77 - Enhancing Communication with Families Who Prefer a Language Other Than English in a Heart Center: A Quality Improvement Study

Publication Number: 4075.77

Nishma Valikodath, Boston Children's Hospital, Jamaica Plain, MA, United States; Cailyn Rood, Boston Children's Hospital, Boston, MA, United States; Anjani Patel, Boston Children's Hospital, Somerville, MA, United States; Miriam T. Fox, Boston Children's Hospital, Boston, MA, United States; Meghan Walsh, Boston Children's Hospital, Braintree, MA, United States; Elizabeth Blume, Boston Children's Hospital, Boston, MA, United States; Katie M. Moynihan, Harvard Medical School, Boston, MA, United States; Jessica A. Barreto, Boston University School of Medicine, Boston, MA, United States

Background: According to US Census Bureau data, 22% of respondents speak a language other than English (LOE) at home. Families who prefer a LOE have lower health care access, more serious medical events during hospitalization, and higher unplanned emergency department revisits. Several centers have demonstrated improved inpatient interpreter use through quality improvement interventions. However, these have not been applied to Intensive Care or step-down Units of a Heart Center, where patient acuity often impacts rounding workflow.

Objective: To improve communication with families who prefer a LOE by increasing interpreter use in the Heart Center of a quaternary children's hospital.

Design/Methods: This two-stage quality improvement initiative followed a Plan-Do-Study-Act framework. As part of a needs assessment, surveys were administered to staff and families to assess barriers to interpreter use and perceptions of communication. A stakeholder group created a Key Driver Diagram (Fig 1) to design interventions and chose those rated as high-impact and low-effort to be sequentially implemented.
Baseline data (January-June 2025) included interpreter service use and hospital length of stay data. The primary outcome was interpreter encounters per patient day (EPPD). Interventions included (1) signage showing each family's preferred language and interpreter contact options (in-person, phone, video) and (2) increasing iPads from 6 to 14. Weekly audits monitored signage accuracy, with compliance reinforced via reminders. Ongoing stakeholder meetings refined interventions and supported adherence.

Results: Baseline data showed a mean of 1.24 interpreter EPPD.
Of 61 staff respondents, communication with LOE families was on average rated 2.9 on a 5-point Likert scale (1 = very poorly, 5 = extremely well). Thirty-three respondents (55%) indicated that the use of an interpreter impedes workflow.
Of 64 surveyed families, 80% of those speaking a LOE knew when rounds occurred, compared to 90% of English-speaking families. Similarly, only 70% of families speaking a LOE knew how to reach their medical team versus 84% of English-speaking families.
Sign compliance was >87% over the study period.
Over a three-month period, after multiple PDSA cycles and two interventions, interpreter use increased from a mean of 1.24 to 2.0 EPPD (Fig 2).

Conclusion(s): Implementing visual reminders of each family's preferred language and expanding iPad interpreter access increased interpreter utilization in a Heart Center. These findings suggest that simple interventions can enhance communication for LOE families, even in high-acuity inpatient settings.

Figure 1: Key Driver Diagram
Key Driver.jpegFigure 1: Key Driver Diagram

Figure 2: Run chart
Average number of interpreter encounters per patient day. Purple boxes represent interventions, and brown boxes represent PDSA cycles