Improving communication on medical ward rounds with patients who speak limited English with implementation of medical communication charts.

Aim: To improve communication on the medical ward round with patients with limited English through implementation of a medical communication chart.

Local Problem: King's College Hospital (KCH), London, is situated in Southwark in which 11% of households have no members that speak English as a first language, 4.1% of London's population report they do not speak English well. Language barriers impair healthcare delivery including during daily ward rounds. This has been exacerbated by the need for PPE during the SARS-CoV2 pandemic. Effective communication between healthcare teams and patients is essential for high quality, patient-centred care. Communication tools commonly used include online, telephone and face-to-face translation services but these have limitations.

Methods: Face-to-face patient questionnaires were conducted in the pre-QIP (baseline) group to assess communication on medical ward rounds. Medical communication charts were designed by adapting pre-existing aids commonly used by speech and language therapy. Charts were translated into commonly spoken languages among KCH inpatients. Patients with limited English were selected from both COVID-19 and non-Covid wards. Preintervention and postintervention questionnaires were completed in three Plan-Do-Study-Act (PDSA) cycles.

Results: At baseline, patients agreed or strongly agreed that the ward round addressed physical symptoms (8/8), concerns or anxieties (7/8), ongoing needs (7/8). Only two of eight doctors felt they could communicate effectively with patients. In PDSA 1, four of five patients reported high satisfaction in communicating physical symptoms, anxieties or concerns preintervention with five of five postchart implementation. Five of five patients reported high satisfaction in communicating ongoing needs preintervention but only three of five postintervention. In PDSA 2, two of five patients reported increased satisfaction in communicating physical symptoms, concerns or anxieties with four of four doctors reporting improved satisfaction in communication in PDSA 2 and two of three doctors reporting higher satisfaction in communication in PDSA 3.

Conclusion: Using communication charts in patients with limited English can improve bidirectional communication on medical ward rounds.