PCORI funds Dissemination and Implementation projects to increase awareness and promote the use of PCORI research findings to improve healthcare practices and health outcomes. This project is proposing to conduct dissemination and implementation activities for the results of the research project: Does a Patient- and Family-Centered Hospital Communications Program Reduce Medical Errors?.
1. What research finding is this project implementing?
This project seeks to spread the Patient- and Family-Centered I-PASS program to 18 diverse US children’s hospitals. Patient- and Family-Centered I-PASS is an intervention to improve how patients, families, and staff communicate in hospitals. It includes changes to communication during and after family-centered rounds (FCRs). Rounds are the time every morning when hospital staff—usually doctors, sometimes nurses—meet with patients to come up with the day’s plan. Often, staff may tell families the plan, but they don’t always listen or partner with families to produce it collaboratively. Staff often use medical jargon and don’t always ask families for input or questions, or make sure the family understands the plan. Plans are often made outside patient rooms without direct patient or family input. When actual FCRs do happen, they often do so with the family present, but not truly involved.
2. Why is this research finding important?
Medical errors and adverse events in hospitals occur often, and thousands of patients each year die from them. Poor communication is a major cause of many of the most serious adverse events. Communication among physicians, nurses, and patients and families is an important, but overlooked, part of hospital safety and family experience. Many physician, patient, and nursing advocacy groups call for more family-centered communication. However, we don’t know a lot of about how such communication affects safety. Although research has focused on how staff communicate with each other, little focuses on how staff communicate with families, especially when it comes to safety. The Patient- and Family-Centered I-PASS program does this. It is the first multicenter study to show that a family-centered communication program directly improves hospital safety.
3. What is the goal of the implementation project?
We hope to build on our prior work to spread and put the Patient- and Family-Centered I-PASS intervention in place to improve safety and communication among families, nurses, and doctors across a range of hospital settings. We have three aims: To implement Patient- and Family-Centered I-PASS in 18 diverse community and academic hospitals; to test whether implementing it improves patient safety, family and staff experience, hospital safety culture, and communication practices; and to study how different types of hospitals and patients/families put Patient- and Family-Centered I-PASS in place, so we can better meet the needs of all groups as we spread it in the future.
4. What is the project team doing?
We will work closely with all 18 participating sites to put the intervention in place using the Society for Hospital Medicine (SHM)’s award-winning Mentored Implementation Program. The program, which we and SHM have used successfully in the past, pairs hospitals with experts who provide individualized support. This allows for safety and quality improvement projects to be put in place successfully that are tailored to each hospital’s individual needs. Embodying our spirit of partnership with families and nurses, we will assign a doctor, nurse, and family advisory mentorship team to work with each site to put the program in place. Sites will choose local doctor, nurse, and family champions who will work closely with local families and staff and the expert mentorship team to put the intervention in place in one or two units of interest over an 18-month period. Sites will track data from families and staff about safety events, experience, and safety culture. They will also observe FCRs. Together, these metrics will measure success of the program.
5. How will the project team evaluate their dissemination activities?
We will measure the process by which our intervention is put in place by tracking data we collect through our observations of FCRs. For instance, we will track how well staff engage families on FCRs and whether staff speak in an easy to understand way. To measure short and long-term impact, we will also track safety events (both reported by staff, and most importantly, by families). We have included such family-safety reporting in our prior studies, and have fully integrated it into the standard processes our group uses to measure safety. Though our research shows that families provide useful safety information, most hospitals do not actively collect it. This will be an added benefit to putting our program in place. We will also measure family (and staff) experience. We will compare these short and long-term measures before and after the intervention is put in place.
6. How is the project team involving patients and others in this dissemination project?
Our project team is a diverse group of families, nurses, doctors, educators, and researchers who work collaboratively as equal partners. Patient- and Family-Centered I-PASS includes families and nurses as equal team members in everything we do. This includes developing the intervention, designing the study, publishing our findings, and spreading and mentoring others to put it in place. As one of our parent stakeholders stated in reference to our group, “They never lose sight of the moral necessity for patient engagement that underlies the project. They have been transparent and responsive to our family advisory committee in a way I have not seen elsewhere. We are included in the project as a whole, our opinions are asked on important matters, and—more importantly—our answers are always acted upon.”
In the proposed project, our family and nurse partners will continue to serve as mentors, leaders, and collaborators. They will continue to take part in dedicated family and nurse advisory councils. They will remain integrated in all working groups and have a voice in all study decisions. They will take part in monthly leadership calls, provide feedback on curricular materials, implementation plans, and data collection. They will join all working groups. They will also provide local support to site mentors as they mentor the 18 sites. We will also recruit nurse and family partners in the participating 18 mentee sites.
7. How will this project help ensure future uptake and use of PCORI results?
Our intervention is well aligned with the missions and goals of many key patient, nurse, and physician advocacy groups. Senior leaders of several organizations have expressed their enthusiasm for our project and willingness to participate in it and have written letters of support. These include the Beryl Institute, the Patients’ View Institute, Consumers Advancing Patient Safety, Mothers Against Medical Error, the Institute for Healthcare Improvement, the American Academy of Nursing, the Society of Pediatric Nurses, the National Patient Safety Foundation, the American Academy of Pediatrics, the Children’s Hospital Association, and the Hospital Research Education Trust. Along with these groups, we will leverage the multisite hospital collaboratives Pediatric Research in Inpatient Settings and SHM to widely spread our program. We will aim to publish our findings in leading medical journals, medical education repositories (e.g., MedEdPORTAL), newspapers, lay press, blogs (e.g., Justin’s Hope), social media, and the mailing lists of these partners. We will also continue to present our findings at workshops and platforms at various medical, scientific, nursing, and patient advocacy conferences. This will ensure our project is widely spread.
Learn more about PCORI’s Dissemination and Implementation program here.
Related PCORI-funded Research Project
Note: Results from the original project have completed PCORI’s Peer Review and are available here.
Implementing a Family-Centered Communication Strategy to Improve Patient Safety
Following the results of a PCORI-funded study that showed family-centered hospital rounds could reduce medical errors and improve care processes, Christopher Landrigan of Boston Children’s Hospital and Harvard Medical School is working to implement his program more broadly through a PCORI-funded Dissemination and Implementation Award.