Promoting Effective Communication with Limited English Proficient Families: Implementation of Video Remote Interpreting as Part of a Comprehensive Language Services Program in a Children's Hospital.

The aim of this study was to evaluate the process of implementing video remote interpreting (VRI) in a hospital already using in-person and over-the-phone interpreting (OPI), including the impact on utilization of language services, efficiency, and costs, as well as implementation challenges. METHODS: A prospective program-evaluation design was used. From 2012 to 2017, 165 VRI carts and iPads were rolled out in clinics, inpatient wards, and the emergency department. Each area was supported for six weeks with training and problem-solving issues. Additional VRI rollouts occurred in groups, every two to four months. Outcomes were assessed using utilization and observation/interview data. RESULTS: Postimplementation, 50,611 VRI encounters occurred for a total of 556,938 interpretation minutes. OPI decreased by 37.5%. Mean wait time for language services fell from 60 to 5 minutes. Rapid VRI uptake (> 10,000 VRI minutes in Year 1) occurred in clinics previously lacking access to in-person interpreters. VRI was associated with in-person interpreters having more time for professional development activities and with five promotions. Implementation challenges included initial resistance to VRI use, device connectivity problems, and six months' lead-in time to establish proper VRI use. Challenges were overcome through ongoing education, dialogue, and implementation rounds. CONCLUSION: After overcoming initial challenges, VRI implementation, as part of provision of comprehensive language services, can potentially yield several benefits, including immediate extensive use, decreased OPI, reduced wait times for language services, rapid uptake in clinics previously lacking in-person interpreter access, and increased average minutes per encounter by in-person interpreters.

Preoperative Educational Intervention Decreases Unplanned Gastrostomy-Related Health Care Utilization.

Apprehension in taking independent care of children with medical devices may lead to unnecessary visits to the ED and/or acute clinic (AC). To address these concerns, our institution implemented a gastrostomy tube (GT) class in 2011 for caretakers. We hypothesized that inappropriate GT-related ED/AC visits would be lower in preoperatively educated caregivers. We performed a retrospective cohort study of all patients aged 0 to 18 who received GT (surgical or percutaneous) at our institution between 2006 and 2015 (n = 1340). Class attendance (trained vs untrained) and unscheduled GT-related ED/AC visits one year after GT placement were reviewed. Gastrostomy-related ED/AC visits were classified as appropriate (hospital-based intervention) or inappropriate (site care and education/reassurance). Occurrence of ED/AC visits was compared between trained and untrained cohorts. We found that 59 per cent of patients had an unscheduled GT-related ED/AC visit within one year of placement. The trained cohort had 27 per cent less unplanned ED/AC visits within one year (mean 1.21 (SD 1.82) vs untrained 1.65 (2.24), P < 0.001). On multivariate analysis, GT education independently decreased one-year GT-related health care utilization (Odds Ratio 0.75, 95% Confidence Interval 0.59-0.95). Formal education seems to decrease GT-related health care utilization within one year of placement and should be integrated into a comprehensive care plan to improve caregiver self-efficacy.