Communicating in Real-Time: Simultaneous In-Person Interpretation on Family-Centered Rounds Free

Family-centered rounds (FCR) are the standard of care in pediatric academic hospitals for ensuring daily communication between the patients, families, and inpatient multidisciplinary teams. They represent one of the key time points during hospitalization when families have a chance to ask questions and provide critical input for clinical decision-making.¹  The effectiveness of FCR is rooted in families feeling safe, valued, and empowered to partake in the medical conversation.^2,3  For patients and families with a primary language other than English (PLOE), FCR additionally require successful and consistent interpretation to allow for family engagement. Previous studies have demonstrated differences between FCR for families with PLOE, including selective interpretation of medical information, failing to interpret conversations among members of the medical team, and soliciting family questions and perspectives on patient care less frequently.⁴  Studies exploring parent perceptions of interpretation on FCR have demonstrated a strong desire for consistent interpreter use and a preference for in-person interpreters.⁵  Indeed, in-person interpreter use has been associated with increased parent understanding and satisfaction. To date, modalities for interpretation in pediatric hospitals have been limited to in-person, video, or telephone. Simultaneous interpretation, however, is an alternative modality commonly used in international government affairs and legal settings. In legal settings, in which quality interpretation of high-stakes testimony is critical, simultaneous interpretation has been shown to reduce errors and improve client trust.^6–8  Given the fundamental need for trust in the patient-family-medical provider triad, there is much to be learned about how simultaneous interpretation can be used in medical settings, including FCR.

In this issue of Hospital Pediatrics, Kosack et al use mixed methods to explore Spanish-speaking families’ satisfaction in care after the implementation of Spanish Equipment-Assisted Simultaneous Medical Interpretation (EASMI).⁹  EASMI was used during FCR with Spanish-speaking families on weekday, nonholiday mornings. Family report of satisfaction with communication, using the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) survey, improved significantly for Spanish-speaking families in association with implementation of EASMI. Top-box scores for survey items such as “How often did your child’s doctors explain things to you in a way that was easy to understand ?” showed a significant differential improvement in Spanish speakers (with scores improving from 58% to 95% for Spanish-speaking families compared to 85% to 83% for English-speaking families). Interviews with medical team members and Spanish-speaking families revealed high satisfaction with EASMI as well as improved family participation in care plan, decreased communication errors, and reduction of family interpretation burden.

This study provides insight into the use of a novel interpretation modality for FCR but has several limitations worth noting. First, the study was conducted at a single academic center, exclusively with Spanish-speaking families. This sample limits generalizability and may not reflect the perspectives of all patients and families with PLOE, particularly those who speak less commonly encountered languages. Second, the intervention of simultaneous interpretation was conducted to include the presence of in-person interpreters on rounds. In-person interpreters were not consistently present before this intervention; therefore, it is difficult to disentangle the extent to which physical presence of an interpreter versus simultaneous interpretation impacted findings. Further study comparing in-person consecutive to in-person simultaneous interpretation is necessary. Finally, Child HCAHPS survey response rates were low (8.2% for English-speaking and 5.5% for Spanish-speaking families), and although comparable to national averages, the results may be subject to selection bias and not representative of all patient experiences. Additionally, the pre-post design of the study limits causality, and there may be other secular trends that influence findings.

Despite these limitations, EASMI is a promising alternative modality that addresses multiple known barriers to communication with patients and families with PLOE, including provider time constraints, filtering of medical information, uncertainty in communication, and unmet family engagement expectations.^10,11  The authors implemented a system in which interpreters scheduled themselves for rounds, set up equipment, and required less time to interpret compared to consecutive interpretation modalities. The emphasis on efficiency and reduction of administrative burden could allow providers to reinvest time in building rapport (an important component of psychological safety and ensuring trust) with patients and families with PLOE, better engaging them, and facilitating shared decision-making. Compared to video and phone interpretation, EASMI may create space for more authentic interactions in which patients and families with PLOE can experience matched nonverbal cues and verbal communication from the medical team in real-time.

However, there are numerous important factors to consider in the broader application of EAMSI. Chief among them would be the need to recruit or train qualified medical interpreters in the complex skill of simultaneous interpretation. The authors estimate a time frame of 6 months to 1 year for an interpreter to become skilled in simultaneous interpretation but do not elaborate on the rigor of the training process or expense associated with additional training. These factors may limit availability of simultaneous interpreters in a domain in which in-person interpreters are already limited. This may also pose challenges to expanding simultaneous interpretation to other less common languages. Further, EAMSI, although favored by providers and families in this study for FCR, does not address the challenges in consistent interpretation during other encounters in a patient’s hospitalization. This includes nursing care, laboratory draws, and conversations with consultants. Patients and families with PLOE are already at risk for fewer touch points and increased adverse events^12,13 ; therefore, it is imperative to provide interpretation modalities that are easy to access and use by all medical providers in all facets of a patient’s hospital care.

At the core of eliminating disparities in the care of patients with PLOE is strengthening communication and providing an equitable safety climate. As the authors highlight, the American Academy of Pediatrics states that FCR should be “available in the range of cultural and linguistic diversity in the community.”¹  As the US population becomes more linguistically diverse, it is urgent that medical providers explore new ways of communicating effectively with patients with PLOE and optimize existing resources. EASMI represents a new frontier in medical interpretation with promising benefits that could be part of the solution in achieving high-quality care for patients with PLOE.