193 - Heard and Understood: A QI Project on Increasing Interpreter Use Documentation on Admission

Publication Number: 3185.193

Peri Fouss, Dayton Children's Hospital, Dayton, OH, United States; Amy M. Jeffers, Dayton Childrens' Hospital, Dayton, OH, United States; Kyra G. Bufi, Wright State University Boonshoft School of Medicine, Dayton, OH, United States; Aimee Yeates, Dayton Children's Hospital, Beavercreek, OH, United States; Nevia Mason, Dayton Children's Hospital, Dayton, OH, United States; Jonathan Geis, Dayton Children's Hospital, Dayton, OH, United States; Paige A. Triplett, Dayton Children's Hospital, Dayton, OH, United States; Christopher Bugnitz, Dayton Children's Hospital, Columbus, OH, United States; Teresa L. Prouty, Dayton Children's Hospital, Dayton, OH, United States; Wendla Sensing, Dayton Children's Hospital, Dayton, OH, United States

Background: A language barrier amplifies the risk of miscommunication among the healthcare team. In 2025, the US Census Bureau found that 1 in 5 Americans speaks a language other than English at home. This highlights the increasing demand for interpreter use in healthcare. Professional interpretation is proven to reduce disparities in health outcomes experienced by patients with limited English proficiency. While regulations ensure language services (LS) are offered, documentation of their use is suboptimal. Physicians rarely receive formal training on interpreter use, and documentation is inconsistent lacking standard practice. Efforts to facilitate interpreter utilization and documentation are needed to improve communication at the bedside and within the electronic health record (EHR).

Objective: The aim of this quality improvement (QI) project was to increase physician documentation of interpreter use within the History and Physical (H&P) note on the Pediatric Hospital Medicine (PHM) service from 43% to 85% in 9 months. Investigation focused on improving compliance with balancing measures of patient and physician satisfaction to establish best practice.

Design/Methods: A multidisciplinary team consisting of a PHM fellow as principal investigator, 2 PHM attendings, 2 resident physicians, QI consultant, LS manager, and a data analyst used QI methodology for implementation of interventions. Biweekly data on all PHM admissions with interpreter need was collected from September 2024 to May 2025, and manual audits were performed and analyzed using statistical process control charts. Interventions centered on physician education, distribution of LS badge cards and an interpreter use dot phrase template for H&Ps. Data transparency was later incorporated for engagement. Feedback surveys were conducted with a cohort of Spanish-speaking families and physician participants.

Results: Following multiple Plan-Do-Study-Act (PDSA) cycles, the mean line for documenting interpreter use within the H&P note shifted from 50% to 88% and held for 9 months, indicating sustainable change. Qualitative data from physician and patient satisfaction surveys noted positive perceptions of LS use and documentation.

Conclusion(s): Interpreter use documentation can be improved through education, EHR tools, and data transparency. The creation of a LS badge card and interpreter dot phrase template is an effective way to increase awareness and compliance. Future work will focus on expansion of these tools into additional departments and note types to enhance patient safety and satisfaction with an accountable communication best practice.

Key Driver Diagram
Schema of the project's aim and key drivers used to direct interventions to improve interpreter documentation on admission.
Abbreviations: ED, Emergency Department; LOR, level of reliability.

Run Control Chart
P-chart demonstrating the percentage of interpreter use documented at admission within the PHM division.
Abbreviations: H&P, history and physical; PHM, pediatric hospital medicine.


Plan-Do-Study-Act (PDSA) Summary
PDSA ramp chart denoting process interventions and results with improving interpreter documentation on admission.