Amrita D'Souza: Medical Communication Charts

Our Medical Communication Chart (MCC) project started on a ward round during the Covid-19 pandemic in 2020 at King’s College Hospital in London. I was an F2 redeployed to Covid HDU, supervised by Dr LJ Smith (Respiratory Consultant at KCH).

Many of our inpatients on HDU were on Non-Invasive Ventilation masks and could not speak English. Language barriers were exacerbated during the Covid-19 pandemic due to the use of FFP3 masks which impaired speech perception, strict visiting criteria limiting the use of face-to-face translators and patient relatives and infection prevention and control (IPC) concerns of using shared ward telephones for telephone translation.

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 (ONS Census 2021).

We therefore set out to design a communication aid to address this gap in communication on daily medical ward rounds which was easy to use, patient friendly and quality assured.

These Medical Communication Charts (MCCs) are based on four commonly used speech and language therapy charts which were utilised during the COVID-19 pandemic, tailored for daily medical ward rounds.

We designed these initial MCCs and had them translated into the most commonly spoken languages at KCH by recruiting staff volunteers through the Trust Bulletin. We assessed them through a Quality Improvement Project conducted with 3 Plan-Do-Study-Act cycles and sought patient feedback at each stage to improve on their design and content.

Due to a lack of funding, we were not able to have them professionally translated to make them formally available for Trust use as they were not quality assured.

In 2023, I joined Chelsea and Westminster Hospital as a Postgraduate Medical Education Fellow. Chelsea & Westminster NHS Foundation Trust is made up of two sister hospitals – Chelsea & Westminster Hospital based in the borough of Kensington & Chelsea and West Middlesex Hospital based in the borough of Hounslow. ONS 2021 data shows that 15.1% of Hounslow residents, 9.8% of Hammersmith and Fulham residents and 9.1% of Kensington & Chelsea residents report they cannot speak English well with 1.2-2.9% of residents in the Trust’s surrounding Boroughs reporting they cannot speak English at all. This has significant implications for inpatients at Chelsea & Westminster Hospital NHS Foundation Trust as language barrier affects healthcare access, patient safety and patient experience.

Recognising the ongoing need for MCCs to improve patient communication on the medical ward round which needed to be quality assured, I collaborated with Matt Robinson (Head of Patient Experience at Chelsea & Westminster NHS Foundation Trust) and applied for the CW+ Small-Change-Big-Impact grant from our hospital charity CW+ to have these MCCs professionally translated into the Trust’s 25 most commonly spoken languages based on Trust language and patient safety data. We then had these professionally translated MCCs redesigned by George Vasilopoulos (Web Communications and Graphic Design Manager at Chelsea & Westminster NHS Foundation Trust).

Having further developed these MCCs, we engaged with the Trust’s Maternity Forum and Patient Experience Group with representation of service users and staff members including through a ward visit to gain verbal feedback on our MCCs with positive response from patients and staff members.