Design: Plan-Do-Study-Act (PDSA) cycles

Setting: An academic-affiliated community hospital in southeastern USA performing over 8000 surgical cases annually

Patients or Participants: All patients with LEP admitted for surgery and the teams caring for these patients

Interventions: Two separate, week-long PDSA cycles assessing feasibility and benefit of incorporating tablet-based interpretative services in the OR pre procedure

Measurements and Main Results: Despite over 10% of patients identified as LEP, no interpreter services were available in the OR. Teams used hand gestures, limited vocabulary in patients’ languages, and unvetted, automated, web-based translators. The first PDSA cycle trialed OR utilization of interpreter tablets already available for perioperative use, however only 5/17 eligible cases utilized a tablet. A stakeholder survey, including nurses, anesthesiology, surgeons, and OR leadership, found the vast majority of respondents felt interpretation should be offered in the OR, however there were not enough tablets available, and the tablets were difficult to transport with patients as they were mounted on a stand. Using this information, a second PDSA cycle was performed after acquisition of three additional, unmounted tablets that were able to remain with patients all day (preop, intra-op, and postop). In this cycle, 14/14 eligible cases utilized a tablet. A repeat stakeholder survey highlighted significant process improvement, describing OR interpreter services as feasible and useful. This initiative has been expanded for all cases at this hospital. The final phase will include a rollout to the entire health system.

Conclusion: Robust perioperative interpretation is necessary for equitable care. While providers have grown accustomed to limited communication in the operating room, the care provided to patients with LEP is divergent from standard of care. By increasing resources and decreasing workflow barriers, patient equity can be improved while minimizing burden to providers.