Interpretation Modalities Used on Family-Centered Rounds: Perspectives of Spanish-Speaking Families

Influence of Medical Interpreters on the Healthcare Experiences of Hospitalized Spanish-Speaking Patients

Introduction: The perspective of hospitalized patients with limited English proficiency (LEP) in US hospitals interacting with language-discordant healthcare providers remains understudied. Our goal is to examine the inpatient experiences of Spanish-speaking patients and offer suggestions to improve patient satisfaction. Methods: A survey was administered to Spanish-speaking patients using interpreters during their admission to medicine at an urban, academic hospital. Qualitative thematic analysis of responses was conducted. Results: Thirty-six patients completed the survey. Despite limited use of interpreters, the majority of patients rated interpretation services as excellent, reported high level of involvement in care and respect of their opinions, and preferred video remote interpreting and in-person interpreters. Language barrier and cost affected patients' comfort level requesting health care services. The mean patient satisfaction score was 9.64. Patients suggested an increase in bilingual personnel, improved access to interpreters, specifically in-person. Conclusion: Although highly satisfied, patients reported inconsistent use of interpretation services in the inpatient setting and suboptimal access. Hospitals should strive to provide language-concordant care and patient-centered interpretation. Patients' understanding of their health care rights needs better assessment to ease the inpatient experience. Further research is needed to estimate the regard for autonomy by Spanish-speaking patients in their own care.

Initiative to increase family presence and participation in daily rounds on a paediatric acute care cardiology unit

INTRODUCTION

Family-centred rounds benefit families and clinicians and improve outcomes in general paediatrics, but are understudied in subspecialty settings. We sought to improve family presence and participation in rounds in a paediatric acute care cardiology unit.

METHODS

We created operational definitions for family presence, our process measure, and participation, our outcome measure, and gathered baseline data over 4 months of 2021. Our SMART aim was to increase mean family presence from 43 to 75% and mean family participation from 81 to 90% by 30 May, 2022. We tested interventions with iterative plan-do-study-act cycles between 6 January, 2022 and 20 May, 2022, including provider education, calling families not at bedside, and adjustment to rounding presentations. We visualised change over time relative to interventions with statistical control charts. We conducted a high census days subanalysis. Length of stay and time of transfer from the ICU served as balancing measures.

RESULTS

Mean presence increased from 43 to 83%, demonstrating special cause variation twice. Mean participation increased from 81 to 96%, demonstrating special cause variation once. Mean presence and participation were lower during high census (61 and 93% at project end) but improved with special cause variation. Length of stay and time of transfer remained stable.

CONCLUSIONS

Through our interventions, family presence and participation in rounds improved without apparent unintended consequences. Family presence and participation may improve family and staff experience and outcomes; future research is warranted to evaluate this. Development of high level of reliability interventions may further improve family presence and participation, particularly on high census days.

Video interpretation in a medical spine clinic: A descriptive study of a diverse population and intervention

OBJECTIVES

Back pain is one of the most challenging health conditions to manage. Healthcare providers face additional challenges when managing back pain for patients with culturally diverse backgrounds including addressing linguistic barriers and understanding patients' cultural beliefs about pain and healthcare. Knowledge about patients with culturally diverse backgrounds experiencing back pain and the interventions available to them is limited. Therefore, this study aims to describe the characteristics of patients with culturally diverse backgrounds experiencing back pain and the video interpretation intervention offered to them and further to explore the clinician's perspective on this intervention.

METHODS

Data were collected from the electronic medical records and the Interpreter Gateway. Four clinicians participated in a group interview, where they described and evaluated the video interpretation intervention in detail inspired by the template for intervention description and replication (TIDieR) checklist and guide.

RESULTS

A total of 119 (68%) patients accepted the intervention (53% women, mean 44 years). These patients represent 24 different languages, with 50% having at least one hospital-registered diagnosis and a mean number of five outpatient contacts, 1 year before receiving the intervention. Fifty-seven patients did not accept the intervention and declined interpretation or opted to use relatives or through video conferencing equipment. The intervention was positively evaluated by the clinicians.

CONCLUSIONS

The detailed description of the population and the intervention together with the clinician perspective provides a valuable foundation for developing and refining similar interventions, allocating resources, and designing future research studies. The intervention consisted of a consultation lasting up to 2 h delivered by a rheumatologist and a physiotherapist, with a remote interpreter connected.

Experiences and Communication Preferences in Pregnancy Care Among Patients With a Spanish Language Preference: A Qualitative Study

OBJECTIVE

To explore Spanish-speaking patients' experiences and preferences regarding communication during pregnancy care with specific attention to language barriers.

METHODS

Patients with a Spanish language preference who gave birth between July 2022 and February 2023 at an academic medical center were invited to participate in focus groups. Focus groups were held over Zoom, audio-recorded, transcribed in Spanish, translated into English, and reviewed for translation accuracy. Thematic analysis was conducted with deductive and inductive approaches. Three investigators double-coded all transcripts, and discrepancies were resolved through team consensus.

RESULTS

Seven focus groups (27 total participants, range 2-6 per group) were held. Three key themes emerged regarding patient experiences and communication preferences when seeking pregnancy care: 1) language concordance and discordance between patients and clinicians are not binary-they exist on a continuum; 2) language-discordant care is common and presents communication challenges, even with qualified interpreters present; and 3) language discordance can be overcome with positive interpersonal dynamics between clinicians and patients.

