346 - Family Language Preference and Disparities in Infant Care Involvement in the NICU

Poster Number: 346
Publication Number: 346.1911

Background: Family engagement in kangaroo care in the Neonatal Intensive Care Unit (NICU) is lower for families with limited English proficiency (LEP). The underutilization of certified interpreters results in poor communication, medical errors, and low patient satisfaction. In addition, language discordance can impact the degree of family engagement in infant cares (e.g. feeding, diaper change). Language cards (pictorial and bilingual communication assistance tools), in the setting of language discordance, have been used in adult and pediatric medicine, but no literature exists on use in the NICU.

Objective: The study purpose was to determine if NICU specific language card use increased infant care involvement for families with LEP.

Design/Methods: This is a prospective pilot cohort study performed in a single level IV academic NICU of family involvement in infant care stratified by language. Eligible infants (identified as Spanish language in the electronic medical record [EMR]) had a language card (Figure 1) placed at their bedside to be used as a communication assistance tool beginning August 2022. Chart reviews were conducted between December 2021 and April 2023 (8 months before and after implementation) on family bedside presence (documented in the EMR by the nurse as “present” or “not present” each care time) and involvement in cares. Family presence pre/post intervention data were analyzed using Welches t-test of proportions and odds ratios. Mixed effect models explored the interaction of language and intervention on care outcomes including diaper changes, positive touch (holding, touch, and skin-to-skin), bathing, temperature checks, dressing, feeding and overall participation (combined variable). Interpreter utilization was monitored throughout the study period.

Results: 850 infants were admitted to the NICU over the study period; 93% English, 4% Spanish, and 3% non-English, non-Spanish. Spanish-preferred family bedside presence significantly increased post-implementation. Pre-implementation, Spanish-preferred families had lower odds of involvement in all categories (Table 1). Post-implementation there was a statistically significant increase in odds of Spanish-preferred family involvement for infant dressing and feeding. Certified interpreter utilization increased over this period from averaged 1.05 encounters per limited English proficient patient days to 1.21.

Conclusion(s): Language cards, as communication assistance tools, may result in increased family involvement in certain aspects of infant cares including feeding. Additionally, language cards do not decrease the use of certified interpreters.