Background: Communication problems are the number-one cause of serious medical errors in hospitals. To address this problem, we developed I-PASS, a bundle of interventions to improve communication between providers when a patient is handed off from one doctor or nurse to another. We found in a pilot study that implementing a handoff bundle in one hospital led to a reduction in medical errors, including errors that harmed patients. We then rolled our handoff improvement program, I-PASS, in nine additional hospitals, and found that medical errors decreased by 34%. However, while uptake of the program across hospitals was excellent, its use has been limited to improving physician-to-physician handoffs and nurse-to-nurse handoffs. It has not involved patients and families. At the same time we have been developing I-PASS, there has been a movement nationally toward involving families in morning rounds in hospitals with doctors and nurses. However, the manner in which physicians, nurses, and families interact on these rounds and later in the day is not well structured. Also, communication is not usually well-tailored to the preferences of diverse families and patients. Objectives: We propose to test the effects of incorporating I-PASS into morning family-centered rounds and in communication with families throughout the day. We believe that using these tools will improve lines of communication, and will help to better bring patients' families into the decision-making process in hospitals. Doing so could decrease medical errors and miscommunications between doctors, nurses, and patients. Methods: We plan to adapt the I-PASS materials we have previously developed for use in family-centered rounds and for other communications with families. This will be guided by a family advisory board made up of families and family advocates from across hospitals and from national family advocacy organizations.
The details of the intervention will be developed collaboratively and will involve:
- how best to train resident-physicians, senior doctors, and nurses to communicate with families and take their preferences into account;
- how to modify our I-PASS handoff tools for use during morning rounds in a way that will engage families; and
- how best to develop a computerized or printed sign-out tool for families.
We will compare care after the intervention with current care. Patient Outcomes: We hypothesize that implementing family-centered I-PASS will lead to:
- Reductions in medical errors
- Improved communication during morning family-centered rounds
- Better shared understanding of the care plan by families, nurses, and doctors
- Improvements in family, physician, and nurse experience and satisfaction
In addition, we will look at whether specific hospital or patient characteristics (such as race/ethnicity, education level, comfort with English, or chronic illness) seems to alter the effect of the intervention.