CONCLUSION

Our findings highlight the importance of relationship to overcome language discordance among patients with limited English proficiency during pregnancy care. These findings inform potential structural change and patient-clinician dyad interventions to better meet the communication needs of patients with limited English proficiency.

Communication Experiences of Caregivers Using a Language Other Than English on Inpatient Services

OBJECTIVES

Individuals who prefer to communicate about health care in a language other than English (LOE) experience poorer quality medical care and challenges when communicating with health care providers. The objective of this study was to elucidate how caregivers who prefer an LOE perceive communication with their physicians on an inpatient general pediatrics service.

METHODS

Caregivers of patients admitted to the general pediatrics service at our urban freestanding children's hospital whose preferred language for medical care was Spanish, Arabic, Brazilian Portuguese, or Mandarin were eligible for this qualitative study. Semistructured interviews using video interpreter services were conducted to explore the participants' experiences communicating with their physicians. Interview transcripts were analyzed using conventional content analysis.

RESULTS

We interviewed 15 participants representing 7 countries of origin and 4 non-English languages: Spanish, Arabic, Brazilian Portuguese, and Mandarin. Three main domains emerged, including: (1) use of interpreter services, (2) overall communication experience with physician providers, and (3) suggestions for improvement in physician communication. Salient themes included early identification of the need for an interpreter is essential and physicians' use of body language in combination with an interpreter enhances successful communication.

CONCLUSIONS

This project fills a gap in existing literature by describing the perspectives of caregivers who prefer an LOE, including those speaking languages other than Spanish, because they communicate with inpatient pediatricians. In addition to ensuring appropriate use of interpreter services, physicians can focus on using plain language and gestures during encounters, helping to facilitate communication and provide culturally competent care for this population.

Professional Interpreter Services and the Impact on Hospital Care Outcomes: An Integrative Review of Literature

Migration patterns have rapidly changed in Australia and elsewhere, which have contributed to increasingly culturally and linguistically diverse societies. This requires healthcare sectors to provide professional interpreter services for patients with a language barrier to eliminate healthcare disparities. This integrative review aimed to investigate the impact of professional interpreter services on hospital care outcomes and the associated cost of service provision. A systematic search of five databases was conducted for peer-reviewed articles from January 1996 to December 2020. Data were extracted for the hospital setting, intervention, population, study design, outcomes and key findings. Following the PRISMA guidelines, full-text screening identified 37 articles that were analysed and included. Communication quality, hospital care outcomes and hospital costs were the three main themes identified. Closing the language gap should be a primary consideration to prevent adverse events that affect patient safety and the standard of care in hospitals. The findings of this review indicate the provision of professional interpreter services can enhance hospital care for linguistically diverse patients by improving patient-provider communication. To gain insight into the changing patterns on the outcomes of medical care, further research requires efforts by the hospital administrative system to document complete records of service usage.

A sequential, multiple assignment randomized trial comparing web-based education to mobile video interpreter access for improving provider interpreter use in primary care clinics: the mVOCAL hybrid type 3 study protocol

BACKGROUND

Individuals who use a language other than English for medical care are at risk for disparities related to healthcare safety, patient-centered care, and quality. Professional interpreter use decreases these disparities but remains underutilized, despite widespread access and legal mandates. In this study, we compare two discrete implementation strategies for improving interpreter use: (1) enhanced education targeting intrapersonal barriers to use delivered in a scalable format (interactive web-based educational modules) and (2) a strategy targeting system barriers to use in which mobile video interpreting is enabled on providers' own mobile devices.

METHODS

We will conduct a type 3 hybrid implementation-effectiveness study in 3-5 primary care organizations, using a sequential multiple assignment randomized trial (SMART) design. Our primary implementation outcome is interpreter use, calculated by matching clinic visits to interpreter invoices. Our secondary effectiveness outcome is patient comprehension, determined by comparing patient-reported to provider-documented visit diagnosis. Enrolled providers (n = 55) will be randomized to mobile video interpreting or educational modules, plus standard interpreter access. After 9 months, providers with high interpreter use will continue as assigned; those with lower use will be randomized to continue as before or add the alternative strategy. After another 9 months, both strategies will be available to enrolled providers for 9 more months. Providers will complete 2 surveys (beginning and end) and 3 in-depth interviews (beginning, middle, and end) to understand barriers to interpreter use, based on the Theoretical Domains Framework. Patients who use a language other than English will be surveyed (n = 648) and interviewed (n = 75) following visits with enrolled providers to understand their experiences with communication. Visits will be video recorded (n = 100) to assess fidelity to assigned strategies. We will explore strategy mechanism activation to refine causal pathway models using a quantitative plus qualitative approach. We will also determine the incremental cost-effectiveness of each implementation strategy from a healthcare organization perspective, using administrative and provider survey data.

DISCUSSION

Determining how these two scalable strategies, alone and in sequence, perform for improving interpreter use, the mechanisms by which they do so, and at what cost, will provide critical insights for addressing a persistent cause of healthcare disparities.

TRIAL REGISTRATION

NCT05591586.

