The following article is a part of conference coverage from the National Association of Pediatric Nurse Practitioners (NAPNAP) 42nd National Conference on Pediatric Health Care, held virtually from March 24 to March 27, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading nurse practitioners in pediatrics. Check back for more from NAPNAP 2021.


Use of a mobile interpreter app among staff at a Midwestern pediatric hospital lead to an 85% increase in total communication encounters with patients and families with limited English proficiency (LEP), according to findings from a poster presented virtually at the National Association of Pediatric Nurse Practitioners Annual Meeting (NAPNAP 2021).

“The results from the project and the positive feedback we received from health care staff who had access to the app have shown a lot of promise and indicate immediate steps that health care organizations and health care professionals can take towards helping to better serve patients with LEP,” lead author Whitney Getzfrid, BSN, RN, DNP student, said in an interview.

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Access to Medical Interpreter Services Are Lacking

Health care disparities seen among the LEP population in the hospital setting include increased adverse events, higher readmission rates, greater lengths of stay in the hospital, and decreased patient satisfaction, according to Ms Getzfrid and coauthor Susan Connelly, DNP, APRN NP, PC/AC, both of Creighton University College of Nursing in Omaha, Nebraska.

Although Federal policies and health care standards mandate the provision of interpreter services to patients and families with LEP, time constraints and limited access to professional interpreter services are marked barriers to achieving this goal.

The project was conducted at a 26-bed medical-surgical unit at Children’s Hospital & Medical Center Omaha where current interpretive services are limited to 1 in-person Spanish-speaking interpreter, 2 mobile tablets, and 1 telephone service per inpatient medical-surgical floor that offers access to hundreds of languages.

“These services are often cumbersome to initiate and are shared among the unit, which have contributed greatly to their limited accessibility and underutilization,” the researchers noted. Approximately 10% of patients at this pediatric hospital are non-English speaking.

Mobile Interpreter Services

The intervention consisted of implementation of the CyraCom mobile app, which was downloaded onto mobile work phones to be used by advanced practice providers, physicians, and nursing staff in addition to current interpreter services resources on the unit.

Data was collected over the 90-day implementation period from September 1 to November 2, 2020, and were compared to data from the same period in 2019. Collected data included the number of communication encounters between patients with LEP and health care staff members using the app, the length of time of each encounter, the average time between requesting an interpreter and when an interpreter becomes available, and the cost of each encounter in addition to the total interpreter service cost per month.

Intervention Markedly Increases Use of Interpreter Services

The mobile interpreter app was used with patients 162 times for a total of 975 minutes during the 3 months of use in 2020 (Table). The number of interpreter communication encounters increased by 85% during the intervention compared with the 2019 reference period, despite a 32% decrease in the number of patients entering the hospital in 2020 because of the COVID-19 pandemic and a 28% decreased in admissions among patient needing interpreter services, according to the researchers.

Table. Interpreter Usage Before and After Use of Mobile Interpreter App

OutcomeSept-Nov 2019Sept-Nov 2020
Total encounters (calls)204378
Total minutes25643891
Total cost$4,350.70$5,757.09

In a survey on usage of the app, more than half of the healthcare staff (60%) who responded to the survey (n=20) used the app at least once per shift when caring for a patient requiring interpreter services and 40% used it 2 to 4 times per shift while caring for a patient requiring interpreter services. Nearly all of the healthcare staff in the survey (95%) used the audio vs video option on the mobile app. Additionally, 41% of respondents said they used the app for updating patients’ families on plan of care and 23% said they used it to communicate while performing a nursing task.

Information on the number of encounters and total minutes spent with the in-person professional interpreter was not available for inclusion in this project. Other limitations include the lack of data on patient satisfaction with the app, the decreased number of patient visits in 2020 vs 2019, and that medical residents in this unit did not have access to the mobile app on their work phones.

“Health care staff had increased utilization of interpreter services with the implementation of an additional mode of accessing interpreter services, indicating patients of LEP status received improved communication during their hospital stay,” the researchers concluded. Although increased use of interpreter services may initially increase costs, eventually this practice may decrease overall costs associated with improving health care disparities among patients with LEP.

Looking Ahead

The hospital staff included in this project are still utilizing the app, Ms Getzfrid said. “We are currently working on increasing awareness of the app among all physicians and advanced practice providers throughout the whole organization so that they have access to the application from their mobile phones when they see patients.”

Children’s Hospital and Medical Center in Omaha is also planning to implement the interpreter services app on mobile tablet devices when the new Hubbard Center for Children opens this fall, she explained. Each family entering the Hubbard Center will be provided with a mobile tablet upon admission to use to initiate conversations with the app on demand throughout their stay.

Additionally, the researchers hope to capture patient satisfaction and perceptions on the quality of care that is provided through the app. “I am hoping that providing more communication opportunities with the LEP population through increased access to interpreter services will help decrease the health care disparities associated with limited usage of interpreter services,” Ms Getzfrid concluded. 

The authors declare no conflicts of interest.

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Getzfrid W, Connelly S. Implementing a remote interpreter service mobile phone application among advanced practice providers, physicians, and nursing staff in the pediatric hospital setting. Poster presented virtually at: NAPNAP 2021; March 24-27, 2021. EP-PI130.