(1282) Improving Access to PICU FCR for Families of Limited English Proficiency to Reduce Safety Events

Introduction: Improved communication is associated with reduced safety events. Providing families healthcare in the language of their choice is a fundamental component of family centered rounds (FCR). However structural changes to our pediatric intensive care unit (PICU) during the COVID pandemic led to a decreased use of interpreter services on FCR for patients with limited English proficiency (LEP). Via a quality improvement initiation, we developed a bundle to prevent safety events related to access to communication on FCR in the PICU for families with LEP. Our SMART Aim was to decrease the rate of safety events for families with LEP by 10% by June 2022.

Methods: Using the model for improvement and several PDSA cycles our bundle included the following interventions- developing a seminar to regularly discuss inequities, implementing a daily LEP communication checklist, implementing a Diversity, Equity and Inclusion (DEI) checklist to analyze safety events and reporting out this data at PICU quality meetings. Our process measures were the percentage of FCR when an interpreter was used for LEP families and the total number of interpreter calls made. Our balancing measure was the completion timing of FCR. Statistical process control charts were used to analyze data and API rules were applied to detect special cause variation.

Results: 922 charts were reviewed during the study period of January 2022 to May 2022 and 124 safety events were reviewed from September 2021 to January 2023. The percentage of safety events occurring for families with LEP over the total number of safety events in our PICU was baseline at 40% and reduced to 18% during the study period and maintained sustainability after that. The percentage of interpreter use during FCR was 75% during the study period with the number of interpreter calls placed during rounds increasing from baseline of 7 monthly to 15, increasing to 40 calls in the last study month. There was no difference during in the timing of completion of FCR during the study period.

Conclusions: A bundle including education, checklists and reviewing safety events through a DEI lens can increase interpreter use for families with LEP during FCR and help to reduce the number of safety events for those patients. We have expanded this practice to the Department at our institution.