Background
As members of the Pediatric Residents Advocacy Committee, we’ve been inspired by the question: How can we ensure every child and their family receives access to equitable and high quality medical care? In our diverse city of Toronto, where nearly half of our residents speak a language other than English at home, language discordance remains one of the most persistent barriers to truly effective care.

The inspiration for this project stemmed from our collective experiences in the emergency department (ED). Too often, we saw families leave with discharge instructions they couldn’t read or understand, despite the critical role these documents play in ensuring safe recovery and appropriate follow-up. While interpreter services are increasingly promoted (and rightly so), the lack of translated written instructions remained a glaring gap. Before this project began, only one discharge instruction was available in translated form in the SickKids ED (‘viral illness’). Baseline data from retrospective chart review revealed that only 7% of eligible patients received written information in their preferred language.

We knew we had to do better to serve our diverse patient population. With the generous support of the Pediatricians Alliance of Ontario (PAO) Resident Advocacy Grant, we set out to tackle this challenge in a sustainable and meaningful way. We were able to create a library of translated standardized discharge instructions for patients with non-English language preference (NELP), to be used by providers in the SickKids ED. Our goal was to increase the percentage of patients with an eligible NELP who receive language-concordant discharge instructions by 30%. Thanks to the PAO’s support, what began as a seed of an idea, has already blossomed into a growing initiative that’s making an impact.

Our Project
Our team began by identifying the 10 most common ED presentations, which included asthma, croup, fever, abdominal pain, and urinary tract infections. We worked closely with ED staff physicians to update each discharge instruction into a standardized format, designed to explain the diagnosis and address common caregiver questions – including when to return to the ED. These instructions were then revised further based on caregiver feedback.

We next hired a certified medical translation company to translate the instructions into the following written languages: Arabic, Chinese Simplified, Chinese Traditional, Spanish, and Tamil. These five languages were identified as the most common non-English language preferences in patients presenting to the SK ED based on stats from our navigation department. In addition, French translations were also provided by the Ministry of Health Translation Network Service at no cost.

Our EMR team was then able to integrate these translated discharge instructions into the EMR system.  A ‘preferred language’ option for eligible instructions is automatically displayed for patients with an NELP listed on their medical chart. This will prompt providers to use the translated instructions when applicable. Recognizing the importance of increasing awareness of this feature to improve use, we also created educational posters (for patients and physicians), email communications, and provided training for our ED staff to further inform.

On March 27^th 2025, we officially launched our library of translated instructions, comprised of 11 instructions in each of the 6 languages above (10 new instructions plus 1 previously existing). In the first month alone, 32 out of 80 eligible patients (40%) received at least one set of discharge instructions in their preferred language. This was an exciting milestone for our team, as we both surpassed our goal and reinforced that when the right tools are in place, providers are eager to use them!

Reflections
The PAO grant made this possible. Every dollar of funding was directed to the translation of these materials—a one-time investment that will yield ongoing, sustainable benefits. These resources are now permanently embedded in the ED workflow and accessible to all care providers. Moreover, families now know they can (and should) ask for written discharge instructions in the language they understand best.

The early feedback from families and staff has been incredibly affirming. Seeing caregivers’ relief when receiving discharge instructions in their native language has been the most rewarding experience. It reminds us that language access isn’t a luxury, it’s a fundamental aspect of quality care.

We’re continuing to collect data, assess usage, and refine our approach. Going forward, we hope to expand this library to include instructions for additional illnesses, with translations into more written languages. We also hope our project demonstrates a scalable model that will inspire similar efforts across pediatric healthcare.

To the PAO, we extend our deepest thanks. Your belief in this project gave us the momentum and the means to take action. You’ve helped us move closer to a healthcare system where every family feels heard, informed, and empowered. We’re continuously grateful for your support and excited to provide updates on how this project continues to evolve!

Sincerely,

The Pediatric Residents Advocacy Committee
Carolyn Akladious, Courtney Hardy, Sarah Moor, Mallory Jackman, Nazeefah Laher, Vanessa Montemurri, Yasmeen Razvi, Bryan Wong
University of Toronto & The Hospital for Sick Children