(113) Promoting Family Voices: A QI Initiative to Increase In-person Interpreter Use on Pediatric Hospitalist Rounds

Background: Patients that speak a language other than English (LOE) have worse health care quality and outcomes. In-person interpreters provide the most effective communication.

Objectives: Our specific aim was to increase use of in-person interpreters on pediatric hospitalist round from 39% to 75% over 9 months.

Design/Methods: Using the model for improvement, a multidisciplinary stakeholder team conducted this quality improvement study. LOE families on the pediatric hospitalist service were identified via chart review and demographic information obtained. Attendings and fellows completed daily surveys regarding interpreter use. Encounters were excluded if person needing an interpreter was not present at rounds. Baseline data was collected September to November 2024; implementation data from November 2024 to July 2025. Primary outcome measures were percent of in-person interpreter use and interpreter use documentation, tracked over time using run charts. Process measure was presence of consult interpreter services order. Balancing measure was time waiting for in-person interpreter. Interventions included piloting a secure chat workflow to schedule in-person interpreters and Epic smartphrase to improve documentation.

Results: Preliminary results through March 2025 demonstrate survey response rate of 94.2%. There were 187 rounding encounters and 62 unique patients (4 readmitted during the study period). Language spoken was 59% Spanish, 14% Swahili, 7% American Sign Language; average length of stay was 91 hours. An in-person interpreter was used in 29% of rounding encounters, video interpreter in 60%, and 11% family declined an interpreter. For Spanish-speaking patients, an in-person interpreter was used in 42% of rounding encounters. No sustained improvement was seen after interventions. Interpreter use was documented in 36% of notes. Consult interpreter services order was present in 98% of patient admissions. In-person interpreter was waiting for the team 63% of the time, while 21% of the time team waited more than 10 minutes.

Conclusions: Preliminary results demonstrate no sustained change in in-person interpreter use, and use was higher for Spanish-speaking families. Changing the culture of in-person interpreter use is challenging. Future interventions include increasing resident education, expanding workflow to additional pediatric hospitalist units, and individual audits with feedback to hospitalists.