P3C116: Evaluating the Feasibility of Caregiver-initiated Access to Language Services in a Pediatric Emergency Department

Background: Professional medical interpretation improves the quality of patient care for patients with limited English proficiency (LEP) and decreases healthcare disparities. Multiple studies indicate an under-utilization of professional interpreters. One recent study in the pediatric emergency department (PED) revealed that 50% of encounters with LEP patients and families were in English; professional interpretation was least often used for procedures and medication administration, which are high-risk activities for potential patient harm. Currently in healthcare settings including the Johns Hopkins Children’s Center PED, patients and families rely on medical staff to initiate calls to interpreter services.

Methods: We conducted a novel pilot feasibility study in a large academic PED evaluating an intervention where bilingual study staff teach caregivers how to use the interpretation application Cyracom on an iPad during their PED stay. Study staff shared a guide on Cyracom use (Figure 1) and ensured caregivers could independently perform the steps. Caregivers were asked to call interpreters when medical staff entered the room, but staff were not restricted from calling interpreters. Inclusion criteria: 1. Spanish-speaking caregiver who requested language services at registration and had self-reported LEP, 2. Pediatric patients with Emergency Severity Index (ESI) triage level 2-5. To evaluate feasibility, we measured the percentage of caregivers who used Cyracom to call an interpreter at least once. We evaluated the usability of Cyracom, with an adapted System Usability Scale (SUS). The Wilcoxon rank-sum test compared continuous variables, and Fisher’s exact test compared categorical variables, by Cyracom use. The Johns Hopkins Institutional Review Board granted approval (CIR00087771 for: IRB00341749). The Thomas Wilson Foundation provided funding.

Results: Table 1 shows data collected on caregivers from the surveys and on pediatric patients and the PED visits from chart review. 29 caregivers were approached, of which 22 agreed to participate. 13/22 (59%) used Cyracom on the iPad at least once; mean frequency of use=1.6, standard deviation=0.87, and range=2. 15/22 (68%) of all participants responded to the survey; 9/13 (69%) of those who used Cyracom responded to the survey. 8/9 (89%) of those who responded to the survey and used Cyracom reported above average SUS score (>68). No statistically significant differences were observed between those who did and did not use Cyracom (all p > 0.05).

Conclusion: To our knowledge, this is the first study that evaluates the role of adding caregiver-initiated access to interpreters. This intervention was feasible and user-friendly. There was no statistically significant difference by Cyracom use, based on characteristics of caregivers, pediatric patients, or PED visits, allowing use of this intervention in a broad population and PED settings. Future goals include conducting interviews with caregivers to determine the reasons for use or non-use of Cyracom and inquiring about additional interventions that could improve their experience with language services.