Family-Initiated Interpretation: A New Approach to Communication in the Pediatric ICU

Familial use of a language other than English (LOE) is associated with worse outcomes among hospitalized children. Professional interpretation improves outcomes but is underused. This pilot study aimed to evaluate the impact of a family-initiated interpretation intervention on use of interpreters.

We conducted a single-site pilot from April 2023 to January 2024 at a quaternary children's hospital in the midwestern United States. The intervention took place in the pediatric intensive care unit (PICU). Families who used an LOE were encouraged to independently initiate interpretation using hospital-provided tablets. Each patient room had a video interpreter tablet with instructions in the family's primary language. Primary outcomes were the average number and duration of interpreter encounters per patient-day before and after intervention (September 2022-March 2023 vs April 2023-January 2024), analyzed using interrupted time series. Medical team perceptions of intervention feasibility, acceptability, and appropriateness were also measured.

There were 158 families in the preintervention group and 271 in the postintervention group. The average duration of interpreter use per patient-day increased from 7.6 to 16.2 minutes (P < .001), and interpreter encounters increased from 0.66 to 1.34 per patient-day (P = .001). Clinician survey responses indicated high acceptability (mean 4.7 ± 0.5), appropriateness (4.7 ± 0.5), and feasibility (4.4 ± 0.7) on a 1 to 5 scale, with 5 indicating "completely agree," with top-box ("completely agree") responses on 73%, 74%, and 46% of items, respectively.

Family-initiated interpretation was associated with increased interpretation. This strategy may improve interpretation in the PICU.