P3.J193: Interpreter Use Documentation among Pediatric Residents and Faculty: A Quality Improvement Study

Purpose/Objectives: Appropriate and consistent collaboration with preferred language interpreters improves clinical outcomes, combats health disparities, and is associated with increased patient satisfaction. However, use and documentation of interpreter services for patient encounters is often inconsistent. For patients whose preferred language is not English, our quality improvement (QI) study aims to increase appropriate documentation of interpreter collaboration in the primary team’s daily note from 33.3% to 80% by March 30, 2024.

Design/Methods: Using the Model for Improvement and the plan-do-study-act (PDSA) framework, interventions were developed and implemented on 3 separate units/wards in a 60 bed children's hospital nested within an adult hospital. Our primary outcome measure was: appropriate documentation of interpreter collaboration in the primary team’s daily clinical notes. This was defined as the documentation of preferred language with the interpreter identifier and type of service (in person versus virtual service), or the documentation of collaboration with a bilingual provider. Using randomization via Excel, a minimum of 15 charts were reviewed weekly during baseline (08/13/23-11/05/23) and intervention (11/06/23-03/03/24) periods. Data were tracked in a standardized data collection tool. A run chart was created and updated to provide real-time feedback. Standard definitions of special cause and shift were utilized. Multiple PDSA cycles were performed targeting key drivers (Figure 1).

Results: After 3 months of interventions, adequate documentation of eligible encounters improved from a baseline of 33.3% to 50%. Special cause variation was established in January 2024 (Figure 2). Documentation of interpreter collaboration varied among primary hospital service teams. Appropriate documentation was completed in 58.1% of Hospitalist (n=236), 24.2% of Hematology/oncology (n=132), and 7.6% of GI/Liver/Renal/Neuro (n=53) encounters.

Conclusion/Discussion: The documentation of interpreter collaboration improved following 3 months of QI interventions, though this trend was not sustained in the last month of data collection. Results are likely multifactorial and may relate to institutional culture and dissemination of knowledge surrounding expectations for interpreter documentation. Documentation variation among hospital services may be related to variation in availability of care team assistants and in rounding structure on subspecialty services. Further interventions are needed to realize sustained, equitable care and corresponding documentation for non-English speaking families.