Expanding Use of a Program to Improve Patient Safety in Children's Hospitals

Project Summary

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 is expanding use of the Patient and Family Centered I-PASS program shown to improve communication among doctors, nurses, and families and reduce serious adverse events that can lead to patient injury or death.
Thousands of patients are harmed each year due to medical errors and adverse events in hospitals. Improving doctor and nurse communication with families 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 common. An adverse event is when health care causes harm. A PCORI-funded research study found that the Patient and Family Centered 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 rounds. Rounds are daily meetings to review patients’ progress and come up with a care plan for the day.

This project is expanding use of this program to large and small hospitals that care for children across the country to improve staff communication with families and reduce adverse events.

What will this project do?

The project team is working with 21 hospitals that care for children across 16 states to set up the Patient and Family Centered I-PASS program. At each hospital, a team of I-PASS mentors is helping to put the program in place in a way that works with how the hospital delivers care. The Society of Hospital Medicine is assisting I-PASS mentors with this effort. With the program:

Doctors, nurses, and other staff receive training on how to include families in daily rounds.
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.

Each hospital has doctors, nurses, and family members who work to make the program part of routine care. The team is also:

Creating a guide for and training mentor teams
Supporting doctors and nurses in using the program
Creating a guide to help other hospitals put the program in place

What is the expected impact of this project

More than 48,000 patients and families, 1,400 doctors, and 1,400 nurses at 21 hospitals will receive the program. The project will show what’s required for routine use of the program at children’s hospitals. The project evaluation will confirm that the program is working as intended to improve communication and reduce adverse events.

More about this implementation project:

Stakeholders Involved in This Project

PRIS Network
Society of Hospital Medicine
Institute for Healthcare Improvement
National Patient Safety Foundation
American Academy of Pediatrics
Children’s Hospital Association
Hospital Research & Educational Trust
Beryl Institute
Patients’ View Institute
Consumers Advancing Patient Safety
Mothers Against Medical Error
Leapfrog Group
Connecticut Center for Patient Safety
American Academy of Nursing
Society of Pediatric Nurses
MedEdPORTAL

Implementation Strategies

Adapt the program to work with existing hospital resources and workflows.
Provide sites with web-based tools to support implementation, e.g., to coordinate mentor-mentee activities, provide access to feedback reports, and share resources and best practices.
Train physicians and nurses to use the program.
Train mentors to support local implementation activities, using an in-person course and structured guide.
Use a phased implementation approach, launching the program in three waves.
Conduct cyclical small tests of change.
Provide sites with monthly audit and feedback reports.
Provide educational materials to patients.
Identify and prepare local champions at sites, including physicians, nurses, and family representatives.
Conduct site visits.
Provide technical assistance to sites, including ongoing monthly mentor-mentee consultation while sites take on increasing responsibility for implementing the program.
Partner with national stakeholder organization to promote implementation.

Evaluation Outcomes

To document implementation:

Use of intervention
Fidelity of delivery (in-person observation, review of discussions in the family-centered rounds)

To assess healthcare and health outcomes:

Family- and clinician-reported adverse events
Institutional safety ratings (clinician survey)
Shared decision making between families and clinicians
Family and clinician experiences with care

More to Explore...

PCORI Stories

Hearing All Voices in Planning a Child’s Hospital Care
A PCORI-funded team folded parents into daily care conversations with doctors and nurses at pediatric units in hospitals, leading to a marked reduction in medical errors and an improvement in patient care. Now, with this PCORI Dissemination and Implementation Award, the project team is spreading the program to 21 hospitals across the country.

Journal Citations

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Project Information

Principal Investigator Principal Investigator The lead researcher and primary contact for the project. View Glossary:

Christopher Landrigan, MD, MPH

Organization Organization The institution/organization in which the project originates, or the primary institution or organization that received funding for the project. View Glossary:

The Children's Hospital Corporation

Project Budget:

$2,243,684

Project Title Project Title The original title of the project supplied by the principal investigator or project lead/team. View Glossary:

Disseminating and Implementing Patient- and Family-Centered I-PASS to Improve Patient Safety

Key Dates

Board Approval Date Board Approval Date The date of approval to fund by the PCORI Board of Governors. The actual project start dates vary as the negotiation of project milestones must be completed before the contract can be fully executed. View Glossary:

July 2018

Project End Date Project End Date Includes the research project period and may be subject to modification to allow other research-related activities such as peer review. View Glossary:

January 2023

Year Awarded Year Awarded The year that funding for the project was approved, or the year the proposal received a notice of award. View Glossary:

2018

Study Registration Information

HSR Project Number:

HSRP20193215

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Does a Patient- and Family-Centered Hospital Communications Program Reduce Medical Errors?

PCORI

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Research

Impact

Highlights of PCORI-Funded Research Results

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Engagement

Funding Opportunities

Applicant and Awardee Resources

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