(861) Interdisciplinary Development of Interventions to Improve Language-Concordant Care in the PICU

Introduction: Language barriers contribute to health disparities and are associated with increased risk of adverse safety events. The high acuity and complexity of the Pediatric Intensive Care Unit (PICU) poses challenges to effective language-concordant care. We developed an interdisciplinary working group to investigate current practices and facilitators/barriers to interpretation use in the PICU; results were used to design four interventions to improve language-concordant care.

Methods: We created a working group of physicians, nurses, social workers, language services administrators, interpreters, and care team assistants. We conducted a survey to elicit provider and nurse perspectives on interpretation practices in a large 75-bed PICU within a quaternary referral center from Aug to Sept 2022 (providers) and Feb 2023 (nurses). We used survey data to develop and implement interventions to increase language-concordant care.

Results: 67 providers and 41 nurses completed the survey. Response rate was approximately 70% for attending, 84% for fellow, 60% for hospitalist, and 10% for resident physicians (although not all residents who received survey had recently rotated in PICU to be eligible for participation), 18% for advance practice providers, and 12% for nurses. 79% of providers and 62% of nurses stated they rarely or never use interpretation services for families with non-English preferred languages during rounds. They identified the following barriers: inadequate time to coordinate and use interpreters, competing priorities, high medical acuity, and lack of defined responsibilities. Based on these results, we developed four interventions to increase interpreter use: 1) preferred language signs on all patient doors with QR code for interpreter 2) education on phone and video interpreter access on provider phones 3) increased availability of video interpreter iPADs for patient rooms and 4) standardized coordination of in-person interpreters during morning provider huddle.

Conclusions: There are unique barriers to effective use of language interpretation in the PICU. A multidisciplinary approach focused on awareness, accessibility, standardization, and integration into current practice can be useful to address perceived barriers, change current practices, and improve delivery of language-concordant care.