P3.180: Speak Easy: A Multidisciplinary Quality Improvement Initiative to Increase Face-to-Face Language Interpreting in the PICU

Purpose/Objectives: While use of interpreting services is standard of care for children and caregivers with a preferred language other than English, we often fail to include interpreters, thereby compromising the quality of communication and care provided. Previous studies have suggested that caregivers prefer and better understand when face-to-face (in-person or video) modes of interpreting are used in inpatient settings rather than telephone. Unfortunately, face-to-face modes of interpreting often require advanced scheduling and/or locating video equipment, steps which may further limit access amidst the time pressures of critical care. The goal of our quality improvement (QI) project was to improve communication with caregivers who prefer a language other than English (LOE) by increasing total and face-to-face interpreting encounters.

Design/Methods: This was a single-center QI initiative in a 75-bed pediatric intensive care unit within the Children's Hospital of Philadelphia. We first conducted a survey to elicit clinician and nursing input about barriers to using interpreting services. As a multidisciplinary team, we then enacted a bundle of interventions collectively known as the Speak Easy program: (1) multidisciplinary education, (2) preferred language signs, (3) a novel, standardized opt-out in-person interpreting program, and (4) increased number of video interpreting devices and presence of devices in patient rooms. We analyzed total and face-to-face interpreting encounters during the intervention period (03/2023-12/2024) and compared to pre-intervention (11/2021-02/2023) using statistical process control charts. We collected data on our process measures, in-person Spanish interpreting encounters and video interpreting encounters, over this time period, as well. Finally, we elicited clinician, nurse, and social worker perspectives about the program via a post-implementation survey.

Results: Total interpreting encounters nearly tripled (43 to 121 encounters per 100 patient-days) and face-to-face interpreting encounters increased by more than four times (23 to 104 encounters per 100 patient-days), significant shifts that were driven by increases in the number of in-person Spanish interpreting encounters (11 to 53 encounters per 100 patient-days) and video interpreting encounters (14 to 78 encounters per 100 patient-days) following interventions 3 and 4. Post-intervention surveys demonstrated that clinicians, nurses, and social workers viewed these changes favorably and felt they should be continued.

Conclusion/Discussion: There are unique barriers to using interpreting services in the PICU, including limited time and unpredictability, as well as competing priorities that accompany high medical acuity. A multidisciplinary approach emphasizing interventions to decrease the time and planning necessary to coordinate in-person and video interpreting can effectively engender cultural change and promote the delivery of language-concordant care, even in busy inpatient environments such as the PICU.