99 - Unit-Based Pathways to Reduce InequitieS for FamiliEs with Limited English Proficiency: UPRISE-LEP in the Intensive Care Unit

Poster Number: 99
Publication Number: 99.211

Mónica O. Ruiz, Stanford University School of Medicine, Palo Alto, CA, United States; Kanwaljeet S. Anand, Stanford University School of Medicine, Stanford, CA, United States; Felice Su, Stanford University School of Medicine, Stanford, CA, United States; Daniela Rey Ardila, Lucile Packard Children's Hospital Stanford, Santa Clara, CA, United States; Jennie Magana-Soto, Lucile Packard Children's Hospital Stanford, Temecula, CA, United States

Background:
The higher incidence of adverse events and worse outcomes in children from Limited English Proficient (LEP) families hospitalized in the pediatric intensive care unit (PICU) yields a palpable health inequity for the estimated 250,00 million LEP individuals in the US. The lack of communication in a patient’s preferred language inhibits the delivery of high-quality care. Therefore, measuring, monitoring and improving interpreter utilization is essential for addressing this critical health inequity.

Objective:
The objective of this study is to improve interpreter utilization in the PICU via communication bundle implementation and examine interpreter utilization as a metric for inpatient health equity dashboards.

Design/Methods: This longitudinal study enrolled 415 patients with LEP caregivers at a tertiary academic hospital with a 36-bed PICU. Electronic medical record report enhancements, novel automated flowsheets, and LEP patient lists were implemented to capture data for the health equity dashboard (Picture 1). The rounding checklist was modified to include an “LEP communication” item. Caregiver tools such as an interpreter request card, a PICU orientation packet, and a unit-based interpreter (UBI) were provided to empower LEP families. The primary outcome was change in in-person interpreter utilization by medical providers after implementation of the communication bundle. Statistical analyses included basic frequencies and unpaired t-tests.

Results: Overall interpreter utilization rates (# of days interpreter utilized/total # of days with LEP patients) increased from 4.2% to 20.2% (Graph 1) after implementation of the communication bundle (p-value 0.001). Interpreter utilization rates were higher on weekdays (UBI present) vs. weekends (UBI not present) (Graph 2), which supports the effectiveness of UBIs in improving interpreter utilization rates (58.9% vs. 42.6%, p-value 0.012). Furthermore, the communication bundle increased in-person interpreter use for medical updates, discharge instructions, and LEP patients with long PICU stays (35.9% to 55%, 33.3% to 60%, and 35.1% to 61.4%, respectively). Conclusion(s):
The communication bundle effectively increases in-person interpreter utilization rates in the PICU. Furthermore, interpreter utilization is a feasible metric for the development of inpatient health equity dashboards. Future steps include assessment of communication bundle acceptance by providers and utilization of our health equity dashboards to conduct correlation analyses between interpreter use and clinical benchmarks such as nutrition initiation and early mobilization.  

Picture 1: Health Equity DashboardLEP-Staging.002.jpegPicture 1: Depiction of UPRISE-LEP health equity dashboard.
Graph 1: In-Person Medical Utilization Rate – Unit Based Interpreter vs. OverallLEP-Staging-3.002.jpegGraph 1: Rates of in-person interpreter utilization based on the Unit-Based Interpreter (UBI) vs. all interpreter services (i.e., UBI, iPad interpreter and phone interpreter).