Improving Documentation of Language Interpreter Use to Increase Compliance, Quality, and Safety

Introduction: The standard of care for language interpretation in healthcare encounters is well established and supported by civil rights law and hospital policy. However, the use of language interpreters for healthcare communication is inconsistent for families who use languages other than English. To promote interpreter use and improve compliance, a quality improvement team implemented a project to enhance documentation of interpreter use in clinical notes. Methods: The team developed a rule-based electronic health record tool to prompt documentation of interpreter use for the right patient at the right time. The team piloted and revised the tool in a primary care setting, and then implemented and disseminated it in a more complex inpatient pediatric hospital setting. The team measured compliance with documentation in hospital pediatric history and physical and discharge summary notes using statistical process control p-charts. Balancing measures included the authors’ time spent documenting interpreter use and perceived difficulty in documenting in the clinical notes. Results: On the hospital pediatrics service, the rate of compliant documentation in history and physical notes increased from 15% to 74% and was sustained for 14 months. Compliant documentation for discharge summary notes increased from 11% to 93% and sustained for 14 months. Conclusions: Electronic health record tools designed to document interpreter use can effectively prompt and monitor compliance through integrated and rule-based systems. Thus, they are essential for comprehensive quality improvement initiatives that encourage clinicians to use language interpreters and optimize communication, quality, and safety for children and families who use languages other than English.