Family-Initiated Interpretation in the PICU

More than 25 million people in the United States have limited English proficiency. Patients with limited English proficiency face worse clinical outcomes than their English proficient counterparts, like longer length of stays, increased adverse events, and decreased understanding of their child's care. Language barriers may be particularly important in the pediatric intensive care unit (PICU), where parents encounter challenging medical decisions like choosing to pursue high-risk therapies or making end-of-life decisions.

Professional interpretation has been shown to mitigate negative outcomes for this population. For instance, one study showed decreased mortality in the pediatric intensive care unit (PICU) for Latino patients after in-person interpreter availability was increased; however, interpreters are still widely underutilized. One study in a PICU revealed that only 53% of doctors and 41% of nurses used an interpreter "often" for their patients who needed it. To improve clinical outcomes for this population, communication with patients with LEP needs to be improved.

Health disparities as a result of limited English proficiency are unjust, and a just medical system would allow patients with LEP to access the same quality of care as their English-proficiency counterparts. One way to improve communication may be to provide families with an opportunity to initiate interpreter use on their own. Although families have expressed a desire for this, no previous studies have examined the effects of this strategy.

Hypothesis:

The study team hypothesizes that implementing a novel family-initiated interpretation system will lead to greater use of interpreters, compared to the current standard of care. The investigators plan to test this hypothesis in the PICU. The specific aims are:

Explore the feasibility, usability, and acceptability of a family-initiated interpreter intervention among healthcare providers, and the acceptability of the intervention among families with limited English proficiency.

Examine the impact of family-initiated interpretation intervention on professional interpreter utilization by comparing pre and post-intervention professional interpreter utilization rates in the PICU.

By allowing families to initiate contact with an interpreter, the study team believe that interpreter utilization will increase, with the potential to decrease disparities in the limited English proficiency population. This work will inform future work to improve care for patients with limited English proficiency, and the investigators plan to investigate the clinical impact of this interpreter modality in future projects.

Inclusion criteria

• All patients and families admitted to the pediatric intensive care unit (PICU) whose family requires an interpreter

Exclusion criteria

• Patients and families who do not require interpretation