Speak Easy: A Multidisciplinary Quality Improvement Initiative to Increase Face-to-Face Language Interpreting in the PICU

Objectives: To improve communication with caregivers who prefer a language other than English (LOE) by increasing interpreting encounters with an emphasis on face-to-face (in-person or video) modalities. Design: Single-center quality improvement initiative. Setting: Seventy-five-bed PICU in a quaternary children’s hospital. Patients: Patients whose caregivers preferred a LOE during the period from March 2023 to December 2024. Interventions: Based on clinician and nursing input about barriers to using interpreting services, we enacted a bundle of interventions collectively known as the Speak Easy program which included: 1) multidisciplinary education; 2) preferred language signs; 3) a novel, standardized opt-out in-person interpreting program for caregivers whose preferred language was Spanish; and 4) increased number of video interpreting devices and presence of devices in patient rooms. Measurements and Main Results: We analyzed total and face-to-face interpreting encounters during the intervention period (from March 2023 to December 2024) compared with the pre-intervention period (from November 2021 to February 2023) using statistical process control charts. Total interpreting encounters nearly tripled (from 43 to 121 encounters per 100 LOE patient-days) and face-to-face interpreting encounters increased by more than four times (from 23 to 104 encounters per 100 LOE patient-days). Significant shifts were driven by increases in the number of in-person Spanish interpreting encounters and video interpreting encounters following interventions 3 and 4. Pre-intervention surveys revealed that time constraints, unpredictability, and competing priorities represent barriers to using interpreting services that may be particularly relevant in high-acuity settings; post-intervention surveys showed that clinicians, nurses, and social workers viewed the changes that were made favorably. Conclusions: A multidisciplinary approach emphasizing interventions to decrease the time and planning necessary to coordinate in-person and video interpreting can effectively engender cultural change and promote the delivery of language-concordant care.