoid putting the patient at risk for further harm or pain. After the hospital staff and the video interpreter clearly assessed the situation, they determined an on-site interpreter was required for effective communication.

In this case, VRI wasn’t effective due to the physical state of the patient and the limits of a computer bound interpreter. While an on-site interpreter was going to take some time to arrive, this would give the Deaf patient the effective communication he was entitled to, without compromising care.

How To Decide

Resources like the “Decision Tree” can be used to assess situations in which an on-site interpreter might be most appropriate.

Patient preference or even hospital preference may be the reason an on-site or VRI is initially requested or refused, but the ultimate goal is to ensure quality, effective communication complies with legal policies, protects patient care, and ensures efficient, accurate and cost-effective communication.


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