A Quality Improvement (QI) Initiative to Provide Language-Concordant Care in the PICU

Introduction: In the U.S. the NELP population is steadily growing. Within Mount Sinai Pediatrics, approximately 25% of our annual admissions are from NELP families. Language discordance can lead to communication breakdowns, medication errors, and increased morbidity and mortality. Our SMART aim was to improve access to equitable, language-concordant family-centered care by increasing the percentage of NELP patients with daily documentation of interpreter usage by a physician, nurse practitioner, or physician assistant - a proxy for working with an interpreter in the pediatric intensive care unit (PICU) and pediatric cardiac intensive care unit (PCICU)- from 0% to 50% from September 1, 2024 to March 1, 2025.


Methods: This QI project, conducted in the PICU and PCICU, used the Model for Improvement. Key drivers included NELP identification, video interpretation availability, and staff language proficiency. PDSA cycles were implemented, and a control chart analyzed responses to interventions, such as a visual aids for preferred language on patient doors, LanguageLine integration, and a medical Spanish course for ICU staff. The outcome measure was the percentage of NELP patients with at least one documented interpreter use per day.


Results: Interpreter documentation increased to 51.1% the PICU and 60.1% in the PCICU between September 1, 2024, to January 27, 2025, following interventions aimed at improving rounding flow and data sharing.


Conclusions: We successfully increased the rate of interpreter documentation using several interventions. Future interventions will focus on increasing the compliance rate to 85% and patient-centered measures to evaluate the quality of communication.