Despite ongoing efforts to improve care, medical errors—mistakes that may or may not harm patients—are a leading cause of death nationally. But results from a PCORI-funded study on improving communication between parents of hospitalized children and clinicians published today in The BMJ provide promising insights that could significantly reduce medical errors harmful to patients.
Past research has focused on how staff communicate with each other, but few studies have focused on how staff communicate with patients and families. So, a PCORI-funded research team, led by Christopher Landrigan, MD, MPH, of Boston Children’s Hospital, worked to implement a program created with parents and other stakeholders to help doctors and nurses communicate with families in the pediatrics department during hospital rounds—daily meetings when a care team reviews patients’ progress and plan for the day.
At PCORI, our mission doesn’t stop with funding research that helps patients and those who care for them make better-informed healthcare decisions. We also strive to ensure that word of those results gets out widely and that the results are taken up in practice.
To that end, this research project’s team, led by Christopher Landrigan, MD, MPH, of Boston Children’s Hospital, received a second PCORI award to spread I-PASS to 18 diverse community and academic hospitals across the country.
Rounds often happen without directly involving the patient—or more importantly when the patients are children, their parents. The program, named I-PASS (see box below), aimed to flip that by creating family-centered rounds. The program created checks to ensure that rounds include patients and parents, that medical staff discuss all important elements of care each day, and that parents receive write-ups of daily rounds. It also provided training for staff to learn how to facilitate family-centered rounds.
The research team tested I-PASS with more than 3,000 children in pediatric units across seven hospitals, and as The BMJ reports, the results were encouraging. Although the overall rate of errors was unchanged, harmful medical errors—characterized as preventable adverse events—decreased by 38 percent. And departments that implemented I-PASS saw improvements in families’ hospital experience and in their communication processes.
The paper also importantly notes that these improvements occurred without a major increase in duration of rounds or reduction in teaching. It is the first multicenter study to show that a family-centered communication program directly improves hospital safety.
I–Illness severity: the family reports if child was better, worse, or the same as the day before, with input from nurses
P–Patient summary: a brief summary of the patient’s condition
A–Action list: to-dos for day
S–Situation awareness and contingency planning: what family and staff should look out for and what might happen
S–Synthesis by receiver: the family reads back key points of plan for day