Professional Abstract

Objective

To test the effectiveness of a program to improve communication between physicians, nurses, and families and to better involve families in all aspects of daily decision making in hospital pediatric units

Study Design

Design Elements	Description
Design	Quasi-experimental study
Population	A total of 3,106 admitted patients, as well as 1,837 parents, 330 nurses, and 595 resident physicians from 2 different assessment periods at 7 pediatric hospitals
Interventions/ Comparators	Not applicable
Outcomes	Primary: medical errors, adverse events Secondary: family experience, family and nurse engagement, communication processes
Timeframe	3 months of data collection preintervention and 3 months of data collection postintervention at each site, separated by a 9 month “wash in” period of intervention roll-out

This study tested the effectiveness of Patient and Family Centered I-PASS, a program that facilitates information exchange between physicians, nurses, patients, and families to reduce medical errors and adverse events. Medical errors are failures in the delivery of medical care. Adverse events are harms to patients due to medical care.

Patient and Family Centered I-PASS uses a structured communication program. It includes a framework to better engage patients and families by making rounds more family centered, a staff training program, written rounds summaries for families, and strategies to support teamwork and implementation of the program.

The program took place over nine months at seven pediatric hospitals in the United States and Canada. Researchers measured outcomes three months before and after implementation. Intensive chart review, provider event-reporting surveys, and family safety interviews provided data on medical errors and adverse events. Researchers conducted structured observations of rounds to document communication processes.

Researchers recruited two groups of patients, parents, and clinicians—one for each measurement period. The preintervention group included 1,574 patient admissions. Of these, 52% were white, 20% were black, and 5% were Asian. Also, 9% had two or more complex chronic conditions and 50% were female. The postintervention group included 1,532 patient admissions. Of these, 47% were white, 17% were black, and 5% were Asian. Also, 7% had two or more complex chronic conditions and 51% were female. The study also included 947 parents of children under age 18 in the preintervention group and 890 parents in the postintervention group.

Hospital staff, including 595 resident physicians and 330 nurses, also participated across the preintervention and postintervention periods of the study.

Family members, nurses, physicians, researchers, and health literacy professionals provided input on all aspects of the study, including the design, delivery, and assessment of the intervention, and the reporting of results.

Results

In the postintervention period compared with the preintervention period, researchers found 38% fewer harmful medical errors (p=0.01), as well as 46% fewer adverse events overall (p=0.002). There were also fewer nonpreventable adverse events (p=0.003). The team found no significant differences in the overall medical error rate, which includes both harmful and nonharmful errors.

Compared with families in the preintervention period, families in the postintervention period gave higher scores on 6 of 25 survey items for family-reported experience (p=0.03); scores did not worsen for any items. Researchers also found an increase in family engagement (p=0.04) and nurse engagement (p=0.03) in the postintervention period compared with the preintervention period.

Family-centered rounds occurred more frequently (p=0.02) in the postintervention period than in the preintervention period. Teaching of resident physicians during rounds and rounds duration did not differ between the two periods.

Limitations

Because this study did not use a randomized design, it is not possible to attribute changes in harmful medical errors and adverse events to the intervention with certainty.

Findings may not be generalizable to nonpediatric hospital units.

Conclusions and Relevance

After implementation of the program, patient safety, family engagement, and nurse engagement increased significantly compared with before the program, with no negative impact on teaching resident physicians and medical students during rounds or on rounds duration.

Future Research Needs

Future research could test how community and academic hospitals that care for adults as well as children can adapt Patient and Family Centered I-PASS for use across more diverse settings.