Family-Initiated Interpretation: A Novel Approach to Communication in the Pediatric Intensive Care Unit
Phase: NA
Conditions: Limited English Proficiency
Sponsor: Ann & Robert H Lurie Children's Hospital of Chicago

Title: Family-Initiated Interpretation: A Novel Approach to Communication in the Pediatric
Intensive Care Unit
NCT Number: Not Yet Assigned
Document Date: 3/20/2023

3-20-2023
Date:
IRB #: IRB 2022-5221
Title: A Novel Approach to Interpretation in the Pediatric Intensive Care Unit: Family-Initiated Interpretation
2-1-2022
Creation Date:
End Date:
Status: Approved
Mary Pilarz
Principal Investigator:
Panel #2
Review Board:
Sponsor:
Study History
 
 
Initial
Submission Type
Exempt
Review Type
Decision Exempt
 
 
Modification
Submission Type
Expedited
Review Type
Decision Approved
Key Study Contacts
 
 
Mary Pilarz
Member
Principal Investigator
Role
Contact
mpilarz@luriechildrens.org
 
 
Mary Pilarz
Member
Primary Contact
Role
Contact
mpilarz@luriechildrens.org
 
 
REDCap User
Member
Investigator
Role
Contact
redcap@northwestern.edu
 
 
Victoria Rodriguez
Member
Co-Principal Investigator
Role
Contact
varodriguez@luriechildrens.org
 
 
Marcelo Malakooti
Member
Co-Principal Investigator
Role
Contact
mmalakooti@luriechildrens.org
 
 
Briseyda Morales
Member
Co-Principal Investigator
Role
Contact
Bmorales@luriechildrens.org

Family Initiated Interpretation: A Novel Approach to Communication in the Pediatric Intensive Care Unit
Specific Aims:
Limited English proficiency (LEP) adversely affects pediatric hospital outcomes. Children from families with LEP
are more likely to have longer lengths of stay, an increased number of adverse events, and less pain medication than
their counterparts with English proficiency. Although consistent use of professional interpretation mitigates negative
outcomes for this population, professional interpretation remains widely underused in the hospital setting. Language
barriers may be particularly harmful in the pediatric intensive care unit (PICU), where parents encounter challenging
medical decisions like choosing to pursue high-risk therapies or making end-of-life decisions. In the PICU, LEP
families report less understanding of what happens on rounds and are dissatisfied with the communication from
nursing staff. Spanish speaking families of hospitalized children have reported that one barrier to interpreter use was
the inability to directly request services. Currently, at our institution, families do not have a mechanism to
initiate contact with an interpreter. The study team plans to improve the rate of professional interpretation in the
PICU by allowing families to directly request interpreter services.
There have been no published reports of giving families access to interpreter technology and allowing families to
initiate calls with an interpreter. In previous research regarding the climate of safety for families with limited English
proficiency, the lack of interpreter availability and accessibility have been cited as reasons that most communication
with patients with limited English proficiency takes place without an interpreter. In order to improve the hospital
environment for these patients and families, the hospital system should make it easier for patients with limited
English proficiency to speak up about their questions and concerns. The investigators hypothesize that
family-initiated interpretation will be a feasible, usable, and acceptable way to increase the rate of professional
interpretation in the PICU. The team will collect baseline demographic and interpreter utilization data from the
PICU, initiate our family-initiated interpretation intervention, then collect post-intervention data on interpreter
utilization. To accomplish this, the investigators will use the following specific aims:
Specific Aims:
Aim 1: Explore the feasibility, usability, and acceptability of a family-initiated interpreter intervention among
healthcare providers as well as families with limited English proficiency. The study team will survey both patients
and the healthcare team regarding the acceptability of our intervention, using a validated tool. The study team
expects that this will be a feasible, usable, and acceptable intervention.
Aim 2: Examine the impact of family-initiated interpretation intervention on professional interpreter
utilization by comparing pre and post-intervention professional interpreter utilization rates in the PICU. All families
with a preferred language besides English will be given tablets with video and audio interpreting capabilities. They
will be instructed to call an interpreter with any questions or concerns for the medical team. The investigators will
measure interpreter utilization before and after the intervention to determine if this intervention increases
professional interpreter use.

