title: Evaluation of a quality improvement intervention to increase use of telephonic interpretation.
abstract: BACKGROUND
  Language barriers are associated with poor health care outcomes, and barriers exist for timely in-person interpretation. Although available on-demand, telephonic interpretation remains underutilized. This study evaluates whether a quality improvement (QI) intervention was associated with rates of interpretation and parent-reported language service use at a children's hospital.
  
  
  METHODS
  The QI intervention was developed by a multidisciplinary team and included provider education, electronic alerts, standardized dual-handset telephones, and 1-touch dialing in all hospital rooms. Interpreter use was tracked for 12 months before, 5 months during, and 12 months after the intervention. Weekly rates of interpretation per limited English proficient (LEP) patient-day were evaluated by using segmented linear regression. LEP parents were surveyed about professional interpretation and delays in care. Responses before, during, and after the intervention were compared by using the χ(2) test for trend.
  
  
  RESULTS
  Telephonic interpretation rates increased by 53% after the intervention (baseline 0.38 per patient-day, increased 0.20 [0.13-0.28]). Overall (telephonic and in-person) interpretation increased by 54% (baseline 0.96, increased by 0.51 [0.38-0.64]). Parent-reported interpreter use improved, including more frequent use of professional interpreters (53.3% before, 71.8% during, 69.3% after, P trend = .001), less frequent use of ad hoc interpreters (52.4% before, 38.1% during, 41.4% after, P trend = .03), and fewer interpretation-related delays in care (13.3% before, 7.9% during, 6.0% after, P trend = .01).
  
  
  CONCLUSIONS
  This QI intervention was associated with increased telephonic interpreter use and improved parent-reported use of professional language services. This is a promising approach to deliver safe, timely, and equitable care for the growing population of LEP children and families.
authors.affiliation: Department of Pediatrics and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; and casey.lion@seattlechildrens.org.
authors.forename: K Casey
authors.initials: KC
authors.lastname: Lion
authors.affiliation: Department of Pediatrics and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; and Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, Washington Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington;
authors.forename: Beth E
authors.initials: BE
authors.lastname: Ebel
authors.affiliation: Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rafton
authors.affiliation: Department of Pediatrics and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; and.
authors.forename: Chuan
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Patty
authors.initials: P
authors.lastname: Hencz
authors.affiliation: Department of Pediatrics and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; and.
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
mesh_terms: D002648:Child; D002675:Child, Preschool; D003144:Communication Barriers; D005260:Female; D054625:Healthcare Disparities / Q000592:standards*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D058996:Quality Improvement / Q000458:organization & administration*; D013689:Telephone; D014175:Translating; D014861:Washington
keywords: health care disparities; hospitals; language barriers; pediatric; quality improvement