Cincinnati, Ohio, United States
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Systematically turning language barriers into opportunities by building in global…

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  • Cincinnati Children's Hospital Medical Center

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Volunteer Experience

  • National Council on Interpreting in Health Care (NCIHC) Graphic

    Vice President

    National Council on Interpreting in Health Care (NCIHC)

    - Present 3 years 1 month

    Health

    Served on the Board of Directors April 2023 - April 2025.

  • Spanish Interpreter

    Su Casa Hispanic Ministry

    - 2 years 1 month

    Health

  • Spanish Interpreter

    The Center for Closing the Health Gap

    - 1 month

    Health

Publications

  • Advancing Equity in Emergency Department Discharge Communication for Spanish-Speaking Families

    Hospital Pediatrics

    OBJECTIVE
    Patients and families who speak Spanish as a primary language are at risk for communication barriers; studies in the emergency department (ED) have shown that discharge instructions are frequently incomplete and brief, underscoring the need for improved health care communication. Our family experience data suggested this disparity in communication exists with our Spanish-speaking families. Thus, we aimed to optimize equitable communication by implementing language-congruent…

    OBJECTIVE
    Patients and families who speak Spanish as a primary language are at risk for communication barriers; studies in the emergency department (ED) have shown that discharge instructions are frequently incomplete and brief, underscoring the need for improved health care communication. Our family experience data suggested this disparity in communication exists with our Spanish-speaking families. Thus, we aimed to optimize equitable communication by implementing language-congruent discharge instruction videos for common conditions seen in the ED and enhancing awareness of interpreter needs, thereby mitigating disparities in this population.

    METHODS
    A multidisciplinary team designed interventions targeting key drivers to improve communication with Spanish-speaking families. We a priori selected specific International Classification of Disease, Tenth Revision codes relevant to discharge videos to establish baselines. To assess the effect of these interventions, we tracked families’ responses to communication scores, discharge video use during the visit, and return visits within 72 hours of the index visit. As a balancing measure, we assessed eligible patients’ length of stay (LOS).

    RESULTS
    The percentage of Spanish-speaking families affirming that they received enough information about their child’s condition and treatment increased from 56% to 70.6%; English-speaking families remained stable at 66.7%. The equity gap improved from a baseline of 10% to −3%. Discharge instruction video order rate improved from 0% to 27.6%. There was no change in return visits or LOS.

    CONCLUSION
    This multifaceted approach to language equity integrated the awareness of language barriers with effective communication tools. Providing standardized, understandable, and linguistically congruent discharge instructions in a clinical setting with increased emphasis on recognizing language barriers enhanced communication equity.

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  • Improving Interpreter Presence for Pediatric Hospital Medicine Patients and Families

    Hospital Pediatrics

    BACKGROUND
    For hospitalized patients and families who speak languages other than English (LOE), consistent interpreter-mediated communication is necessary to ensure equitable health care delivery. Despite the availability of interpreter services, variability exists in their presence for all communication touchpoints during hospitalization. To improve interpreter presence during hospitalization, our quality improvement study aimed to increase the average number of interpreted encounters per…

    BACKGROUND
    For hospitalized patients and families who speak languages other than English (LOE), consistent interpreter-mediated communication is necessary to ensure equitable health care delivery. Despite the availability of interpreter services, variability exists in their presence for all communication touchpoints during hospitalization. To improve interpreter presence during hospitalization, our quality improvement study aimed to increase the average number of interpreted encounters per LOE patient day within 6 months.

    METHODS
    Our multidisciplinary improvement team tracked all interpreted in-person, phone, and remote audio and video encounters on a hospital medicine unit. Using the Model for Improvement, we performed Plan-Do-Study-Act cycles to test interventions, including provider education, increased language access devices on the unit, and in-room family language signs. Our outcome measure was the average number of interpreted encounters per LOE patient day measured weekly. We also tracked the proportion of in-person interpreted encounters per LOE patient day as a balancing measure to ensure improving remote interpreter availability did not discourage requesting in-person interpreters.

    RESULTS
    During the 6-month intervention period, there was a total of 651 LOE patient days. The average number of interpreted encounters per LOE patient day increased from a mean of 1.8 to 3.2, and the balancing measure of average number of in-person interpreted encounters per LOE patient day remained unchanged at 0.11.

    CONCLUSIONS
    We observed increased presence of interpreters per LOE patient day on a hospital medicine unit without significant changes to in-person interpreter presence. Creating standard workflows and increased availability of language access devices were key interventions.

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  • Improving Discharge Instructions for Hospitalized Children With Limited English Proficiency

    Hospital Pediatrics

    BACKGROUND AND OBJECTIVES
    Patients with limited English proficiency (LEP) have increased risk of adverse events after hospitalization. At our institution, LEP families did not routinely receive translated discharge instructions in their preferred language. Our objective for this study was to increase the percentage of patients with LEP on the hospital medicine (HM) service receiving translated discharge instructions from 12% to 80%.

    METHODS
    Following the Model for Improvement, we…

    BACKGROUND AND OBJECTIVES
    Patients with limited English proficiency (LEP) have increased risk of adverse events after hospitalization. At our institution, LEP families did not routinely receive translated discharge instructions in their preferred language. Our objective for this study was to increase the percentage of patients with LEP on the hospital medicine (HM) service receiving translated discharge instructions from 12% to 80%.

    METHODS
    Following the Model for Improvement, we convened an interdisciplinary team that included HM providers, pediatric residents, language access services staff, and nurses to design and test interventions aimed at key drivers through multiple plan-do-study-act cycles. Interventions addressed the translation request process, care team education, standardizing discharge instructions for common conditions, and identification and mitigation of failures. We used established rules for analyzing statistical process control charts to evaluate the percentage of patients with translated discharge instructions for all languages and for Spanish.

    RESULTS
    During the study period, 540 patients with LEP were discharged from the HM service. Spanish was the preferred language for 66% of patients with LEP. The percentage of patients with LEP who received translated discharge instructions increased from 12% to 50% in 3 months and to 77% in 18 months. For patients whose preferred language was Spanish, the percentage increased from 16% to 69% in 4 months and to 96% in 18 months.

    CONCLUSIONS
    Interventions targeting knowledge of the translation process and standardized Spanish discharge instructions were associated with an increased percentage of families receiving translated discharge instructions. Future work will be used to assess the impact of these interventions on postdischarge disparities, including emergency department revisits and readmissions.

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Languages

  • Spanish

    Full professional proficiency

  • Chinese

    Limited working proficiency

  • Portuguese

    Limited working proficiency

  • English

    Native or bilingual proficiency

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