Enlisting Families as Patient Safety Allies

Graedon, Joe; Graedon, Teresa

doi:10.1016/j.cpem.2006.08.006

Cited by 5 publications

(2 citation statements)

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“…Families have a unique knowledge of their child's normal behaviour and temperament and may recognise significant changes before experienced clinicians 7 8. We believed that we were having failures to activate METs and that a mechanism for families to directly activate METs could improve our collective recognition of changes in the child's status, increase MET activations and reduce preventable codes.…”

Section: Background and Significancementioning

confidence: 99%

Developing and evaluating the success of a family activated medical emergency team: a quality improvement report

et al. 2014

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Background Family-activated medical emergency teams (MET) have the potential to improve the timely recognition of clinical deterioration and reduce preventable adverse events. Adoption of family-activated METs is hindered by concerns that the calls may substantially increase MET workload. We aimed to develop a reliable process for family activated METs and to evaluate its effect on MET call rate and subsequent transfer to the intensive care unit (ICU). Methods The setting was our free-standing children's hospital. We partnered with families to develop and test an educational intervention for clinicians and families, an informational poster in each patient room and a redesigned process with hospital operators who handle MET calls. We tracked our primary outcome of count of familyactivated MET calls on a statistical process control chart. Additionally, we determined the association between family-activated versus clinician-activated MET and transfer to the ICU. Finally, we compared the reason for MET activation between family calls and a 2:1 matched sample of clinician calls. Results Over our 6-year study period, we had a total of 83 family-activated MET calls. Families made an average of 1.2 calls per month, which represented 2.9% of all MET calls. Children with family-activated METs were transferred to the ICU less commonly than those with clinician MET calls (24% vs 60%, p<0.001). Families, like clinicians, most commonly called MET for concerns of clinical deterioration. Families also identified lack of response from clinicians and a dismissive interaction between team and family as reasons. Conclusions Family MET activations were uncommon and not a burden on responders. These calls recognised clinical deterioration and communication failures. Family activated METs should be tested and implemented in hospitals that care for children.

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Section: Background and Significancementioning

confidence: 99%

Developing and evaluating the success of a family activated medical emergency team: a quality improvement report

et al. 2014

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“…159,160 Health-care professionals depend on families to explain their child's normal physiological baseline and to identify subtle changes in their child's condition, but this information is not always systematically obtained. 161,162 Some authors propose family involvement in interdisciplinary rounds, 163 but this requires parents to have detailed information about the signs and symptoms they should be attending to, 162 and, as yet, there is little evidence on effective strategies for how they might be involved in the detection of deterioration. 163 Although much of the literature reports on intermittent manual vital signs monitoring and paper-based recording systems, across the developed world, there is a growing use of electronic technologies, which has important implications for the wider detection subsystem.…”

Section: Detectionmentioning

confidence: 99%

Development, implementation and evaluation of an early warning system improvement programme for children in hospital: the PUMA mixed-methods study

Allen

Lloyd

Edwards

et al. 2022

Health Soc Care Deliv Res

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Background The Paediatric early warning system Utilisation and Morbidity Avoidance (PUMA) study was commissioned to develop, implement and evaluate a paediatric track-and-trigger tool for widespread adoption. Following findings from three systematic reviews, revised aims focused on implementation of a whole-systems improvement programme. Objectives (1) Identify, through systematic review, the following: evidence for core components of effective paediatric track-and-trigger tools and paediatric early warning systems, and contextual factors consequential for paediatric track-and-trigger tool and early warning system effectiveness. (2) Develop and implement an evidence-based paediatric early warning system improvement programme (i.e. the PUMA programme). (3) Evaluate the effectiveness of the PUMA programme by examining clinical practice and core outcomes trends. (4) Identify ingredients of successful implementation of the PUMA programme. Review methods The quantitative reviews addressed the following two questions: how well validated are existing paediatric track-and-trigger tools and their component parts for predicting inpatient deterioration? How effective are paediatric early warning systems (with or without a tool) at reducing mortality and critical events? The qualitative review addressed the following question: what sociomaterial and contextual factors are associated with successful or unsuccessful paediatric early warning systems (with or without tools)? Design Interrupted time series and ethnographic case studies were used to evaluate the PUMA programme. Qualitative methods were deployed in a process evaluation. Setting The study was set in two district general and two tertiary children’s hospitals. Intervention The PUMA programme is a paediatric early warning system improvement programme designed to harness local expertise to implement contextually appropriate interventions. Main outcome measures The primary outcome was a composite metric, representing children who experienced one of the following in 1 month: mortality, cardiac arrest, respiratory arrest, unplanned admission to a paediatric intensive care unit or unplanned admission to a high-dependency unit. Paediatric early warning system changes were assessed through ethnographic ward case studies. Results The reviews showed limited effectiveness of paediatric track-and-trigger tools in isolation, and multiple failure points in paediatric early warning systems. All sites made paediatric early warning system changes; some of the clearer quantitative findings appeared to relate to qualitative observations. Systems changed in response to wider contextual factors. Limitations Low event rates made quantitative outcome measures challenging. Implementation was not a one-shot event, creating challenges for the interrupted time series in conceptualising ‘implementation’ and ‘post-intervention’ periods. Conclusions Detecting and acting on deterioration in the acute hospital setting requires a whole-systems approach. The PUMA programme offers a framework to support ongoing system-improvement work; the approach could be used more widely. Organisational-level system change can affect clinical outcomes positively. Alternative outcome measures are required for research and quality improvement. Future work The following further research is recommended: a consensus study to identify upstream indicators of paediatric early warning system performance; an evaluation of OUTCOME approach in other clinical areas; an evaluation of supernumerary nurse co-ordinator role; and an evaluation of mandated system improvement. Study registration This study is registered as PROSPERO CRD42015015326. Funding This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 1. See the NIHR Journals Library website for further project information.

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The art of communication: strategies to improve efficiency, quality of care and patient safety in the emergency department

Krug

2008

Pediatr Radiol

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The practice of pediatric emergency medicine (PEM) has been supported by wonderful advancements in diagnostic testing, particularly in medical imaging. One of the most remarkable has been CT, which has arguably become our most valuable diagnostic tool in the emergency department (ED). PEM specialists have grown increasingly aware of quality and safety concerns in the care of children in emergency medical settings, spurred in part by a rapid growth in ED utilization and significant overcrowding. In the midst of this comes the revelation that one of our most valued diagnostic tools might place our youngest patients at a significant risk for the development of fatal cancer. This article reinforces the fundamental importance of communication and teamwork as a means to promote patient care quality and safety in the ED, and it offers partnership strategies for PEM and pediatric radiology specialists to consider as they address these important concerns.

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Enlisting Families as Patient Safety Allies

Cited by 5 publications

References 0 publications

Developing and evaluating the success of a family activated medical emergency team: a quality improvement report

Developing and evaluating the success of a family activated medical emergency team: a quality improvement report

Development, implementation and evaluation of an early warning system improvement programme for children in hospital: the PUMA mixed-methods study

The art of communication: strategies to improve efficiency, quality of care and patient safety in the emergency department

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