Intervention Title: Engaging of Language Services by Pediatric Intensive Care (PICU) Staff, UC Davis Health System; Sacramento, Calif.

Goal:
Raise the level of awareness and engagement of the Language Services team with families and children in the PICU. 

Innovation:
The hospital’s PICU team regularly holds a monthly, multidisciplinary committee meeting that includes representatives of all PICU staff—physicians, nurses, respiratory therapists, social workers and more. This regularly scheduled gathering serves as a forum for discussion and problem-solving among the disciplines. The team recently invited the director of Medical Interpreting Services to join them.

Result:
Members of the hospital’s PICU team now personally know the director of Medical Interpreting Services well. Consequently, they are more apt to call her and her team with questions, and more readily involve Interpreting Services in the care of families and patients with limited English proficiency (LEP).

Institution:
UC Davis Health System
2315 Stockton Boulevard
Sacramento, CA 95817
P: (916) 734-2011

From the Leadership: 

“What has made this a success is that Medical Interpreting is no longer an auxiliary team in another part of the hospital that we just call on the phone when we have a patient or family struggling with English. They’re now part of the PICU care team and are sitting at the table with nurses, physicians, respiratory therapists—giving everyone a better sense of what interpreters can provide to our families. They take part in regular discussions about patient care.”  

Robert K. Pretzlaff, M.D.
Chief, Pediatric Critical Care Division

Profile:
The leading referral center in a region covering 65,000 square miles and the region’s only academic medical center with 577 licensed beds, approximately 34,000 annual admissions and nearly 53,000 annual emergency department visits

Clinical areas affected:

• Pediatric Intensive Care

Staff involved:

• Dieticians
• Interpreters
• Nurses
• Pharmacists
• Physicians
• Respiratory therapists
• Social workers
• Transport team members

Timeline:
The suggestion was made to invite Medical Interpreting Services to the table at one of the monthly PICU meetings. Because the group quickly concurred, the department participated in the following month’s meeting.

Contact:
JoAnne Natale, M.D., Ph.D.
Associate Professor of Pediatrics
Joanne.natale@ucdmc.ucdavis.edu
P: (916) 734-4545 

Innovation implementation:
Between 15 and 20 percent of families in the UC Davis PICU speak a language other than English—most frequently Spanish. Although PICU nurses regularly called upon members of the Medical Interpreting team, physicians and others who communicate with LEP families didn’t really know any of the interpreters personally or fully appreciate the demands on interpreters’ time.

Since Inez Talbot, director, Medical Interpreting Services, began attending and providing monthly updates/reports at the PICU Committee meetings, all who work in the PICU now have a better understanding of what services interpreters can provide and how to better engage them.

The greatest benefit has been that Medical Interpreting no longer merely interprets for PICU families. They are now considered a full-fledged member of the PICU team and regularly help physicians, nurses, and others problem-solve for PICU families. 

One such example is that of a Hmong family whose child was in the PICU for a serious infectious disease. The family was having a hard time understanding when, why and how to use protective gear (i.e., gowns, gloves). When straightforward interpreting between the physician and family wasn’t working, the interpreter suggested involving an infection control nurse who usually explains the procedure to family members in English. The family immediately understood how wearing such gear was vital to the protection and health of their child and themselves, as well as other patients and families in the PICU.

Advice and lessons learned:

1. Bring people across disciplines together. It’s much easier to collaborate in providing patient care if you know each other. It’s also a lot harder to be critical or demeaning of other disciplines when you’re sitting across the table from them.  
2. Respect the demands on your colleagues’ time. It wasn’t until Medical Interpreting began to attend meetings and would periodically need to leave in order to provide interpreting for a patient/family in another part of the hospital, that the PICU team fully appreciated the demands on interpreters’ time.
3. In-person announcements are better received. A secondary benefit is that when Medical Interpreting is kicking off a new program, they can inform everyone in-person rather than posting it on an intranet site that nobody has time to read.

Cost/benefit estimate:
While no cost benefits have been examined or tabulated, PICU care providers are more frequently calling upon Medical Interpreting and anecdotally, using them more effectively.