A Quality Improvement Project to Increase Utilization of Interpretive Services for Limited English Proficiency Patients Seeking Care at an Emergency Room

Abstract

In the United States, approximately 59 million people speak another language other than English at home, 37 million of non-English speaking (NES) patients identified Spanish as their primary language (Flores, Abreu, Barone, Bachur & Lin, 2012; Ryan, 2013). An estimated 25.2 million have Limited English Proficiency (LEP) (Flores, Abreu, Barone, Bachur & Lin, 2012; Ryan, 2013). LEP patients are a vulnerable population with greater risk for poor health outcomes due to inappropriate provider-to-patient communication barriers (Diamond, Schenker, Curry, Bradley & Fernandez, 2009). The DNP student and a Quality Improvement (QI) team collaborated to implement a QI project using the QI Plan Do Study Act (PDSA) cycles model. The aim of this QI project was to increase implementation rates of interpretive resources including in-person professional interpreters or use of technological interpreter ad-hoc tools for LEP patients by 10% from baseline measure within four weeks of implementation at the UNMH- ED. The QI team applied the Vocera technical intervention ad-hoc tool to facilitate access for communication between Interpreter Language Services (ILS) and staff who are caring for LEP patient(s).The ILS dashboard results showed use of ILS in the pre-intervention month totaled 82% of ILS ED need met. In contrast, post-intervention use of ILS demonstrated an increase of 89% of ILS ED met. Thus, representing a 7% difference in ILS percent need met demonstrating to be statistically significant with a Chi-Square of 7.898 and p-value of .005. Correspondingly, a 6- month ILS need met was determined when considering the 6-month pre-intervention baseline of 76.8%. Consequently, demonstrating that the projected 10% increase of ILS ED need percent was met, the findings revealed an increase compared to baseline percent. These findings represent a 12% improvement from the pre-intervention baseline ILS ED need met. However, the analysis and results only demonstrate statistical significance but lack to indicate to be clinical significance. This QI project confirmed the intervention was effective in increasing and facilitating ILS access. Time restriction and limited time period for data collection were identified as the main limitations. The project discusses the DNP role in executing opportunity to employ systematic change models driven by QI evidence-based research for improvement in an emergency department setting.