605 - Improving Rates of Hospital Discharge Instruction Translation for Spanish-Preferring Patients through Technology and Workflow Solutions

Publication Number: 2590.605

Josh Kurtz, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Danielle Capriola, Childrens Hospital of Philadelphia, Sanatoga, PA, United States; Feihan Xin, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Osvaldo Mercado, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Priscilla Ortiz, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Massiel Ortega Rivera, Children's Hospital of Philadelphia, Ambler, PA, United States; Sanjay Chainani, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Hannah Dickens, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Luke Nolan, Childrens Hospital of Philadelphia, Yardley, PA, United States; Megan Ellis, Childrens Hospital of Philadelphia, Springfield, PA, United States; Grace L. Bancroft, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Mia M. Morrison, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Alyssa Frazier, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Brooke Luo, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Stephanie G. Menko, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; May Shum, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Gloria Gutierrez, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Rebekah Madrid, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Lily Stafford, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; William Zhuo-Ming Li, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Melodie Noel, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Yvette Portilla, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Chris Bonafide, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Rebecca Tenney-Soeiro, CHOP/PENN, Philadelphia, PA, United States; Jessica Hart, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Kristin D. Maletsky, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Consistent with literature describing disparities in discharge instruction translation, we found that inpatient discharge instructions for Spanish-preferring patients on General Pediatrics Resident (GPR) teams at our institution were translated 2% (n=54) of the time.

Objective: Improve rates of discharge instruction translation for Spanish-preferring patients on GPR teams from 2% to 50% by September 30, 2025.

Design/Methods: Following the Model for Improvement, we engaged peer hospitals and institutional stakeholders to identify key drivers of discharge instruction translation. We implemented PDSA cycles including a new discharge instruction translation process and automatic inclusion of pre-translated Spanish (and English) discharge instruction text in the electronic health record (EHR) (PDSA 1); additionally, we provided audit and feedback for care team members (PDSA 2). Process measures were time to translation completion and discharge instruction submission timing. Balancing metrics included length of stay, 14-day readmission rates, interpreter use at discharge and caregiver perspectives (summarized from electronic survey). Data were plotted on statistical-process control (P- and X-Median-R) charts. Nelson rules were applied to determine if the interventions resulted in special cause variation.

Results: From 9/1/24-9/30/25, 139 Spanish-preferring patients were discharged from the GPR teams during weekdays (when translation services were available). After PDSA 1 and 2, rates of discharge instruction translation increased from 2% (n= 54) to 88% (n= 85) (Figure 1). 64% (n=48) of discharge instructions were translated prior to discharge, and 36% (n=27) were translated after discharge and shared via the patient portal. The median time to translation completion post-implementation was 1.7 hours, and the median translation submission time was 4.9 hours prior to discharge. Median length of stay (2.2 days, Figure 2), 14-day readmission rates (4.4%), and interpreter use at discharge (54%, Figure 3) remained unchanged post implementation. Caregivers (n=3) expressed gratitude for being able to understand their discharge instructions and not having to utilize phone applications or relatives to translate.

Conclusion(s): Through implementing a new discharge instruction translation process, leveraging the EHR's automatic text replacement and eliciting audit & feedback, rates of weekday discharge instruction translation increased from 2% to 88% without adversely affecting readmission rates, length of stay or interpreter use at discharge. Next steps include expanding these changes to additional languages and services.

Figures 1-3
PAS Abstracts Figures 1-3.pdf