Significance:
Limited English proficiency (LEP) adversely affects pediatric hospital outcomes. Families with LEP are at
risk of longer lengths of stay,1increased readmissions,2-3 and decreased satisfaction with care.4 LEP is also
associated with an increased number of adverse events in the hospital,5 and these families are less likely to ask
questions and speak up when something does not seem right about their child’s care.6 Multiple studies have
shown that professional interpretation can mitigate these negative outcomes, and it has the potential to raise
the quality of clinical care for patients with LEP to be equal, or nearly equal, to that of patients without
language barriers.7 However, professional interpretation is still widely underused.8 Most communication with
patients with limited English proficiency takes place without an interpreter, even high-risk interactions like
medication administration and procedures.8-10 Members of the medical team also often take communication
shortcuts that make it challenging, if not impossible, for families to ask questions of the staff. One common
shortcut is medical staff using their own, insufficient, language skills instead of utilizing a professional
interpreter.11,12 In the pediatric intensive care unit, families with LEP report less understanding of what
happens on rounds and are dissatisfied with the communication from nursing staff.13 Spanish speaking
families of hospitalized children have reported that one barrier to interpreter use was the inability to directly
request services.14 To correct this injustice, resources must be more equitably distributed and there will need
to be changes to institutional norms and practices.15 By innovating the way that interpreters are incorporated
into PICU care, this project aims to decrease healthcare disparities.
To our knowledge, there has been no research on giving limited English proficiency families unfettered access
to interpretation technology to initiate communication with the medical team.7 The current model of
interpretation at our institution relies on a member of the care team electing to use an interpreter, despite the
evidence that the medical staff unreliably uses professional interpretation. Families are not given direct access
to interpretation technology, nor do they have a way to contact an in-person interpreter. As a result, families
cannot guarantee communication with an interpreter while they are in the hospital.
The investigators plan to conduct a quasi-experimental study to investigate whether implementing
family-initiated interpretation will lead to greater use of interpreters, compared to the current standard of care.
The investigators plan to give all families with limited English proficiency a video interpretation tablet on
admission to the PICU. They will be given instructions on how to call an interpreter whenever they would like
to speak with a member of the medical staff. The study team hypothesizes that allowing families to control
interpretation will lead to increased interpreter utilization.
Innovation:
The underutilization of interpreters by the medical staff and the injurious impact of limited English
proficiency on pediatric hospital outcomes is well-described. However, there is a need for further research
on how to improve the care of children and families with limited English proficiency in order to
attenuate negative outcomes. This will be the first study to challenge the existing paradigm of how
interpretation is used in the hospital, by allowing families to initiate contact with professional interpreters.
The investigators also will be including the non-Spanish speaking LEP population in our design and
outcomes, as this population is historically understudied and has worse outcomes than their Spanish speaking
counterparts.16,17
Approach:

This will be a quasi-experimental interventional study. First, the study team will collect baseline data
regarding baseline patient demographics and interpreter utilization. via electronic medical record (EMR) data
extraction and the data from the hospital’s remote interpretation vendor. The study team will then initiate our
intervention and implement it over 9 months and collect post-intervention data.
Specific Aim #1: Explore the feasibility, usability, and acceptability of a family-initiated interpreter
intervention among healthcare providers, and the acceptability of the intervention among families with
limited English proficiency.
The investigators will conduct user-testing to ensure usability of the tablet and its instructions. Prior to
implementing the intervention, the team plans to observe a random sampling of families with limited English
proficiency using the tablet to understand potential pitfalls in the instructions and the team will conduct short
interviews with limited English proficiency families after they use the tablets. A bilingual member of the
research team will observe use of the tablet and conduct these interviews in Spanish with PICU patients and
families. Only Spanish speaking families will be able to participate in the user-testing. The investigators will
incorporate feedback about the instructions and presentation of the tablets into our final instructions to
families.
After the intervention is implemented, the investigators will assess acceptability, feasibility, and
appropriateness of the intervention. Using the validated implementation outcome measures developed by
Weiner et. al,18 the investigators will survey the families who used the family-initiated interpretation
intervention to explore its acceptability, feasibility, and appropriateness. A survey in the most common
languages (Spanish, Arabic, Chinese, Polish, and Burmese) will be distributed to all families who participated
in the intervention. These language groups encompass over 90% of the non-English languages spoken among
our patient population.
After three months of family-initiated interpretation, the study team will survey the medical team in the PICU
to explore the acceptability, feasibility, and appropriateness of the intervention using the validated tools
developed by Weiner et. al.18 All members of the PICU medical team will be eligible to complete the survey
on feasibility, acceptability, and appropriateness.
Specific Aim #2: Describe the impact of family-initiated interpretation intervention on interpreter
utilization.
Patient Population and Enrollment: All patients and families with limited English proficiency admitted to the
Ann & Robert H. Lurie Children’s Hospital of Chicago Pediatric Intensive Care Unit. A member of the PICU
staff will explain the study and give the families with LEP a video interpretation tablet on the family’s
admission to the PICU.
Approach: Our planned intervention will allow families with LEP to initiate interpretation on hospital
provided tablets. A tablet with video interpretation capability will be placed into every LEP patient’s room for
the duration of their PICU admission. Families will be given instructions in their preferred language on how
to use the interpretation technology. Families will be encouraged to initiate a call to the interpreter whenever
they would like to communicate with any member of the staff. The PICU team will be oriented to the new

interpreting workflow by key stakeholders — nursing leadership and research team members. Both nursing
leadership and medical leadership support this project.
Outcome: Our primary outcome is the number of professional interpretations per LEP patient day before and
after the intervention. The investigators will collect baseline interpreter utilization data from the EMR as well
as records of telephonic/video interpretation from the remote interpretation vendor.

Cited Literature:
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