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OBJECTIVES Patients and families preferring languages other than English (LOE) often experience inequitable communication with their health care providers, including the underutilization of professional interpretation. This study had 2 aims: to characterize resident-perceived communication with families preferring LOE and to evaluate the impact of language preference on frequency of resident interactions with hospitalized patients and families. METHODS This was a cross-sectional study at a quaternary care children’s hospital. We developed a questionnaire for residents regarding their interactions with patients preferring LOE. We concurrently developed a communication tracking tool to measure the frequency of resident communication events with hospitalized patients. Data were analyzed with logistic and Poisson regression models. RESULTS Questionnaire results demonstrated a high level of resident comfort with interpretation, though more than 30% of residents reported “sometimes” or “usually” communicating with families preferring LOE without appropriate interpretation (response rate, 47%). The communication tracking tool was completed by 36 unique residents regarding 151 patients, with a 95% completion rate. Results demonstrated that patients and families preferring LOE were less likely to be present on rounds compared with their counterparts preferring English (adjusted odds ratio, 0.17; 95% confidence interval [CI], 0.07–0.39). Similarly, patients and families preferring LOE were less likely to receive a resident update after rounds (adjusted odds ratio, 0.29; 95% CI, 0.13–0.62) and received fewer resident updates overall (incidence rate ratio, 0.45; 95% CI, 0.30–0.69). CONCLUSIONS Hospitalized patients and families preferring LOE experience significant communication-related inequities. Ongoing efforts are needed to promote equitable communication with this population and should consider the unique role of residents.

OBJECTIVES Undertriage, the underestimation of acuity, can result in delayed care and potential morbidity in the emergency department (ED). Although inequities in ED care based on language preference have been noted, little is known about its association with undertriage. We evaluated for differences in undertriage based on caregiver language preference. METHODS This was a retrospective cross-sectional study of patients aged younger than 21 years, triaged as Emergency Severity Index (ESI) level 4 or 5 (nonurgent), to the pediatric ED from January 1, 2019, through January 31, 2021. Indicators of undertriage were defined as hospital admission, significant ED resource use, or return visits with admission. We used logistic regression with generalized estimating equations to measure the association of preferred language with undertriage. RESULTS Of 114 266 ED visits included in the study, 22 525 (19.8%) represented patients with caregivers preferring languages other than English. These children were more likely to experience undertriage compared with those with caregivers preferring English (3.7% [English] versus 4.6% [Spanish] versus 5.9% [other languages]; Spanish versus English: odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2–1.4] and other languages versus English: OR, 1.6; 95% CI, 1.2–2.2). Differences remained after adjusting for sex, insurance, mode of arrival, and clustering by triage nurse (Spanish versus English: adjusted OR, 1.3; 95% CI, 1.3–1.5) and other languages versus English: adjusted OR, 1.6; 95% CI, 1.2–2.2). CONCLUSIONS Children accompanied by caregivers preferring languages other than English are more likely to be undertriaged in the pediatric ED. Efforts to improve the triage process are needed to promote equitable care for this population.

“Dolor?” My ears perked up as I overheard the Spanish word for pain while prerounding on an early weekday morning. I followed the voice of my coresident and quietly observed as she continued to ask “dolor?” while pointing to various body parts on a young child. The patient’s father was communicating back by either nodding or shaking his head. As a Dominican woman fluent in Spanish, I introduced myself and gently offered to interpret. My coresident and the patient’s family offered me grateful smiles. Although I was happy to help my colleague and this patient, I also felt unsettled, likely because of experiences I had growing up. As a child, I went to doctors’ appointments with my grandparents and witnessed interpreter experiences that ranged from outstanding to absent altogether. I watched as they were put in the awkward position of trying to communicate in broken English, while simultaneously feigning understanding of the broken Spanish spoken by health care providers. In thinking about these memories, I became frustrated. Why don’t health care providers request and use an interpreter each time one is needed? However, I cannot deny that I too have taken “shortcuts.” For example, I remember quickly talking to an Arabic-speaking family without an interpreter, using a hand signal to indicate that I would be back later. Yet although providers are certainly part of the problem, the core issue at hand is not with me or my coresident as individuals. The reality is that our health care system and culture remain inadequately prepared to ensure equitable communication with patients and families with limited English proficiency (LEP). The scope …

Background: Patients with limited English proficiency (LEP) experience worse health outcomes compared to fluent English speakers. Although the use of interpretation services helps mitigate these disparities, it has been well documented that these resources are underutilized. Residents are often the front-line communicators with patients with LEP. However, the frequency of and barriers to resident use of interpreter services have not been well-characterized. Objective: Our objectives were (1) to characterize resident behaviors regarding interpreter use …

// Arun Satelli 1, * , Izhar Batth 1, * , Zachary Brownlee 1 , Abhishek Mitra 1 , Shouhao Zhou 2 , Hyangsoon Noh 1 , Christina R. Rojas 1 , Heming Li 1 , Qing H. Meng 3 and Shulin Li 1 1 Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 2 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 3 Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA * These authors contributed equally to this work Correspondence to: Shulin Li, email: sli4@mdanderson.org Qing H. Meng, email: qhmeng@mdanderson.org Keywords: prostate cancer, epithelial mesenchymal transition, circulating tumor cells, vimentin, castration resistance Received: April 28, 2016 Accepted: April 21, 2017 Published: May 04, 2017 ABSTRACT Recent advances in the field of circulating tumor cells (CTC) have shown promise in this liquid biopsy-based prognosis of patient outcome. However, not all of the circulating cells are tumor cells, as evidenced by a lack of tumor-specific markers. The current FDA standard for capturing CTCs (CellSearch) relies on an epithelial marker and cells captured via CellSearch cannot be considered to have undergone EMT. Therefore, it is difficult to ascertain the presence and relevance of any mesenchymal or EMT-like CTCs. To address this gap in technology, we recently discovered the utility of cell-surface vimentin (CSV) as a marker for detecting mesenchymal CTCs from sarcoma, breast, and colon cancer. Here we studied peripheral blood samples of 48 prostate cancer (PCA) patients including hormone sensitive and castration resistant sub-groups. Blood samples were analyzed for three different properties including our own CSV-based CTC enumeration (using 84-1 mAb against CSV), CellSearch-based epithelial CTC counts, and serum prostate-specific antigen (PSA) quantification. Our data demonstrated that in comparison with CellSearch, the CSV-based method had greater sensitivity and specificity. Further, we observed significantly greater numbers of CTCs in castration resistant patients as measured by our CSV method but not CellSearch. Our data suggests CSV-guided CTC enumeration may hold prognostic value and should be further validated as a possible measurement of PCA progression towards the deadly, androgen-independent form.