Barriers in Healthcare for Latinx Patients with Limited English Proficiency-a Narrative Review

Latinx (includes Hispanics and is the non-gendered term for Latino/Latina which is a person of Latin American origin or descent) constitutes the largest racial and ethnic minority group in the United States (US). Many members of this group report limited English proficiency, experience discrimination, feel distrust in the healthcare setting, and face poorer health outcomes than non-Latinx Whites. As healthcare systems assess internal structures of care, understanding the experiences of Latinx patients may inform strategies to improve care. This narrative review describes studies that assessed the experiences of Latinx patients with limited English proficiency (LEP) in the inpatient and outpatient settings in the US. We searched PubMed for studies published between January 1, 1990, and March 2021. We reviewed all citations and available abstracts (n = 429). We classified study titles (n = 156) as warranting detailed consideration of the original article. Limited English proficiency is a well-documented challenge reported by Latinx patients seeking care in the outpatient setting, resulting in mistrust of healthcare organizations and clinicians. The effects of LEP overlap substantially with challenges related to patients' immigration status, cultural traditions, and socioeconomic needs. Use of professional interpretation rather than ad hoc interpretation improves trust and satisfaction. There is no consensus about the most effective mode of delivering professional interpretation (in person, telephonic, video conferencing), although rapid simultaneous telephone translation is a promising modality. Increasing awareness of the barriers to effective communication, improving skills in communicating through translators, and increasing the amount of time spent with patients may improve communication and trust more than structural changes like mode of translation or bedside rounding. Cultural fluency training, standardized language training for providers, and incentive pay for fluency are also deserving of further consideration.

Interpreter services and effect on healthcare - a systematic review of the impact of different types of interpreters on patient outcome

Background

Utilization of interpreters to facilitate communication between health care providers and non-native speaking patients is essential to provide the best possible quality of care. Yet use and policy on the subject vary widely, as does knowledge on the effect of different types of interpreters. This paper systematically reviews the literature on use of interpreters in the medical setting to evaluate their effects on the quality of care.

Material and methods

We conducted a literature search of PubMed and Embase, supplemented with references from relevant previous literature. We included any report in a medical setting comparing one type of interpretation to any other, including no interpretation and measuring a patient outcome. No limit was set on time or language. Risk of bias was assessed using the Evidence Project Risk of Bias assessment tool and the CASP checklist for qualitative studies. Results were synthesized using REDCap and presented in tables.

Results

We identified 29 reports represented by five types of studies. Types of interpreter intervention examined were professional, ad hoc, relational, any and no interpreter. Outcomes measured were satisfaction, communication, utilization and clinical outcomes. Results were indicative of in-person professional interpreter resulting in highest satisfaction and communication, reaffirming that any interpreter is better than none and relational interpreters can be a valuable interpreter resource for patients in the private practice setting. To be able to further differentiate on outcome for interventions of ad-hoc or relational interpreters, further data is needed.

Discussion

In-person Professional interpreter is the interpreter type resulting in greatest satisfaction and best communication outcome for the patients. This review is limited by most data originating from one country, interpretation from mainly Spanish to English and in one cultural setting.

Funding

No funding was provided for this review.

Cultural care needs of Spanish speaking parents with limited English proficiency whose children are hospitalized: An ethnonursing study

PURPOSE

Parents' inability to speak English proficiently is associated with communication barriers in the care process of their children, social determinants of health, and poor child health outcomes. Research exploring perspectives of Spanish speaking parents with limited English proficiency (SSP-LEP) whose children are hospitalized in the context of culture is lacking in the literature. The purpose of this study was to explore the cultural experiences, values, and beliefs of SSP-LEP, of Mexican origin, whose children were hospitalized and to understand nurses' roles in providing culturally congruent care.

DESIGN AND METHODS

Leininger's qualitative, ethnonursing method was used for this study. The Theory of Culture Care Diversity and Universality provided a guiding framework. Eleven SSP-LEP, of Mexican origin, participated in interviews conducted in-person and via Zoom. Data was analyzed using Leininger's four phases of qualitative analysis.

RESULTS

Three themes emerged: 1. role of the mother as an ever-present manager of care for the hospitalized child and family, 2. parents' difficult, fearful, stressful, and unknowing experiences in the presence of a language barrier, and 3. expected nursing care that was kind, respectful, compassionate, and attentive.

CONCLUSIONS

Lack of knowledge creates hardships for parents who desire to be involved, informed caregivers. Communication in Spanish language is integral to parents' understanding and expected nursing care. SSP-LEP may have negative feelings; yet describe a positive care experience.

PRACTICE IMPLICATIONS

Culturally congruent care should incorporate language services for information sharing that facilitates parent participation and decision-making; be kind, respectful, compassionate, and attentive; and promote maternal role maintenance.

Improving Patient Experience Scores Using Simultaneous Interpretation on Family-Centered Rounds

OBJECTIVES

Patients speaking a primary language other than English face barriers to equitable care, particularly patient-provider communications. There is no gold standard for providing inpatient medical interpretation on family-centered rounds (FCR). We aimed to implement simultaneous, in-person interpretation of FCR for Spanish-speaking families and hypothesized improved satisfaction in care.

