Many patients, particularly at SFGH, are non-native English speakers.  Unfortunately, there few live translators available, and none after hours.   Translator phones are often few and far between or malfunctioning.  Furthermore, many patients are cognitively impaired or have hearing impairment, which makes the use of a translator phone difficult and ineffective.  Language barriers contibute to costs and adverse events: 1. Patient may misunderstand discharge instructions, leading to readmissions  2. Patient may misunderstand safety instructions, leading to falls or other adverse in-hospital events  3.  Patient satisfaction is impaired when not understanding the care plan

Given the above problems, I propose forming language-based hospital units.  As Spanish and Cantonese are likely the two most common non-English primary languages spoke at SFGH, I propose starting with those two languages and forming the Chinese and Spanish Service Programs.  As part of these progams, MDs, RNs, CNAs, unit clerks, therapists, and other ancillary staff who speak Spanish and Cantonese should be assigned preferentially to a certain unit (eg 5A), and patient who speak that language should be preferentially admitted to that unit.  This simple and free grouping of patients and staff into language-based units will save money and improve outcomes with only minimal administration efforts.  This same language-based service program could easily occur at UCSF as well depending on the number of non-native English speakers admitted to that hospital.