P3B103: Improving Communication for Families with Limited English Proficiency in a Level III NICU

Purpose/Objectives: Limited English proficiency (LEP), defined as those with primary language other than English and who have a limited ability to read, speak, write, or understand English, affects 8.6% of the US population and 2.3% of Ohioans. LEP in healthcare settings is associated with increased hospital length of stay and readmissions, delayed diagnosis, inappropriate or excessive testing, and safety events. Access to professional interpreters improves communication, patient satisfaction, compliance, and decreases mortality. Recent research has demonstrated infants in the neonatal intensive care unit (NICU) are affected by racial and ethnic disparities in quality of care, and communication in preferred language can partially mitigate these disparities. Our primary objective was to increase interpreter use with LEP families in an academic level III NICU.

Design/Methods: Our SMART Aim was to increase median interpreted daily encounters from 0.05 to 0.5 per patient admission day. In a pre-intervention assessment of 71 pediatric residents and NICU nurses, the majority (85.7%) reported barriers to effective communication - the most cited barriers were access to in-person (32.7%) or video interpretation (21.8%), written materials for family (16%), and training for staff (12.7%). We designed and implemented tests of change using iterative Plan-Do-Study-Act (PDSA) cycles. Interventions centered around 1) access (informational posters about language services, multi-lingual family call-in cards, family calendars, and language identification signage); 2) training (monthly resident orientation, nursing education module), and 3) awareness (assessment of language needs in morning safety huddle). Staff completed post-intervention surveys after module completion (nursing) or at the end of the rotation (residents). We tracked documentation of interpreted encounters in the medical record.

Results: On matched analysis of 0-5 point scales, nursing confidence identifying resources after intervention increased by 0.11 points (p = 0.82) and confidence using resources increased by 1.44 points (p=0.044). Resident confidence identifying resources increased by 1.5 points (p = 0.0025) and confidence using resources increased by 1.3 points (p = 0.0019); Figure 1. Overall, residents identified on average 1.3 more resources after interventions . Interpreted encounters per patient day increased from a median of 0.05 at baseline to 0.44; Figure 2.

Conclusion/Discussion: Nurses and residents report barriers to effective communication with families with LEP in the NICU setting. Targeted interventions, developed based on needs assessment, appear to have a positive impact on nurse and resident knowledge of available language access support, confidence using these resources, and interpreter use. This data does not account for undocumented encounters, which may be substantial and lead to underestimation of effect size. Anecdotal feedback from NICU staff and the Language Department indicates improved awareness of the needs of the LEP population. Future work will evaluate the impact of these interventions on family experience.