METHODS

In-person, Spanish Equipment-Assisted Simultaneous Medical Interpretation (EASMI) was implemented in March 2018 on FCR. Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) experience scores on communication domains were analyzed for Spanish and English-speaking families pre- (n = 118) and postimplementation (n = 552). Postimplementation, we conducted medical team surveys (n = 104) and semistructured interviews with Spanish-speaking families (n = 25) to determine satisfaction with interpretation modalities (phone, video, and EASMI).

RESULTS

Spanish-speaking families exhibited statistically significant improvements in Child HCAHPS top box scores compared to English-speaking families in multiple communication and informed care-related domains. For example, "How often did your child's doctors explain things to you in a way that was easy to understand?" top box scores improved from 58% to 95% for Spanish-speaking families, compared to 85% to 83% for English speakers, with the differential effect of the intervention showing statistical significance (P = .001). Medical team surveys demonstrated high satisfaction with EASMI. Qualitative themes from interviews and open-ended survey responses emphasized multiple care benefits with EASMI, including a perceived reduction of communication errors and increased family participation.

CONCLUSIONS

EASMI was associated with significant improvements in Child HCAHPS scores in communication domains and increased medical team and family members' satisfaction with interpretation. EASMI presents a novel method for equitable FCR for Spanish-speaking families.

Intervention, individual, and contextual determinants to high adherence to structured family-centered rounds: a national multi-site mixed methods study

Background

Effective communication in transitions between healthcare team members is associated with improved patient safety and experience through a clinically meaningful reduction in serious safety events. Family-centered rounds (FCR) can serve a critical role in interprofessional and patient-family communication. Despite widespread support, FCRs are not utilized consistently in many institutions. Structured FCR approaches may prove beneficial in increasing FCR use but should address organizational challenges. The purpose of this study was to identify intervention, individual, and contextual determinants of high adherence to common elements of structured FCR in pediatric inpatient units during the implementation phase of a large multi-site study implementing a structured FCR approach.

Methods

We performed an explanatory sequential mixed methods study from September 2019 to October 2020 to evaluate the variation in structured FCR adherence across 21 pediatric inpatient units. We analyzed 24 key informant interviews of supervising physician faculty, physician learners, nurses, site administrators, and project leaders at 3 sites using a qualitative content analysis paradigm to investigate site variation in FCR use. We classified implementation determinants based on the Consolidated Framework for Implementation Research.

Results

Provisional measurements of adherence demonstrated considerable variation in structured FCR use across sites at a median time of 5 months into the implementation. Consistent findings across all three sites included generally positive clinician beliefs regarding the use of FCR and structured rounding approaches, benefits to learner self-efficacy, and potential efficiency gains derived through greater rounds standardization, as well as persistent challenges with nurse engagement and interaction on rounds and coordination and use of resources for families with limited English proficiency.

Conclusions

Studies during implementation to identify determinants to high adherence can provide generalizable knowledge regarding implementation determinants that may be difficult to predict prior to implementation, guide adaptation during the implementation, and inform sustainment strategies.

Facilitating Engagement on Family-Centered Rounds for Families With Limited Comfort With English

OBJECTIVE

Conducting family-centered rounds (FCR) for families with limited comfort with English (LCE) presents communication challenges. The objective of this study was to characterize the preferences of Spanish-speaking parents with LCE around interpretation and communication with the medical team during FCR to promote family engagement during rounds.

METHODS

This qualitative study was conducted at a tertiary care children's hospital in New York, New York. Eighteen Spanish-speaking parents of patients admitted to the hospital medicine service participated. Bilingual investigators conducted semistructured interviews over a secure virtual platform. Interview transcriptions were coded and analyzed by using a grounded theory approach and constant comparative method. Parents were recruited until thematic saturation was achieved.

RESULTS

Most participants were mothers (72%) from the Dominican Republic (61%). Responses from participants yielded a conceptual model depicting parents' perspectives on family engagement and bidirectional communication during FCR. Three major themes emerged: (1) importance of interpreter use, (2) understanding of medical information, and (3) participation in FCR. Within each theme, factors that facilitate or impede engagement in FCR were identified. Interpreters facilitated information sharing and parent understanding of medical care, increasing parent appreciation of FCR. Lack of language-concordant care and parents' perceived responsibility for the language barrier limited engagement.

CONCLUSIONS

Families with LCE value involvement during FCR, but face difficulties due to language barriers. Providers can support these families by empowering families' participation and by consistently using an interpreter. Understanding the preferences of families with LCE for participation in FCR will help providers deliver more equitable family-centered care.

Remote interpreting in primary care settings: a feasibility trial in Germany

BACKGROUND

Global migration trends have led to a more diverse population in health care services everywhere, which in turn has set off a paradigm shift away from medical paternalism toward more patient autonomy. Consequently, physicians need to provide a more precise patient-centred healthcare. Professional interpreting appears to play a crucial part in tackling the challenges of language barriers adequately. The aim of this study was to conduct process evaluation through the implementing of video remote interpreting (VR) and telephone remote interpreting (TR) within primary care facilities in the northern German metropolis of Hamburg.

METHODS

We conducted a three-armed exploratory pilot trial, which compared VR to TR and to a control group (CG) in different primary care settings. We assessed feasibility of implementation, as well as the acceptance of interpreting tools among their users. In addition, we compared the quality of communication as perceived by patients and physicians, as well as the enabling of patient-centred medicine over all three study groups using quantitative questionnaires.