Residents and fellows are uniquely positioned to identify opportunities to improve systems of care delivery, yet are often underrepresented in quality improvement (QI) initiatives. Healthcare Hackathons have gained traction over the past decade as a successful innovation tool that relies on a multidisciplinary team tackling modern healthcare problems. In order to engage trainees in the quality and safety mission of our institution, the Housestaff Quality and Safety Council hosted a Healthcare Hackathon with the goal of quickly identifying quality and safety priorities of trainees. The hackathon was hosted over 3 hours. The event was divided into 4 parts: problem identification, solution generation, solution creation, and presentation. All attendees participated in discussion for problem identification and solution generation. Attendees then divided into teams to discuss concrete solutions. Lastly, each team gave a short presentation about their problem and next steps and received feedback on their ideas. Over 40 people attended the event including pediatric residents, clinical fellows across multiple divisions, improvement advisors, and hospital leaders in education, QI, safety, and informatics. Over 40 problems were identified spanning 5 themes: 1) Error Reporting, 2) Handoffs, 3) Intra-hospital Communication, 4) Health Equity, and 5) High Value Care. A post-hackathon survey allowed attendees to vote on 1 housestaff-led project to focus on for the upcoming academic year. The survey also indicated that 100% of attendees felt the hackathon stimulated creativity and discussion and would attend again in following years. Housestaff have an intimate knowledge of the hospital healthcare ecosystem but are often underrepresented in improvement efforts throughout the hospital. The modified healthcare hackathon is a novel approach that provides trainees a place for rapid generation of ideas and problem-solving. This model is a powerful platform to launch innovative ideas quickly institution-wide and has the potential to engage a large interdisciplinary group of learners.

Background Residents and fellows play a key role in patient care at academic medical centers and have unique insights into quality and safety improvement opportunities. To increase integration of trainees into the quality and safety mission of our hospital, the Housestaff Quality and Safety Council (HQSC) was created in 2018. The HQSC represents a collaboration between the housestaff, Graduate Medical Education, office of Quality and Safety, interprofessional hospital staff, and senior leadership. At our institution, Aim Statement Our objective was to increase the monthly incidence of event reporting by graduate medical trainees by 20% from baseline within 12 months. Interventions We used improvement methodology to identify critical drivers of barriers to submitting event reports, which included 1) education and awareness of the hospital's reporting system, 2) time and effort associated with submitting reports, 3) culture of safety, and 4) lack of feedback and transparency surrounding reports (Figure 1). We used an iterative approach with multiple PDSA cycles to increase knowledge and engagement of event reporting. Tests of change included tip sheets, development of a trainee-run Morbidity, Mortality, and Improvement (MM&I) conference, acknowledgement by senior leadership for submitting reports, and educational interventions. Measures The baseline mean number of safety reports by trainees in the 12 months prior to our project was 24.6 per month. Results The number of safety event reports placed by trainees increased in the initial 5 months of the project, reaching special cause variation in month 2 and 4. Educational interventions and tip sheets were implemented in PDSA #1, the MM&I conference was implemented in PDSA #2, and acknowledgement by senior leadership was implemented in PDSA #3. Conclusions and Next Steps Engaging trainees in patient safety concepts through education, interactive conferences, and appreciation can increase safety event reporting by trainees. Future planned PDSA cycles include implementing changes to increase timely feedback, developing patient safety faculty and resident experts, and increasing audit and feedback of reporting data to trainees.

Although circulating tumor cells (CTCs) have potential as diagnostic biomarkers for cancer, determining their prognostic role in cancer patients undergoing treatment is a challenge. We evaluated the prognostic value of programmed death-ligand 1 (PD-L1) expression in CTCs in colorectal and prostate cancer patients undergoing treatment. Peripheral blood samples were collected from 62 metastatic colorectal cancer patients and 30 metastatic prostate cancer patients. CTCs were isolated from the samples using magnetic separation with the cell-surface vimentin(CSV)-specific 84-1 monoclonal antibody that detects epithelial-mesenchymal transitioned (EMT) CTCs. CTCs were enumerated and analyzed for PD-L1 expression using confocal microscopy. PD-L1 expression was detectable in CTCs and was localized in the membrane and/or cytoplasm and nucleus. CTC detection alone was not associated with poor progression-free or overall survival in colorectal cancer or prostate cancer patients, but nuclear PD-L1 (nPD-L1) expression in these patients was significantly associated with short survival durations. These results demonstrated that nPD-L1 has potential as a clinically relevant prognostic biomarker for colorectal and prostate cancer. Our data thus suggested that use of CTC-based models of cancer for risk assessment can improve the standard cancer staging criteria and supported the incorporation of nPD-L1 expression detection in CTCs detection in such models.