PC1222: Improving Interpreter Use in the Pediatric Emergency Department: A Quality Improvement Initiative

Purpose/Objectives: Patients with Limited English Proficiency (LEP) experience higher rates of adverse events, longer wait times, and decreased patient satisfaction. Evidence suggests identification of LEP is often delayed, and that involvement of appropriate interpreter services is crucial for safe and efficient care. The aim of our quality improvement (QI) initiative was to increase the proportion of patients with LEP to 70% for whom both self-identified preferred language was documented correctly in the electronic medical record (EMR) and appropriate engagement with interpreters occurred in the Pediatric Emergency Department (PED) in a one year period.

Design/Methods: This QI initiative took place from April 2021 to April 2022 at a large, urban, tertiary medical center in Boston, Massachusetts. Based on the Model for Improvement, our QI team completed three “Plan-Do-Study-Act” (PDSA) cycles. Interventions included: standardizing documentation of preferred language during registration, disseminating baseline data to increase provider awareness, and obtaining funding to increase the number of video interpreter devices available to the PED team. The composite primary outcome was the proportion of patients for whom the correct interpreter was used during their PED visit and the correct language was documented in the EMR. Process measures included EMR documentation of interpreter use and patient satisfaction. Balancing measures included provider satisfaction and PED length of stay (LOS). Data were collected retrospectively through EMR chart review and prospectively through patient and provider surveys. Data was analyzed and presented in run chart formats.

Results: A total of 235 (56%) families were successfully surveyed of 423 contacted, between April 2021 and March 2022. Baseline data prior to PDSA 1 showed that 25% of patients/families with LEP had a composite outcome of reported appropriate interpreter use during PED visits (defined as “always had an interpreter when one was needed”) and correct preferred language documented in the EMR. This improved over the intervention period (Figure 1). However, appropriate interpreter use both as reported by patients/families and in EMR documentation remained below goal of 70% (Figures 1 and 2). Patient satisfaction remained high. Data for balancing measures showed that average ED LOS increased during the intervention and provider satisfaction was unchanged.

Conclusion/Discussion: We believe that this QI initiative has been a success to date and has improved care of LEP patients in our PED. While not yet at our goal, we have seen an improvement in the proportion of LEP patients for whom both the correct language was documented in the EMR and the appropriate interpreter services utilized. Additionally, we have seen an improvement in patient satisfaction. We are currently planning for future PDSA cycles which will include increasing the number of remote interpretation devices, streamlining training and certification of bilingual providers, and standardizing EMR documentation of interpreter use.