Equity-Focused Interventions Improve Interpreter Use in the Pediatric Intensive Care Unit

Area of Science:

• Medical Quality Improvement
• Pediatric Critical Care
• Health Equity

Background:

• Federal guidelines mandate language interpretation for non-English speaking patients to ensure equitable care.
• Significant variability exists in interpreter service utilization within intensive care settings.
• This study focused on improving interpreter use in a pediatric intensive care unit (PICU).

Purpose of the Study:

• To increase the rate of interpreter utilization for pediatric patients requiring language assistance in the PICU.
• To address barriers to equitable care for critically ill children with limited English proficiency.

Main Methods:

• A multidisciplinary team employed a key driver diagram and iterative plan-do-study-act cycles to guide interventions.
• Interventions included standardizing interpretation technology and device placement, provider education, and accountability systems.
• Data from 882 PICU encounters (January 2018-January 2022) were analyzed using statistical process control methods.

Main Results:

• The overall interpretation rate increased from 1.4 to 2.7 interpretations per patient per day.
• All interpretation modalities (video, phone, in-person) showed increased utilization.
• Average interpretation time per patient per day increased for both phone (8 to 10.5 minutes) and video (9.5 to 22 minutes).

Conclusions:

• Iterative quality improvement is effective in identifying and overcoming barriers to equitable care.
• Focused interventions successfully enhanced interpreter use for critically ill pediatric patients.
• The study highlights the importance of systematic approaches to improve language access in critical care settings.