Gupta Katherine M, Campeggio Daria, Madu Chinonyerem, Callahan James M, Jenicek Gabriela, Ortiz Priscilla, Zorc Joseph J
Departments of Pediatrics.
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Pediatrics. 2023 Mar 1;151(3). doi: 10.1542/peds.2022-057330.
Patients with limited English proficiency (LEP) benefit from the appropriate use of medical interpreters. A multidisciplinary quality improvement team sought to improve communication with patients with LEP within a pediatric emergency department (ED). Specifically, the team aimed to improve the early identification of patients and caregivers with LEP, the utilization of interpreter services for those identified, and documentation of interpreter use in the patient chart.
Using clinical observations and data review, the project team identified key processes for improvement in the ED workflow and introduced interventions to increase identification of language needs and offer interpreter services. These include a new triage screening question, an icon on the ED track board that communicates language needs to staff, an electronic health record (EHR) alert with information on how to obtain interpreter services, and a new template to prompt correct documentation in the ED provider's note. Outcomes were tracked using statistical process control charts.
All study measures met special cause for improvement during the 6-month study period and have been sustained during surveillance data collection. Identification rates for patients with LEP during triage increased from 60% to 77%. Interpreter utilization increased from 77% to 86%. The documentation of interpreter use increased from 38% to 73%.
Using improvement methods, a multidisciplinary team increased the identification of patients and caregivers with LEP in an ED. Integration of this information into the EHR allowed for the targeted prompting of providers to use interpreter services and to correctly document their use.
英语水平有限（LEP）的患者可从适当使用医学口译员中受益。一个多学科质量改进团队试图改善儿科急诊科（ED）与LEP患者的沟通。具体而言，该团队旨在提高对LEP患者及其照顾者的早期识别、为已识别者提供口译服务的利用率，以及在患者病历中记录口译服务的使用情况。
通过临床观察和数据审查，项目团队确定了急诊工作流程中需要改进的关键环节，并引入干预措施以增加对语言需求的识别并提供口译服务。这些措施包括一个新的分诊筛查问题、急诊追踪板上一个向工作人员传达语言需求的图标、一个带有如何获取口译服务信息的电子健康记录（EHR）提醒，以及一个新模板，以促使急诊提供者在记录中正确记录。使用统计过程控制图跟踪结果。
在为期6个月的研究期间，所有研究指标均达到了需要改进的特殊原因标准，并且在监测数据收集期间得以维持。分诊时LEP患者的识别率从60%提高到了77%。口译服务的利用率从77%提高到了86%。口译服务使用情况的记录从38%增加到了73%。
通过改进方法，一个多学科团队提高了急诊科对LEP患者及其照顾者的识别率。将这些信息整合到电子健康记录中，能够有针对性地促使提供者使用口译服务并正确记录其使用情况。
