Tertiary care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.
Secondary care is the health care services provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists.
The term Quaternary care is sometimes used as an extension of tertiary care in reference to advanced levels of medicine which are highly specialized and not widely accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are considered Quaternary care.
A certified interpreter is an interpreter who is certified as competent by a professional organization or government entity through rigorous testing based on appropriate and consistent criteria. Interpreters who have had limited training or have taken a screening test administered by an employing health, interpreter or referral agency are not considered certified.
Bilingual staff are often used to interpret, without any assessment of their skills. In a recent study, a total of 840 dual-role staff interpreters were tested for Spanish (75%), Chinese (12%), and Russian (5%) language competence. Two percent did not pass, 21% passed at basic level, 77% passed at medical interpreter level. Staff that passed at the basic level was prone to interpretation errors, including omissions and word confusion. Thus, about 1 in 5 dual-role staff interpreters at a large health care organization had insufficient bilingual skills to serve as interpreters in a medical encounter. Health care organizations that depend on dual-role staff interpreters should consider assessing staff English and second language skills.
In popular usage, the terms "translator" and "translation" are frequently used for conversion of either oral OR written communications. However, within the language professions, translation is distinguished from interpreting according to whether the message is produced orally (interpreting) or in writing (translation).
Many hospitals and health care organizations have an Interpreter Services Manager who is responsible for seeing that qualified interpreters are being provided by their organization. If there is a complication, the Compliance Office should be contacted.
A qualified interpreter is an individual who has been assessed for professional skills, demonstrates a high level of proficiency in at least two languages and has the appropriate training and experience to interpret with skill and accuracy while adhering to the National Code of Ethics and Standards of Practice published by the National Council on Interpreting in Health Care.
General proficiency in speaking and understanding each of the languages in which the applicant would be expected to work. (If multiple languages are involved, it is essential that the applicant's ability in each language be assessed, especially those in which the applicant may have more limited proficiency.)
Department of Health and Human Services Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons describes various options available for providing oral language assistance including the use of bilingual staff, staff interpreters, or contract interpretersThe guidance stresses that interpreters need to be trained and competent, though not necessarily formally certified, and discourages the use of friends and family members, particularly minors, as interpreters.