RESULTS

13 practices (7 GPs, 3 Gynaecologists, 3 Paediatricians) took part in this trial. 183 interpreting calls were documented, 178 physicians as well as 127 patients answered their respective questionnaires. The implementation of the VR- und TR-tools went smoothly and they were broadly accepted by their users. However, the tools were used significantly less often than we had anticipated. With regards to quantitative questionnaires, VR scored significantly better than the control group in terms of the perceived quality of communication by both, patients and physicians and enabled of patient-centred medicine.

CONCLUSION

Our main findings were the discrepancy between the assumed high demand of professional interpreting solutions on the one hand and the low willingness of practices to participate on the other. The rather low utilisation rates were also noteworthy. This discrepancy indicates a lack of awareness concerning the adverse effects of using informal or no interpreter in medical settings, which needs to be rectified. Due to the small sample size, all statistical results must be viewed with caution. However, our results show that remote interpreting represents a promising approach to tackling language barriers in primary care settings.

The Parent's Perspective: A Focus Group Study on Spanish Interpreter Services for Hospitalized Children

BACKGROUND

The US Census confirms a rise in Spanish-speakers, many of whom have limited English proficiency (LEP) and require interpreters. Parent perceptions of interpreter services throughout hospitalization are unknown.

OBJECTIVE

To explore Spanish-speaking LEP parents' views regarding roles of interpreters and providers (attending, resident, or nurse) during a hospital encounter, optimal modalities of interpretation, and barriers to services.

METHODS

Spanish-speaking LEP parents of children discharged from the hospital medicine service participated in focus groups. Sessions were audio-recorded and transcribed in Spanish, translated into English, and verified for translation accuracy. Qualitative methods were used for thematic analysis.

RESULTS

Four sessions (n = 23 participants representing 15 families) were held. Parents felt the interpreter's primary role was to act as a conduit for word-for-word interpretation. They desired kind and trustworthy interpreters with medical knowledge. They saw providers as leaders of the encounter who should allot enough time for interpretation, not use Spanish unless they were fluent, and give frequent medical updates. In-person interpreters were preferred over telephone and video for their ability to convey body language and build relationships. Barriers to requesting interpreters included embarrassment and inability to directly request services, which resulted in using family members as interpreters. On family-centered rounds, parents preferred professional interpreters over bilingual providers.

CONCLUSIONS

Modifications are required to improve interpreter services to meet the needs of LEP families. Parents emphasized in-person interpreters' social skills, frequent provider updates, and additional navigation support as essential components of effective care. Next steps include implementing guidelines and interventions to optimize interpreter services.

Interpreter Use for Limited English Proficiency Patients/Families: A QI Study

BACKGROUND

Communication is fundamental to high-quality health care. Despite federal requirements to provide interpreters and growing evidence favoring the benefits of interpreter use, providers' use of interpreters remains suboptimal. In acute care settings, where decisions need to be made rapidly on the basis of changing clinical circumstances, this has proven to be challenging.

METHODS

We designed a quality improvement project using the model for improvement methodology for patients admitted to the pediatric hospital medicine service. A multidisciplinary team developed interventions focused on provider education and leveraging health information technology (IT). We used health IT to improve the identification of families with limited English proficiency, improve access to various modalities of interpreting, standardize workflow to request face-to-face (F2F) interpreters, and create a designated place in the electronic health record for interpreter use documentation. The use of all forms (telephone, video, and F2F) of interpreter service, documentation of interpreter uses, and F2F interpreter overload were tracked monthly for 3 years.

RESULTS

The baseline use of interpreter services for the pediatric hospital medicine inpatient service was 64%. After starting the project, the use of interpreter service increased to 97% and has sustained for more than a year since the project's completion. The use of F2F interpreters also increased from a baseline of 20% to 54% post intervention.

CONCLUSIONS

We successfully achieved and sustained our goals of improving interpreter use through supportive leadership and a multidisciplinary approach using quality improvement methodology. Future efforts should be focused on defining and standardizing metrics for families with limited English proficiency across institutions and using health IT to improve care.

Utility of mobile technology in medical interpretation: A literature review of current practices

OBJECTIVES

Language barriers limit healthcare access. However, professional interpretation usage is infrequent due to high cost and poor interpreter availability. Healthcare-oriented mobile applications are becoming more accepted and may help alleviate this burden. This literature review aims to better understand the utility of mobile technology in healthcare interpretation. Specifically, the objective of this review is to synthesize the feasibility, outcome, and challenges of implementing technological medical interpretation services.

PATIENT INVOLVEMENT

No patients were involved for this review.

METHODS

In December 2019, MEDLINE (Ovid) was systematically searched according to PRISMA guidelines. All articles discussing the utility of technology in healthcare interpretation encounters were included.

RESULTS

Two major themes emerged: 1) comparing video and phone interpretation with in-person interpretation and 2) assessing direct translation software in healthcare settings. Phone and video interpretation help reduce overall patient wait-times. Both patients and clinicians preferred in-person or video interpretation over interpretation by phone. Chief benefits of using direct translation software include immediate access, low costs, and sustainability. Several studies discussed potential translation inaccuracies and the importance of having professional interpreters in medico-legal discussions.

