TOP 53 - Promoting family voices: A QI initiative to increase in-person interpreter use on pediatric hospitalist rounds

Publication Number: 2805.TOP 53

Michael Z Shen, University of Wisconsin School of Medicine and Public Health, madison, WI, United States; Erik Christensen, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Kristin A. Shadman, University of Wisconsin School of Medicine and Public Health, 600 HIghland Ave, WI, United States; Ann H. Allen, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Shiva Bidar-Sielaff, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Michael Wilhelm, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Laura P.. Chen, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Background: Patients that speak a language other than English (LOE) experience worse health care quality and have increased risk of adverse events. In-person interpreters provide the most effective communication.

Objective: The global aim of this quality improvement (QI) initiative was to improve inpatient communication with LOE families. Our specific aim was to increase the use of in-person interpreters on pediatric hospitalist rounds from 39% to 75% over 12 months.

Design/Methods: This QI study was conducted at a freestanding, tertiary care, university-affiliated children's hospital. Using the model for improvement, a multidisciplinary stakeholder team gathered including attending physicians, resident physicians, nurses, health unit coordinators, and the language access department. This study was deemed exempt by our local IRB. A key driver diagram (Figure 1) was developed to identify change ideas and interventions. Baseline data was collected from September to November 2024 and implementation data was collected from December 2024 to October 2025. LOE patients on the pediatric hospitalist service were identified via daily chart review. Demographic and admission information was obtained including preferred language, patient age, sex, zip code (as measure of area deprivation index), length of stay, primary diagnosis, and whether the patient spent time in the intensive care unit. Pediatric Hospital Medicine attendings and fellows completed daily surveys reporting presence of person needing interpreter on rounds, whether an interpreter was used for rounds, and if so, type of interpreter (in-person, video or phone). Encounters were excluded if the person needing an interpreter was not present at rounds, but were included if the family declined interpreter use. Primary outcome measures were percent of in-person interpreter use and documentation of interpreter use, tracked using p charts. Process measure was the presence of a consult interpreter services order. Balancing measure was self-reported time providers spent waiting for in-person interpreter. Process and balancing measures were descriptively tracked.

Interventions included a novel secure text messaging workflow to schedule in-person interpreters, resident education session on interpreter services by the language department, implementing an Epic smartphrase to improve documentation, and individual provider audit and feedback on in-person interpreter use. Results were subdivided into two groups: 1) All languages and 2) Spanish language only, given our institution has 24/7 Spanish interpreters available in-person.