Editor’s Note: Ha Le (she/hers) is a resident physician in pediatrics at UCSF, whose passions include medical education, social justice, and narrative medicine. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
The US Census Bureau in 2023 estimated that 68–71 million people speak another language other than English (LOE) at home, with about 23% of US households identified as speaking an LOE at home. Healthcare systems thus must be able to support LOE patients and families. Yet children of LOE families are at risk for worse outcomes, including increased rates of medical error. Despite such negative effects, interpreter use within pediatric intensive care units (PICU) is inconsistent.
Lena Oliveros, MSN, CPNP-AC, and colleagues at Seattle Children’s Hospital sought to tackle this issue in their new article, “Equity-Focused interventions Improve Interpreter Use in the Pediatric Intensive Care Unit,” which is being early released in Pediatrics this week (10.1542/peds.2023-065427).
The authors sought to identify issues with and increase the use of video interpretation within the PICU. Prior to the study, while video interpreter services were available on multiple devices, they were neither visible nor designated to remain in the PICU, leading to underutilization. A multi-disciplinary team (involving PICU providers, a family advisor, and the hospital’s language services team) determined barriers to the use of interpreters. They then developed targeted interventions using a standardized quality improvement methodology, including:
- Device standardization (intervention A): Laminated cards with simplified instructions were attached to interpreting devices, and devices were placed in standard locations.
- Bedside optimization (intervention B): within 24 hours of admission, a video interpreting device was placed in the room for each patient with interpretation needs. Bedside education was provided to healthcare staff.
- Accountability (intervention C): The language of care and a tally board (counting each time interpreters were used) were posted on patient room doors.
Each intervention was introduced in a stepwise approach from 2019 to 2021, starting with intervention A and ending with intervention C.
Overall, the monthly interpretation rate (defined as the number of phone, video, and in-person interpretations) nearly doubled, from 1.4% to 2.7% per patient per day. After one month of implementing device standardization, the unit was able to demonstrate need for and obtain more interpreting devices.
Additionally, the authors noted potential cultural shifts in the use of phone or video interpretation. For instance, average video interpretation use rose from 9.5 minutes to 22 minutes.
While this study shows that successive interventions, particularly those focused on decreasing barriers, can increase interpreter use within the PICU, the implementation process was limited by a delay in access to interpretation usage data and difficulty with capturing conversations by certified bilingual hospital staff. Furthermore, the study occurred exclusively in the PICU and during the COVID-19 pandemic, so the results may not be generalizable.
There is still much to understand about why there are gaps in care among LOE families, including inequities in communication quality and time and their impact on patient outcomes. This article can provide a framework for addressing one barrier faced by LOE families.