CONCLUSION

Mobile applications may be used to facilitate access to medical interpreters with high clinician and patient satisfaction. Direct in-app translations facilitate access but risk inaccuracies with important medico-legal considerations.

PRACTICAL VALUE

Mobile applications are available at low costs and can improve access to interpreters though video and phone calls. Mobile software can also provide direct translation and facilitate clinical care. Clinicians should prioritize face-to-face encounters with professional medical interpreters, whenever possible. In a time of social distancing amidst the current COVID-19 pandemic, there is crucial value in elucidating the best telehealth interpretation practices.

Implementing Family-Centered Rounds in Hospital Pediatric Settings: A Scoping Review

CONTEXT

The American Academy of Pediatrics and Institute for Patient and Family-Centered Care issued a joint policy statement in 2012 recommending family and nurse participation in rounds as a standard practice.

OBJECTIVE

To synthesize available evidence on the state of the implementation of family-centered rounds (FCRs), including identified barriers to stakeholder acceptance and participation in FCRs in pediatric inpatient settings and implementation strategies to increase adherence and related outcomes.

DATA SOURCES

PubMed and Medline and the Cochrane Database of Systematic Reviews.

STUDY SELECTION

Observational and experimental studies from January 2009 to July 2020.

DATA EXTRACTON

Two reviewers independently screened each study to determine eligibility and extract data. Initial evidence quality was evaluated on the basis of study design.

RESULTS

A total of 53 studies were included in the final synthesis. FCRs are increasingly accepted by stakeholders, although participation lags. Structural barriers to nurse and family attendance persist. Limited high-quality evidence exists regarding the effectiveness of FCRs and related implementation strategies in improving patient outcomes. The lack of a clear, consistent definition of the elements that combine for a successful FCR encounter remains a significant barrier to measuring its effect.

CONCLUSIONS

Standardized research methods for improving the quality and comparability of FCR studies are needed to enhance the existing guidelines for FCR use. Structural changes in care delivery may be required to ensure the rounding process remains amenable to the needs of patients and their families.

Satisfaction With Telephone Versus In-Person Interpretation Services in Limited English-Proficient Urogynecology Patients: A Randomized Controlled Trial

OBJECTIVE

The objective of this study was to determine if in-person interpreters improve patient satisfaction scores compared with phone interpreters for urogynecology office visits in limited English proficient (LEP) patients.

METHODS

Portuguese and Spanish LEP subjects were randomized to phone or in-person interpreter, and a 14-item questionnaire was administered with 3 subscales assessing the primary outcome of patient satisfaction with the interpreter, physician, and nursing. Subject demographics, English proficiency, overall health status, and yearly household income were recorded. Sample size calculations indicated that a mean difference of 12 in satisfaction scores could be detected with 44 subjects per arm. Analysis was conducted using descriptive statistics, and comparisons between the intervention versus control group were analyzed using Fisher exact test, Wilcoxon rank sum test, and linear regression.

RESULTS

We enrolled and randomized 106 subjects, and 82 subjects completed the study. There was a statistically significant difference in subject satisfaction between randomization groups, favoring in-person interpreters. In the as-treated analysis, the median satisfaction score for the phone interpreter group was 92.9 and 100 for in-person interpreter group (P < 0.001). Linear regression adjusted for English proficiency showed that there was a difference between median scores of 7.14 (P = 0.002).

CONCLUSIONS

Portuguese and Spanish LEP patients experienced higher satisfaction scores for urogynecology office visits when in-person interpreters are used compared with a phone interpreter. Although we found a statistically significant difference between these groups, the clinical significance of our finding is less clear. This topic should continue to be investigated for the field of urogynecology and further studies are needed.

Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review

OBJECTIVE

The objective of the review was to identify, critically appraise and synthesize evidence on the impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency.

INTRODUCTION

A key strategy to facilitate effective communication between limited-English-proficient migrant and refugee families and healthcare providers is the use of professional interpreters. Despite awareness of the importance of professional interpreters, interpreters are underutilized. This results in suboptimal care, including poor access to health care, increased risk of serious medical events, increased admission to hospital and inadequate health literacy.

INCLUSION CRITERIA

Limited-English-proficient migrant, refugee or asylum-seeker families with a hospitalized child aged 0 to 18 years, who had used a professional interpreter, were considered for this review. Comparators included standard care or no interpreter, and reported results of comparisons of the duration, frequency or mode of interpreter delivery. Outcomes were length of stay in hospital, unplanned readmission rates to hospital, non-attendance at hospital clinic appointments and ambulatory care, child and/or parent satisfaction with care in hospital, adherence to treatment, medication errors, and other adverse events relating to patient safety. The review considered all studies conducted using a quantitative approach.

METHODS

A three-step search strategy was used. Databases were searched in December 2018 for published and unpublished articles. Studies published in English were considered for inclusion. The recommended JBI approach to critical appraisal, study selection, data extraction and data synthesis was used.

RESULTS

Six articles reporting results from three randomized controlled trials and one observational study were included. Studies were undertaken in the United States involving Spanish-speaking participants. Three studies were in emergency departments. There was a total of 1813 families, of whom 1753 had limited English proficiency. Migrant and refugee families with limited English proficiency reported greater satisfaction with aspects of care when a professional interpreter service was used compared with using ad hoc interpreters. Using professional in-person interpreters resulted in a shorter total emergency department throughput time compared to using professional interpreters via telephone. There was no difference in concordance of child's discharge diagnoses between parents assigned professional interpreters and those assigned bilingual physicians. Video interpretation provided better understanding of diagnoses than phone interpretation.

