Disparities exist in family-centered rounds for families who speak a language other than English (LOE), including differences in family and nursing engagement, as well as the quality of communication.1 Efforts to summarize rounds are often written on the room's white board in English, presenting an opportunity for large-scale improvement efforts to support equitable, language-concordant communication. Written rounding summaries improve communication between providers and caregivers, but prior studies have not included LOE caregivers.2 In this issue of the Journal of Hospital Medicine, Glick and colleagues describe the development of a health literacy-informed, multilingual, real-time summary of pediatric family-centered rounds (the Rounds eSummary).3 In this study, a multidisciplinary team developed an eSummary tool. During rounds, a clinician team member selected components of the patient's care plan from a pretemplated list of options. Families were immediately provided with a summary of rounds by print, email, or text. These care plan summaries were intentionally brief, highlighting medications (42% of eSummaries), nutrition (30%), oxygen (24%), and consultations (23%) planned for that day. The limited templated choices allowed pretranslation of the eSummary. Rounds eSummaries were created in eight languages, with English (89%) and Spanish (6.2%) being the most common. Usage differences existed between English and LOE eSummaries, with a longer mean engagement time per user for LOE eSummaries compared with English-language eSummaries. In addition, higher proportions of families who used Spanish (89%) and Portuguese (88%) accessed the eSummaries compared with English (56.9%). The authors acknowledge several study limitations including impact on the medical team's workflow. Understanding how much time was required to access the survey, complete the form, and coordinate delivery would help guide efforts to incorporate such tools into existing electronic medical frameworks. Furthermore, discerning caregiver feedback on eSummary usefulness, barriers to access, and average caregiver education level may help identify why one-third of generated eSummaries were not accessed by patients or caregivers. Additionally, with 89% of eSummaries written in English, inclusion of more LOE patients and caregivers would be useful for future analysis. Finally, expansion of this tool to incorporate the needs of medically complex patients would further improve the equity of care we provide. Glick's study developed Rounds eSummaries using best practices for health literacy and through a language equity lens. Hospitalized pediatric patients who speak a LOE experience inequities, including increased adverse events.4 Communication disparities exist for LOE families with loss of interpreted information on family-centered rounds, poor compliance with interpreter utilization, and less frequent updates from hospitalists as compared with English-speaking families.1, 5 Standardized tools such as eSummaries support equitable translation and allow for scalable, systems-level changes. However, the tradeoff of standardization is that it inherently limits the ability to customize content to specific clinical situations. With the creation of a novel tool, this area is ripe for additional research. Future qualitative studies of caregivers would help improve the understanding of how useful this tool is for patient care and communication. Additionally, with the rising development of artificial intelligence (AI), an area of future investigation is how AI can complement a generated eSummary to reduce provider burden and deliver accurate, customized patient instructions. In summary, this study by Glick and colleagues resulted in the creation of an innovative, written communication tool that helps bridge equity gaps for LOE patients and caregivers. While this study utilizes the tool for inpatient rounds, potential applications exist for adapted versions in discharge summaries, discharge instructions, patient education, and interactions with nonphysician team members such as physical therapists or dieticians. Future work is needed to determine how this tool is received by families, incorporate the tool into existing electronic medical record workflow, explore how AI can complement this initiative, and expand customization of the tool to meet the broader needs of pediatric patients. The authors have no funding to report. The authors declare no conflict of interest.
Salada et al. (Thu,) studied this question.