MSKCC perianesthesia LEP communication initiative (staff education + language assistive technology)

Purpose #

To improve communication and foster health equity for surgical oncology patients with limited English proficiency (LEP) — and those with hearing, speech, or visual impairments — in the perianesthesia setting, by equipping perianesthesia nurses with up-to-date language assistive technology and educating them about its proper use so they rely on trained professional interpreters rather than ad hoc family or caregiver interpretation.

"Therefore, to address healthcare disparities for patients with LEP at Memorial Sloan Kettering Cancer Center (MSKCC) in New York, New York, perianesthesia nurses and language assistance staff formed a joint task force to foster health equity for patients with LEP through staff education and communication initiatives." (Linda, 2023, p. 359)

Mechanism #

An interdepartmental joint task force between the Language Assistance Program (LAP) and perianesthesia nurses paired two components: (1) unit-based staff in-service education on the proper use of trained medical interpreters and language assistive technology (initial in-service June 18, 2018; a second session in December 2018 on the video interpreter tablet), and (2) progressively deployed technology — in 2018, smartphones and wearable communication devices integrated with two audio interpreter options (point-to-talk and whiteboards) for nonverbal patients; in 2019, an electronic video interpreter tablet embedded with two video interpreter applications, mounted on a wheeled stand for easy transport to the bedside. Later additions (2020–2021) included clear face masks for lip-reading patients, resource boxes with amplifiers/magnifiers/voice recorders, and a second video interpreter tablet.

"In 2018, smartphones and wearable communication devices—integrated with two audio interpreter options (point-to-talk and whiteboards) for nonverbal patients—were provided to perianesthesia nurses. In addition to the two audio interpreter options provided in 2018, an electronic video interpreter tablet embedded with two video interpreter applications was provided in 2019. The tablet was attached to a stand with wheels, allowing for easy transportation to the patient's bedside (Kwok et al., 2021)." (Linda, 2023, p. 360)

"On June 18, 2018, LAP staff presented an initial in-service session developed by the task force." (Linda, 2023, p. 360)

Example(s) of usage #

Deployed on the main perianesthesia unit at MSKCC (23 presurgical beds and 35 PACU beds) for surgical patients with cancer with LEP admitted between January 2018 and March 2019, with all resources later shared across perianesthesia units. Used during first-case presurgical admission assessments (beginning at 5:30 am, when in-person interpreters were scarce), RN consent verification, and frequent PACU assessments of patients emerging from anesthesia.

"All resources were made available to perioperative staff (nurses, anesthesia providers, and surgical teams) for all interactions with patients with LEP during admission assessments, consent verifications, and PACU assessments." (Linda, 2023, p. 360)

Other Notes #

This is a quality improvement (QI) initiative, not a controlled trial. Its documented impact was interpreter-usage volume from LAP call logs (Figure 1); two illustrative case studies (Figure 2) depict patient-level communication improvements. (Note: the plugin's relation grammar does not yet define EVD/CLM→ART edges, so links to this artifact are wikilinks for now.)