CONCLUSION

There is evidence that use of ad hoc interpreters or no interpreter is inferior to use of professional interpreters of any mode. Although video and in-person interpreters are more favorable for some outcomes, mode of delivery may not be as important as the fact that a professional interpreter is being used. The mode of professional interpreter delivery should be based on accessibility, availability, language requirements and patient preference.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42017058161.

Patterns and Predictors of Professional Interpreter Use in the Pediatric Emergency Department

BACKGROUND AND OBJECTIVES

Professional interpretation for patients with limited English proficiency remains underused. Understanding predictors of use is crucial for intervention. We sought to identify factors associated with professional interpreter use during pediatric emergency department (ED) visits.

METHODS

We video recorded ED visits for a subset of participants (n = 50; 20% of the total sample) in a randomized trial of telephone versus video interpretation for Spanish-speaking limited English proficiency families. Medical communication events were coded for duration, health professional type, interpreter (none, ad hoc, or professional), and content. With communication event as the unit of analysis, associations between professional interpreter use and assigned interpreter modality, health professional type, and communication content were assessed with multivariate random-effects logistic regression, clustered on the patient.

RESULTS

We analyzed 312 communication events from 50 ED visits (28 telephone arm, 22 video arm). Professional interpretation was used for 36% of communications overall, most often for detailed histories (89%) and least often for procedures (11%) and medication administrations (8%). Speaker type, communication content, and duration were all significantly associated with professional interpreter use. Assignment to video interpretation was associated with significantly increased use of professional interpretation for communication with providers (adjusted odds ratio 2.7; 95% confidence interval: 1.1-7.0).

CONCLUSIONS

Professional interpreter use was inconsistent over the course of an ED visit, even for patients enrolled in an interpretation study. Assignment to video rather than telephone interpretation led to greater use of professional interpretation among physicians and nurse practitioners but not nurses and other staff.

Health Care Provider Practices and Perceptions During Family-Centered Rounds With Limited English-Proficient Families

OBJECTIVE

To increase understanding of current practices and perceptions of family-centered rounds (FCR) by providers for limited English-proficient (LEP) families relative to English-proficient families.

METHODS

Using grounded theory methodology, we conducted ethnographic observations of FCR for LEP and English-proficient families on the pediatric wards at an urban teaching hospital. Focused coding of observation fieldnotes was performed independently, followed by regular group meetings to discuss discrepancies, refine codes, and identify theoretical direction. Data informed development of an interview guide used to conduct interviews with pediatric physicians, nurses, and interpreters. The iterative analysis process continued with interview transcriptions.

RESULTS

FCR of 36 unique patient families were observed, of which 10 were LEP families. We conducted 20 interviews with 7 residents, 3 attendings, 5 nurses, and 5 interpreters. Major themes included: 1) standardization of FCR is needed to address equity issues for LEP families, 2) redefining the roles of medical interpreters would enhance the interpersonal interactions and relationships between families and health care providers, and 3) improving resources to allow interpreters to be used consistently will increase equity for LEP families.

CONCLUSIONS

Many differences exist in FCR for LEP versus English-proficient families. FCR for LEP families may be optimized with standardization and training, redefining the interpreters' roles, and improving access to interpreters.

Communication challenges between nurses and migrant paediatric patients

Background

Many people receiving medical treatment in Switzerland speak none of the country's four languages or English, which is a major communicative barrier for health staff. Appropriate treatment in hospitals depends on the successful communication between hospital staff and patients. Consequently, migrant patients can be particularly challenging for hospital staff.

Aims

The aim of this project was to examine the following topics: (a) which communicative challenges hospital nurses are confronted with in the care of migrant paediatric patients and how they cope with them, and (b) what requirements nurses (and other stakeholders) have regarding a digital communication aid to improve the care of migrant paediatric patients in the hospital setting.

Methods

This study used a qualitative approach. The following steps of data collection were undertaken: (a) two literature searches corresponding to the research questions, (b) a focus group interview with paediatric hospital nurses, (c) observation of communication between paediatric nurses/healthcare professionals and children/parents through shadowing, (d) short interviews with paediatric nurses who were being shadowed, and (e) a focus group interview with experts. Data analysis was based on thematic analysis and was supported by MAXQDA software.

Results

Evaluation of the data showed there are multiple communicative challenges that emerge in the care of migrant paediatric patients. These challenges influence each other and appear at different moments in the hospital stay. Additionally, the results revealed that digital communication aids must be user friendly and easily accessible.

Conclusions

This study highlights the areas of hospital care in which a digital communication aid could be feasible. However, many of the described communication challenges stem from issues that cannot be solved solely with a digital communication aid. Instead, strategies to tackle these issues must be embedded in the training of nursing staff, in the hospital management strategy and at the political level.

