Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study

To determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of healthcare provider-family communication on family centered rounds. Prospective, multicenter before and after intervention study. Pedia...

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Bibliographic Details
Published in:BMJ (Online) 2018-12, Vol.363, p.k4764-k4764
Main Authors: Khan, Alisa, Spector, Nancy D, Baird, Jennifer D, Ashland, Michele, Starmer, Amy J, Rosenbluth, Glenn, Garcia, Briana M, Litterer, Katherine P, Rogers, Jayne E, Dalal, Anuj K, Lipsitz, Stuart, Yoon, Catherine S, Zigmont, Katherine R, Guiot, Amy, O'Toole, Jennifer K, Patel, Aarti, Bismilla, Zia, Coffey, Maitreya, Langrish, Kate, Blankenburg, Rebecca L, Destino, Lauren A, Everhart, Jennifer L, Good, Brian P, Kocolas, Irene, Srivastava, Rajendu, Calaman, Sharon, Cray, Sharon, Kuzma, Nicholas, Lewis, Kheyandra, Thompson, E Douglas, Hepps, Jennifer H, Lopreiato, Joseph O, Yu, Clifton E, Haskell, Helen, Kruvand, Elizabeth, Micalizzi, Dale A, Alvarado-Little, Wilma, Dreyer, Benard P, Yin, H Shonna, Subramony, Anupama, Patel, Shilpa J, Sectish, Theodore C, West, Daniel C, Landrigan, Christopher P
Format: Article
Language:English
Subjects:
Adult
Child
Child, Preschool
Communication
Family
Female
Health care
Health education
Health literacy
Holistic medicine
Hospitals
Humans
Inpatients
Intensive care
Intervention
Male
Medical errors
Medical Errors - statistics & numerical data
Medical students
North America
Nurses
Nursing care
Parents & parenting
Patient Care Team - statistics & numerical data
Patient Participation
Patient safety
Patient Safety - statistics & numerical data
Patient-Centered Care - methods
Pediatrics
Physicians
Professional-Family Relations
Program Evaluation - methods
Prospective Studies
Safety
Trends
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Summary:To determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of healthcare provider-family communication on family centered rounds. Prospective, multicenter before and after intervention study. Pediatric inpatient units in seven North American hospitals, 17 December 2014 to 3 January 2017. All patients admitted to study units (3106 admissions, 13171 patient days); 2148 parents or caregivers, 435 nurses, 203 medical students, and 586 residents. Families, nurses, and physicians coproduced an intervention to standardize healthcare provider-family communication on ward rounds ("family centered rounds"), which included structured, high reliability communication on bedside rounds emphasizing health literacy, family engagement, and bidirectional communication; structured, written real-time summaries of rounds; a formal training programme for healthcare providers; and strategies to support teamwork, implementation, and process improvement. Medical errors (primary outcome), including harmful errors (preventable adverse events) and non-harmful errors, modeled using Poisson regression and generalized estimating equations clustered by site; family experience; and communication processes (eg, family engagement on rounds). Errors were measured via an established systematic surveillance methodology including family safety reporting. The overall rate of medical errors (per 1000 patient days) was unchanged (41.2 (95% confidence interval 31.2 to 54.5) pre-intervention 35.8 (26.9 to 47.7) post-intervention, P=0.21), but harmful errors (preventable adverse events) decreased by 37.9% (20.7 (15.3 to 28.1) 12.9 (8.9 to 18.6), P=0.01) post-intervention. Non-preventable adverse events also decreased (12.6 (8.9 to 17.9) 5.2 (3.1 to 8.8), P=0.003). Top box (eg, "excellent") ratings for six of 25 components of family reported experience improved; none worsened. Family centered rounds occurred more frequently (72.2% (53.5% to 85.4%) 82.8% (64.9% to 92.6%), P=0.02). Family engagement 55.6% (32.9% to 76.2%) 66.7% (43.0% to 84.1%), P=0.04) and nurse engagement (20.4% (7.0% to 46.6%) 35.5% (17.0% to 59.6%), P=0.03) on rounds improved. Families expressing concerns at the start of rounds (18.2% (5.6% to 45.3%) 37.7% (17.6% to 63.3%), P=0.03) and reading back plans (4.7% (0.7% to 25.2%) 26.5% (12.7% to 7.3%), P=0.02) increased. Trainee teaching and the duration of rounds did not change signif
ISSN:0959-8138
1756-1833
DOI:10.1136/bmj.k4764