Expanding the Use of a Program to Improve Patient Safety for Children in Hospitals

This implementation project is complete.

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

	This PCORI-funded implementation project expanded the use of Patient and Family-Centered I-PASS, a program shown to improve communication among doctors, nurses, and families and reduce serious adverse events that can lead to patient injury or death.
Each year, thousands of patients are harmed due to medical errors and adverse events in hospitals. An adverse event occurs when health care causes harm. Including families in discussions about their child’s care can help prevent errors and improve patient safety in the hospital.

What was the goal of this implementation project?

Medical errors and adverse events in hospitals are not uncommon. A PCORI-funded research study found that the Patient and Family-Centered I-PASS, or PFC I-PASS, program reduced the rate of adverse events among children in the hospital. The program trains doctors and nurses to communicate better and actively include patients and families during medical rounds. Rounds are daily meetings to review patients’ progress and come up with a care plan for the day.

This project expanded the use of PFC I-PASS in large and small hospitals that care for children to improve staff communication with families and reduce adverse events.

What did this project do?

The project team worked with 21 hospitals that care for children in 16 states across the United States to set up the PFC I-PASS program. With the program:

• Doctors, nurses, and other staff receive training on how to communicate with and include families in daily rounds. Training includes in-person workshop sessions and an online video. It is tailored for clinician groups including medical residents, nurse practitioners, and nurses.
• Staff make sure rounds cover everything important for the patient’s care.
• After rounds, doctors and nurses give families written summaries about what was discussed.

At each hospital, a team of PFC I-PASS mentors helped sites put the program in place in a way that worked with how the hospital delivered care. The mentors had experience and expertise with the program. They conducted site visits and held monthly calls with each site. The Society of Hospital Medicine assisted PFC I-PASS mentors with this effort.

The project team also provided sites with monthly feedback reports on their progress, which mentors discussed during these calls. Over the project period, sites took on increasing independence for their PFC I-PASS program.

To make the program part of routine care, each hospital had a team of champions that included a doctor, nurse, and family member. This team worked with the PFC I-PASS mentors and coached and supported doctors and nurses in their hospital to use the program effectively.

The project team created a guide to help other hospitals put the program in place.

What was the impact of this project?

The project team successfully put the PFC I-PASS program in place at 21 hospitals. The hospitals were different sizes and types and served diverse communities. Due to the COVID-19 pandemic, many hospitals changed their processes for rounds. The project team worked with sites to find ways to continue including families in rounds, like doing them virtually.

During the project, more than 83,000 patients and their families and more than 3,500 doctors and nurses took part in the program. The project’s evaluation showed that hospitals improved on best practices for rounding after putting the program in place.

In observations of rounding before and after the program:

• Rounding at the bedside with families increased from 76% to 90%.
• Following all components of the PFC I-PASS process increased from 26% to 61%.
• Involving families in rounds increased from 71% to 88%.
• Involving nurses in rounds increased from 33% to 63%.
• Use of plain language by doctors and nurses during rounds increased from 50% to 61%.
• Providing families with a written summary of rounds increased from 30% to 72%.

Clinician-reported harms didn’t change overall before and after the program. But harms decreased by 38% at larger hospitals (p=0.006) and by 41% at hospitals that had more nurse involvement during rounds. Also, harms decreased by 24% at hospitals with higher adherence to the PFC I-PASS program (p<0.05).

Patient- and family-reported satisfaction with communication didn’t change overall before and after the program. But measures of satisfaction with communication improved by 5% in larger hospitals (p=0.002).

Clinicians overall reported an improvement in hospitals’ safety climate (p<0.05). Patients and families didn’t report a change in safety climate.

Hospitals reported that they intend to continue to use the program and plan to expand use to other sites.

More about this implementation project: