Objective This study aimed to gather qualitative feedback on patient perceptions of informed consent forms and elicit recommendations to improve readability and utility for enhanced patient safety and engagement in shared decision making. Methods Sixty interviews in personal interviews were conducted consisting of a literacy and numeracy assessment, a comprehension quiz to assess retention of key information, and open-ended questions to determine reactions, clarity of information, and suggestions for improvement. Results Although 68% of the participants had education beyond high school, many still missed comprehension questions and found the forms difficult to read. Recurrent suggestions included specific formatting changes to enhance readability, a need for additional sources of information, mixed attitudes toward inclusion of risk information, and the recognized importance of physician-patient conversations. Conclusions This study provides evidence from the patient perspective that consent forms are too complex and fail to achieve comprehension. Future studies should be conducted using patients’ suggestions for form redesign and inclusion of supplemental educational tools to optimize communication and safety to achieve more informed health care decision making.

Objective: To determine whether augmentation of the Spanish interpreter's role to include cultural education of residents can improve the satisfaction of Latino patients. Design:We assessed parent satisfaction during 4 sequential 2-month periods between June 1, 2004, and February 11, 2005, using different interpretation methods: telephone interpretation (n = 91 patient encounters), trained in-person interpretation (n = 49), in-person interpretation with cultural education of residents (n=65), and postprogram telephone interpretation (n =45). Setting:General pediatric practice at a large teaching hospital.Participants: A total of 250 Spanish-speaking parents who were limited in English proficiency. Interventions:The cultural education program included 3 brief preclinic conferences taught by an interpreter and one-on-one teaching of residents about language and cultural issues after each clinical encounter.Main Outcome Measures: Parent satisfaction was assessed using 8 questions that have previously been validated in Spanish. Lower scores indicated more satisfaction.Results: Because they were limited in English proficiency, our Spanish-speaking patients were significantly more satisfied when an in-person interpreter was used compared with a telephone interpreter (mean total satisfaction score of 14.5 [in-person] Conclusion:Although use of an in-person interpreter can increase Latino parents' satisfaction, a program using an interpreter to educate residents in cultural and language issues can increase satisfaction further.

In this public health practice vignette, we describe an ongoing community and system intervention to identify and address social determinants of health and related needs experienced by ChristianaCare patients and the greater community during the Coronavirus pandemic. This intervention, being conducted by the ChristianaCare Office of Health Equity, in partnership with ChristianaCare's embedded research institute, the Value Institute, and the Community Outreach and Education division of the Helen F. Graham Cancer Center and Research Institute, engages more than 25 community health workers, health Guides, Latinx health promoters and other social care staff as social first responders during the COVID-19 crisis. These experienced front-line social care staff screen patients and community members for social needs; make referrals to agencies and organizations for needed assistance (e.g., food, housing, financial assistance); assess people's understanding of COVID-19 and preventive measures; provide education about COVID-19; and, connect patients and community members to COVID-19 testing and any relevant clinical services. While this ongoing intervention is under evaluation, we share here some preliminary lessons-learned and discuss the critical role that social first responders can play in reducing the growing adverse social and health impacts of COVID-19 across the state of Delaware.

Patient's ability to understand and effectively communicate health information facilitates disease prevention, self-management of illness, the adoption of healthy behaviors, and their ability to act on important public health information. However, patients who have limited English proficiency (LEP) are significantly disadvantaged. Previous studies have shown the benefit of medical interpreter services in bridging the health communication gap between patients and providers. This qualitative study, focusing on medical interpreter utilization within obstetrical and neonatal services, provides perspectives from multiple types of providers to further explore the role of medical interpreter services and specific barriers to the use of such services. Five separate focus groups were conducted with postpartum nurses, labor and delivery/triage nurses, obstetrics and gynecology (OBGYN) resident physicians, neonatal intensive-care unit (NICU) nurses, and faculty physicians, nurse practitioners, and midwives. The data show that barriers to the utilization of professional medical interpreters can be categorized by distinct but related institutional-and individual-level factors. Further interpretation of the barriers, however, suggests that providers' use/non-use of interpreter services is merely one piece of a much "bigger picture" regarding difficulties and challenges in delivering care to a growing culturally diverse patient population, and that these cultural challenges, not just the availability of interpreter services, may affect providers' ability to deliver effective and efficient care. It is argued that simply adding additional communication-based resources may not be sufficient to impact providers' attitudes and behaviors or the overarching organizational culture regarding LEP patients.

Objective: The objective of this paper is to highlight a study on optimizing the full-time equivalent (FTE) for Spanish and Mandarin interpreters at Christiana Care Health System. In this study, there were multiple challenges that needed to be addressed, and a multi-method approach was taken. Methods: These methods include: (1) time-motion study to quantify interpreter workflow and variability of duration of time needed for each task; (2) an integer program to optimize the number of interpreters needed per hour based on historical demand patterns for interpreter services; (3) Discrete-Event Simulation (DES) to examine the use of agency interpreters in order to meet demand; (4) cost modelling to convert FTEs and the use of agency interpreters into overall costs to the hospital; and (5) sensitivity analysis to evaluate alternative number of interpreter FTEs and their corresponding costs to the hospital. Results: Overall cost to the hospital is predicted to decrease with additional FTE interpreters, up to a threshold level above which the cost will start to increase. Through this innovative methodology used in this paper, we predict that hiring 3.5 more FTEs for Spanish interpreters will result in 9.07% of cost savings, and predict that hiring one FTE for Mandarin interpreters will result in 25.87% in cost savings compared to the current expense of providing Mandarin language interpretation. Conclusions: Contrary to intuition, increasing number of FTEs results in cost savings. Besides the financial benefit, hospitals will also be able to ensure the quality of health services that Limited English Proficiency (LEP) patients and families receive.