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barriers communication observed patients families prefer language english medical conversations referred individuals limited english proficiency lep used pediatric family satisfaction icu 24r fsicu survey assess communication satisfaction englishproficient ep spanishspeaking lep caregivers added additional questions related attendance morning rounds frequency provider updates interpreter use general satisfaction communication singlecenter prospective observational cohort study pediatric intensive care unit picu cardiothoracic intensive care unit cicu tertiary academic freestanding childrens hospital caregivers children 18 years old admitted least 48 h picu cicu june september 2022 eligible enrollment 24 lep 74 ep caregivers completed survey questions lep group lower household income education levels higher incidence public insurance fsicu scores lep ep caregivers suggested high satisfaction without significant difference groups however qualitative analysis revealed dissatisfaction lep caregivers related information inclusion language barriers ep caregivers positive references information emotional connection indicated dissatisfaction around consistency responsiveness 18 lep caregivers reported regularly attending rounds versus 67 ep group p value 001 39 lep versus 52 ep caregivers reported multiple daily updates although difference statistically significant 29 lep respondents reported nonfluent mdnps using interpreter never rarely time difference satisfaction scores lep ep caregivers lep caregivers lower socioeconomic status based public insurance reported income education level qualitative data allowed nuanced understanding communication satisfaction correlated lep caregivers reported lower attendance morning rounds inconsistent interpreter use trend toward less frequent provider updates