Results Summary

What was the research about?

Even with ongoing efforts to improve care, medical errors still happen in hospitals. Medical errors are mistakes that may or may not cause harm to patients. An example of a medical error is when a doctor prescribes the wrong medicine to a patient. When medical care causes harm, it is known as an adverse event, for example when a patient has an allergic reaction to a prescribed medicine.

In this study, the research team wanted to see if improving communication would help reduce hospital medical errors and adverse events. The team created a program to help doctors and nurses communicate with families during rounds. Rounds are meetings every day when hospital staff, usually doctors and nurses, review patients’ progress. Then staff come up with a plan for the day. Staff often make these plans without direct input from the patient or their family.

The program took place in hospital pediatric units, where children receive care. The program included

  • A way to make sure that doctors and nurses included families on daily rounds
  • A way to make sure medical staff talked about everything important on daily rounds
  • Write-ups of rounds for patients and their families
  • Training to help staff learn how to include families in the rounds

What were the results?

Compared with before hospitals used the program, after hospitals used the program,

  • There was no difference in overall medical errors, but patients had 38% fewer harmful medical errors.
  • Patients had 46% fewer adverse events.
  • Parents rated their child’s care experiences higher on 6 of 25 measures. None of the measures received a worse rating.
  • Nurses and parents were more involved in rounds. For example, parents spoke up more and asked more questions.

Who was in the study?

The study included 3,106 children receiving care in pediatric units at seven hospitals in the United States and Canada. Of these, 51 percent were girls, and 8 percent had two or more long-term health problems. The average child’s age was seven years. The study also included 1,837 parents of children in the study. In addition, 925 doctors and nurses treating the children took part in the study.

What did the research team do?

The research team taught staff how to use the program for nine months. For three months before the training started and three months after the training ended, the team observed doctors, nurses, and parents to rate their communication. The team also looked for changes in medical errors and adverse events using hospital data, surveys of doctors and nurses, and reports from parents.

Family advisors, nurses, doctors, researchers, teachers, and people trained in health literacy helped plan and carry out the study.

What were the limits of the study?

Because of the design of this study, it isn’t possible to know for sure if the changes in medical errors and adverse events happened because of the program or because of something else that occurred at the same time. This study focused on children and their parents. The program might not have the same results with hospitals that care for adults.

Future research could test the program with hospitals that care for adults as well as children.

How can people use the results?

Doctors and hospitals can use this program to improve how well doctors, nurses, and families communicate and to improve patient safety.

Final Research Report

View this project's final research report.

More About This Research

Blogs

Engaging Parents to Help Reduce Medical Errors in the Hospital
Reporting in The BMJ, the research team in this study found that a family-centered communication program in pediatric departments directly improves hospital safety.

Journal Commentaries

Videos

Can Family-Centered Hospital Rounds Reduce Medical Errors?
Christopher Landrigan describes his team's examination of an intervention for reducing medical errors, which might be as high as the third leading cause of death in the US. His study’s intervention put family at the center of daily hospital rounds conversations at Boston Children’s Hospital.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. Those comments and responses included the following:

Overall, the reviewers found the report to be well written and to have conclusions fully supported by the results.  The reviewer critiques were primarily about adding detail or clarity to the report, specifically in the areas of stakeholder involvement, generalizability, and the delivery of interventions.

Conflict of Interest Disclosures

Project Information

Christopher Landrigan, MD, MPH
Boston Children's Hospital
$2,098,500
10.25302/8.2019.CDR.130603556
Bringing I-PASS to the Bedside: A Communication Bundle to Improve Patient Safety and Experience

Key Dates

December 2013
September 2018
2013
2018

Study Registration Information

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Last updated: January 12, 2022