Leveraging Novel Clinical Decision Support to Improve Preferred Language Documentation in a Neonatal Intensive Care Unit

Background Recognition of patient and family’s diverse backgrounds and language preference is critical for communicating effectively. In our hospital’s electronic health record (EHR), a patient or family’s identified language for communication is documented in a discrete field known as “preferred language.” This field serves as an inter-departmental method to identify patients with a non-English preferred language, creating a bolded banner for non-English speakers easily identifiable by healthcare professionals. Despite the importance of documenting preferred language to facilitate equitable care, this field is often blank. Objectives Using the Institute for Healthcare Improvement’s (IHI) Model for Improvement, our team sought to increase preferred language documentation within the neonatal intensive care unit (NICU) from a baseline of 74% in September 2021 to above 90% within six months. Methods A multidisciplinary team was assembled to address preferred language documentation. Our team incorporated guidance regarding preferred language documentation into a novel clinical decision support (CDS) tool aimed at addressing various safety and quality measures within the NICU. Our primary outcome metric was documentation of family’s preferred language. Process measures included overall compliance with the CDS tool. A secondary outcome was assessment of preferred language documentation accuracy. Results The average rate of preferred language documentation increased from a baseline of 74% to 92% within six months and is currently sustained at 96%. Moreover, our follow-up assessments found that 100% of a random sample of contacted patients (n=88) had their language preference documented correctly. Overall compliance with the CDS tool remained at 85% throughout the project. Conclusions Using a quality improvement framework coupled with a CDS initiative, our team was able to successfully and accurately improve preferred language documentation in our NICU. Future projects include strategies for more equitable care for patients with non-English preference such as improved interpreter usage and discharge instructions in their preferred language.

Publication History

Received: 05 October 2023

Accepted after revision: 22 May 2024

Accepted Manuscript online:
24 May 2024