In March 2017, Ms. Coleman’s daughter Justice Hope, who was medically complex and had multiple disabilities, died at age 11. She was the sunshine in the lives of many and communicated using a thousand smiles.
I vividly remember the first time my daughter was admitted to the pediatric intensive care unit (PICU). It is funny though, because the vivid memories of that first night are dreamlike. Time both slowed and moved at warp speed.
My vision was laser focused: studying my daughter, and looking at every facial expression, movement, medicine, treatment of the providers pouring into and out of the room. But my vision was also fuzzy, seeing only what was in the bubble of care for Justice, and all else was a blur.
I heard everything. I listened to every word. Before I heard a diagnosis, I heard how the nurses changed their words from “we will take care of her” to “your daughter is very sick.” I had never heard “sick” said in that way before, but I knew it was not good. When the words of the diagnosis—“right colonic volvulus”—came, I caught only the letter “V.” I had been texting with our pediatrician, but called her and could only say “they said it is something that starts with a V.”
I spoke English, as did the providers. But that night in the PICU (amidst uncertainty and fear as my daughter’s belly grew to the size of a basketball), I needed an interpreter.
I often reflect on that first night in the PICU. Our pediatrician was our “language line,” but what happens for families who speak a language other than English?
In this month’s Pediatrics, “Equity-focused interventions improve interpreter use in the Pediatric Intensive Care Unit” details one hospital’s efforts to increase interpreter use for families in the PICU who speak other languages (10.1542/peds.2023-065427).
What was the focus of the project?
A team of doctors, nurses, families, and other professionals worked to improve the number of times an interpreter was used when staff communicated with families in the PICU. The hospital had a goal of 2 interpretations a day, but this PICU averaged 1.4 per day. The team used a process called quality improvement (QI) to increase the number of interpretations. QI moves step-by-step (plan, do, study, act) and helps teams learn as they go and make changes along the way to improve.
How did they do it?
The COVID-19 pandemic started a few months into the project, so the team focused on video interpretation using tablets.
The team started by looking at how often and how well interpretation was done in the PICU. They learned that tablets were often hard to find or use. They therefore took the following steps:
- They increased the number of tablets in the PICU, and they taught PICU staff how to use and where to find the tablets.
- Every patient with interpretation needs got a tablet for interpretation in their room within 24 hours of admission. Staff and providers also got education about the importance of and best practices for interpretation.
- They placed signs with the family’s preferred language and the number of interpretations thus far each day on patient doors. This kept care team members accountable.
What were the project results?
The number of interpretations (by tablet, phone, or in-person) per patient per day nearly doubled over the project. In addition:
- Most PICU staff said the education was very helpful.
- The amount of time spent interpreting by tablet and phone increased.
- When in-person interpretation resumed, the number of times it was used increased.
- The tablets remained easy to find.
What can you do with this article?
- Share it with your doctor. If you or a family member needs interpretation, use this article to start talking about how to get interpretation.
- Talk to your doctor about quality improvement. The step-by-step process of plan-do-study-act is a lot like parenting: One step at a time, a day at a time. Ask them about the process and if their clinic has any projects. Use this process to talk through and work to change some of the challenges you may face in caring for your child.
