ABSTRACT
OBJECTIVES: No best practice has been defined for incorporating in-person interpreters into family-centered rounds (FCRs) for patients with limited English proficiency (LEP). We hypothesized that addressing barriers to scheduling in-person interpreters would make FCR encounters more likely, and thus ensure more equitable care for LEP patients. METHODS: A quality improvement initiative was conducted from October 2014 to March 2016 to arrange in-person interpreters for LEP patients during FCRs on the inpatient pediatric service of a large, urban, tertiary care center in Boston. Main interventions included establishing a protocol for scheduling interpreters for rounds and the implementation of a form to track process adherence. Our primary outcome was the percentage of FCR encounters with LEP patients with an interpreter present. Our balancing measures were patient satisfaction, which was assessed using validated surveys administered weekly by nonphysician team members through convenience sampling of families present on the wards, and rounds duration. RESULTS: There were 614 encounters with LEP patients during the intervention, 367 of which included in-person interpreters. The percentage of encounters with LEP patients involving interpreters increased from 0% to 63%. Form completion, our primary process measure, reached 87% in the most recent phase. English-proficient and LEP patients reported similar satisfaction with their rounding experience amid a modest increase in rounds duration (preintervention, 105 minutes; postintervention, 130 minutes; P = .056). CONCLUSIONS: Using quality improvement as a framework to address key barriers, we successfully implemented a process that increased the participation of in-person interpreters on FCRs on a busy pediatric service.
Subject(s)
Communication Barriers , Family , Language , Patient Satisfaction/statistics & numerical data , Quality Improvement/organization & administration , Teaching Rounds/statistics & numerical data , Adolescent , Adult , Child , Child, Preschool , Comprehension , Family/ethnology , Family/psychology , Feasibility Studies , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Physician-Patient Relations , Professional-Family Relations , Translating , Young AdultABSTRACT
Con el propósito de diseñar un proyecto para dar solución al problema principal, surgido de un análisis de situación realizado en la Facultad de Ciencias Médicas de Pinar del Río, se aplicó como procedimiento la matriz o red explicativa de Mario Rovere. Se identificó un listado de problemas aplicando la técnica de grupos nominales y se realizó la selección del problema fundamental mediante el método de priorización o de ranqueo o método SILOS/ OPS; el principal problema resultó ser la insuficiente preparación y desnivel del claustro. Se identificaron las posibles causas y al desarrollar la matriz explicativa se identificó como nudo crítico la priorización de la especialización por sobre la obtención de grados científicos. Se definió el objetivo de cambio y los indicadores y tareas, insertándolos en un proyecto destinado a dar solución al problema planteado en un período de 5 años, por tratarse de una situación que no es posible resolver a corto plazo...(AU)