Caseworker Cultural Mediator Involvement in Neurocritical Care for Patients and Families With Non-English Language Preference: A Quality Improvement Project

Abhijit V Lele; Anna Brooks; Lea Ann Miyagawa; Asmeret Tesfalem; Kim Lundgren; Rosemary E Cano; Niuvus Ferro-Gonzalez; Yodit Wongelemegist; Anab Abdullahi; John T Christianson; Jeniffer S Huong; Piper L Nash; Wei-Yun Wang; Christine T Fong; Marie-Angele Theard; Sarah Wahlster; Gemi E Jannotta; Monica S Vavilala

doi:10.7759/cureus.37687

Caseworker Cultural Mediator Involvement in Neurocritical Care for Patients and Families With Non-English Language Preference: A Quality Improvement Project

Cureus. 2023 Apr 17;15(4):e37687. doi: 10.7759/cureus.37687. eCollection 2023 Apr.

Authors

Abhijit V Lele^{1

2}, Anna Brooks³, Lea Ann Miyagawa⁴, Asmeret Tesfalem⁴, Kim Lundgren⁴, Rosemary E Cano⁴, Niuvus Ferro-Gonzalez⁴, Yodit Wongelemegist⁴, Anab Abdullahi⁴, John T Christianson⁴, Jeniffer S Huong⁴, Piper L Nash⁵, Wei-Yun Wang⁵, Christine T Fong⁵, Marie-Angele Theard¹, Sarah Wahlster^{6

5

7}, Gemi E Jannotta⁸, Monica S Vavilala¹

Affiliations

¹ Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA.
² Neurological Surgery, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA.
³ Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA.
⁴ Interpreter Services, Harborview Medical Center, Seattle, USA.
⁵ Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, USA.
⁶ Neurology, Harborview Medical Center, University of Washington, Seattle, USA.
⁷ Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, USA.
⁸ Neurocritical Care Service, Harborview Medical Center, University of Washington, Seattle, USA.

Abstract

Objective To describe Harborview Medical Center's experience with the involvement of caseworker cultural mediators (CCM) for patients requiring neurocritical care. Methods Using univariate and multivariate analysis (model adjusted for age, Glasgow Coma Scale score (GCS), Sequential Organ Failure Assessment (SOFA) Scores, mechanical ventilation, transition to comfort measures only (CMO), and death by neurologic criteria), we examined CCM team members' involvement in the care of Amharic/Cambodian/Khmer/Somali/Spanish/Vietnamese patients admitted to our neurocritical care service between 2014-2022, factors associated with CCM utilization, and changes in CCM utilization after a QI initiative was implemented in 2020 to encourage healthcare providers to consult the CCM team. Results Compared to eligible patients (n=827) who did not receive CCM referral, patients with CCM involvement (n=121) were younger (49 [interquartile range, IQR 38,63] vs. 56 [IQR 42,68] years, p = 0.002), had greater illness severity (admission GCS 8.5 [IQR 3,14] vs. 14 [IQR 7,15], p < 0.001, SOFA scores (5 [IQR 2,8] vs. 4 [IQR2,6], p = 0.007), and more frequently required mechanical ventilation (67% vs. 40%, odds ratio, OR 3.07, 95% CI 2.06,4.64), with higher all-cause mortality (20% vs. 12%, RR 1.83, 95% CI 1.09, 2.95), and with a higher rate of transition to CMO (11.6% vs. 6.2%, OR 2.00, 95% CI 1.03;3.66). The CCM QI initiative was independently associated with increased CCM involvement (aOR 4.22, 95% CI [2.32;7.66]). Overall, 4/10 attempts made by CCMs to reach out to the family to provide support were declined by the family. CCMs reported providing cultural/emotional support (n=96, 79%), end-of-life counseling (n=16, 13%), conflict mediation (n=15, 12.4%), and facilitating goals of care meetings (n=4, 3.3%). Conclusions Among eligible patients, CCM consultations appeared to occur in patients with higher disease severity. Our QI initiative increased CCM involvement.

Keywords: culture and sensitivity; implementation; interpreters; mediators; neurocritical care; quality improvement research.