Moving From Knowledge to Action: Improving Safety and Quality of Care for Patients With Limited English Proficiency

Objective. This study assessed safety culture and staff communication with patients with limited English proficiency (LEP) to identify system-level approaches to increasing interpreter use and reducing health care disparities. Methods. An electronic survey and 7 focus groups were conducted with health care professionals in pediatrics and obstetrics/gynecology. Survey data were examined with univariate descriptive analysis. Focus group transcripts were coded through an iterative consensus process. Results. Survey participants (n = 68) reported less confidence in their ability to communicate effectively (74%) and form therapeutic relationships (56%) with LEP patients versus English-proficient patients. Focus groups identified knowledge as a facilitator of interpreter use. Workflow constraints, supply-demand mismatch, variable interpretation quality, and gaps in communication with interpretation services management were barriers. Conclusion. Knowledge gaps may not be a primary cause of interpreter underuse. Strategies to address workflow barriers and engage with interpretation services are critical to move from knowledge to action to improve LEP patient care.

Medical Student Workshop Improves Student Confidence in Working With Trained Medical Interpreters

INTRODUCTION

Many physicians care for patients whose primary spoken language is not English, and these interactions present challenges in physician-patient communication. These challenges contribute to the significant health disparities experienced by populations with limited English proficiency (LEP). Using trained medical interpreters is an important step in addressing this problem, as it improves communication outcomes. Despite this, many medical education programs have little formal instruction on how to work effectively with interpreters.

METHODS

To address this gap, we created an interactive workshop led by professional trained interpreters and faculty facilitators for medical students in their clinical years. Students were asked to evaluate the session based on relevance to their clinical experiences and helpfulness in preparing them for interactions with patients with LEP.

RESULTS

Immediately after the session, students reported that the clinical scenarios presented were similar those seen on their clinical clerkships. They also reported increased confidence in their ability to work with interpreters. On later follow-up, students reported that the instruction helped prepare them for subsequent patient interactions that involved interpreters.

CONCLUSION

A workshop is an effective method for improving medical student comfort and confidence when working with interpreters for populations with LEP.

Family-Centered Rounds: Past, Present, and Future

Bedside rounds have evolved concurrently with hospitalist medicine and patient-centered care. Family-centered rounds are the foundation of effective communication in the in-patient pediatric setting. Participant perspectives (family members, patients, nurses, faculty, and trainees) on family-centered rounds differ and goals may not always align. Further, the practical components of how rounds are conducted varies and have continued opportunities for improvement. This article summarizes the most recent experience with rounds in an attempt to identify unified and effective strategies moving forward.

Challenges and opportunities caring for neurology outpatients across language differences

BACKGROUND

With over 66 million Americans who speak over 350 languages other than English at home, we sought to examine attitudes and behaviors of neurology clinicians and staff when communicating across language differences.

METHODS

We conducted an electronic-enabled cross-sectional survey of clinicians and patient services coordinators working at an academic neurology outpatient clinic. Questions focused on professional medical interpreter (PMI) services usage, satisfaction, and perceived barriers to utilization.

RESULTS

A total of 82/235 (35%) neurology clinicians and 24/52 (46%) coordinators met the study eligibility criteria. Most clinicians (96%) reported seeing at least 1 non-English-speaking patient and using PMI services (85%) in the last month. Most commonly self-reported interpretation modalities were face-to-face PMI services (39%) and patients' family members or friends (28%). Perceived barriers to using PMI included time constraints (60%) and lack of available face-to-face PMI (51%). Among patient services coordinators, 33% reported consistently asking patients their preferred language and 50% if they needed a PMI for appointments. Most respondents (77% clinicians and 71% coordinators) were satisfied with PMI services. Recommendations included having more available face-to-face PMI, greater coordinated efforts to preschedule PMI, and more education on the effective use of PMI.

CONCLUSIONS

More than 70% of outpatient neurology clinicians and patient services coordinators were satisfied with PMI. However, their perceived barriers and reported practices suggest a need for updated policies and education to improve the use of PMI services.

Evaluating the Feasibility of Incorporating In-Person Interpreters on Family-Centered Rounds: A QI Initiative

OBJECTIVES

No best practice has been defined for incorporating in-person interpreters into family-centered rounds (FCRs) for patients with limited English proficiency (LEP). We hypothesized that addressing barriers to scheduling in-person interpreters would make FCR encounters more likely, and thus ensure more equitable care for LEP patients.

METHODS

A quality improvement initiative was conducted from October 2014 to March 2016 to arrange in-person interpreters for LEP patients during FCRs on the inpatient pediatric service of a large, urban, tertiary care center in Boston. Main interventions included establishing a protocol for scheduling interpreters for rounds and the implementation of a form to track process adherence. Our primary outcome was the percentage of FCR encounters with LEP patients with an interpreter present. Our balancing measures were patient satisfaction, which was assessed using validated surveys administered weekly by nonphysician team members through convenience sampling of families present on the wards, and rounds duration.

RESULTS

There were 614 encounters with LEP patients during the intervention, 367 of which included in-person interpreters. The percentage of encounters with LEP patients involving interpreters increased from 0% to 63%. Form completion, our primary process measure, reached 87% in the most recent phase. English-proficient and LEP patients reported similar satisfaction with their rounding experience amid a modest increase in rounds duration (preintervention, 105 minutes; postintervention, 130 minutes; P = .056).

CONCLUSIONS

Using quality improvement as a framework to address key barriers, we successfully implemented a process that increased the participation of in-person interpreters on FCRs on a busy pediatric service.