Parent and Provider Experience and Shared Understanding After a Family-Centered Nighttime Communication Intervention

Khan, Alisa; Baird, Jennifer; Rogers, Jayne; Furtak, Stephannie L.; Williams, Kathryn; Allair, Brenda; Litterer, Katherine P.; Sharma, Meesha; Smith, Alla; Schuster, Mark A.; Landrigan, Christopher P.

doi:10.1016/j.acap.2017.01.012

Cited by 19 publications

(17 citation statements)

References 36 publications

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“…Nevertheless, our findings were consistent with what we found in our pilot study in that family reports of experience with nurses improved after implementation of a family centered interprofessional night time communication intervention. 13 Taken together, these findings suggest that small improvements in nursing engagement might lead to larger overall improvements in patient experience. The effect on family experience of improving nursing engagement on rounds and nurse-physician communication warrants further study.…”

Section: Discussionmentioning

confidence: 92%

“…Our current study also addresses several limitations of a previous single center study conducted by our group, in which we found that implementing a family centered, interprofessional night time communication intervention bundle was associated with improved parent and provider experience and shared understanding. 13 We greatly refined the intervention to better integrate it into provider workflow and more effectively engage families and nurses in all study aspects. Importantly, we also directly measured safety outcomes using an expanded active surveillance methodology that included family safety reporting.…”

Section: Discussionmentioning

confidence: 99%

“…We did so through an iterative, consensus building process through a series of teleconferences and in-person meetings informed by a review of the literature and our previous research. 8 13 …”

Section: Methodsmentioning

confidence: 99%

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Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study

Khan

Spector

Baird

et al. 2018

BMJ

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152

158

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ObjectiveTo determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of healthcare provider-family communication on family centered rounds.DesignProspective, multicenter before and after intervention study.SettingPediatric inpatient units in seven North American hospitals, 17 December 2014 to 3 January 2017.ParticipantsAll patients admitted to study units (3106 admissions, 13171 patient days); 2148 parents or caregivers, 435 nurses, 203 medical students, and 586 residents.InterventionFamilies, nurses, and physicians coproduced an intervention to standardize healthcare provider-family communication on ward rounds (“family centered rounds”), which included structured, high reliability communication on bedside rounds emphasizing health literacy, family engagement, and bidirectional communication; structured, written real-time summaries of rounds; a formal training programme for healthcare providers; and strategies to support teamwork, implementation, and process improvement.Main outcome measuresMedical errors (primary outcome), including harmful errors (preventable adverse events) and non-harmful errors, modeled using Poisson regression and generalized estimating equations clustered by site; family experience; and communication processes (eg, family engagement on rounds). Errors were measured via an established systematic surveillance methodology including family safety reporting.ResultsThe overall rate of medical errors (per 1000 patient days) was unchanged (41.2 (95% confidence interval 31.2 to 54.5) pre-intervention v 35.8 (26.9 to 47.7) post-intervention, P=0.21), but harmful errors (preventable adverse events) decreased by 37.9% (20.7 (15.3 to 28.1) v 12.9 (8.9 to 18.6), P=0.01) post-intervention. Non-preventable adverse events also decreased (12.6 (8.9 to 17.9) v 5.2 (3.1 to 8.8), P=0.003). Top box (eg, “excellent”) ratings for six of 25 components of family reported experience improved; none worsened. Family centered rounds occurred more frequently (72.2% (53.5% to 85.4%) v 82.8% (64.9% to 92.6%), P=0.02). Family engagement 55.6% (32.9% to 76.2%) v 66.7% (43.0% to 84.1%), P=0.04) and nurse engagement (20.4% (7.0% to 46.6%) v 35.5% (17.0% to 59.6%), P=0.03) on rounds improved. Families expressing concerns at the start of rounds (18.2% (5.6% to 45.3%) v 37.7% (17.6% to 63.3%), P=0.03) and reading back plans (4.7% (0.7% to 25.2%) v 26.5% (12.7% to 7.3%), P=0.02) increased. Trainee teaching and the duration of rounds did not change significantly.ConclusionsAlthough overall errors were unchanged, harmful medical errors decreased and family experience and communication processes improved after implementation of a structured communication intervention for family centered rounds coproduced by families, nurses, and physicians. Family centered care processes may improve safety and quality of care without negatively impacting teaching or duration of rounds.Trial registrationClinicalTrials.gov NCT02320175.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study

Khan

Spector

Baird

et al. 2018

BMJ

Self Cite

152

158

View full text Add to dashboard Cite

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“…We collected data as part of a multifaceted nighttime communication study. 26 We included patients from general pediatric, short-stay (straightforward patients with often, but not always, shorter stays), and subspecialty (eg, hematology) services. We obtained parent verbal consent using a study information sheet.…”

Section: Methodsmentioning

confidence: 99%

Parent-Provider Miscommunications in Hospitalized Children

Khan

Furtak²,

Melvin

et al. 2017

Hospital Pediatrics

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“…As a result, substantial information gaps exist between parents and providers, with 45% of parents in 1 study lacking a shared understanding about their child' s care plan with their inpatient provider. 2 To narrow this information gap, a growing number of hospitals offer patients and caregivers "inpatient portals." Inpatient portals are Web-based applications on tablet computers that provide real-time access to clinical information from the electronic health record (EHR) (eg, diagnoses, medications, test results, and education).…”

mentioning

confidence: 99%

Parent Perceptions of Real-time Access to Their Hospitalized Child’s Medical Records Using an Inpatient Portal: A Qualitative Study

Kelly

Thurber²,

Coller³

et al. 2019

Hospital Pediatrics

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A B S T R A C TBACKGROUND AND OBJECTIVES: Engaging with parents in care improves pediatric care quality and patient safety; however, parents of hospitalized children often lack the information necessary to effectively participate. To enhance engagement, some hospitals now provide parents with real-time online access to information from their child's inpatient medical record during hospitalization. Whether these "inpatient portals" provide benefits for parents of hospitalized children is unknown. Our objectives were to identify why parents used an inpatient portal application on a tablet computer during their child's hospitalization and identify their perspectives of ways to optimize the technology.METHODS: Semistructured in-person interviews were conducted with 14 parents who were given a tablet computer with a commercially available inpatient portal application for use throughout their child's hospitalization. The portal included vital signs, diagnoses, medications, laboratory test results, patients' schedule, messaging, education, and provider pictures and/or roles. Interviews were audio recorded and transcribed and continued until reaching thematic saturation. Three researchers used an inductive approach to identify emergent themes regarding why parents used the portal. RESULTS:Five themes emerged regarding parent motivations for accessing information within the portal: (1) monitoring progress, (2) feeling empowered and/or relying less on staff, (3) facilitating rounding communication and/or decision-making, (4) ensuring information accuracy and/or providing reassurance, and (5) aiding memory. Parents recommended that the hospital continue to offer the portal and expand it to allow parents to answer admission questions, provide feedback, and access doctors' daily notes.CONCLUSIONS: Providing parents with real-time clinical information during their child's hospitalization using an inpatient portal may enhance their ability to engage in caregiving tasks critical to ensuring inpatient care quality and safety.

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Parent and Provider Experience and Shared Understanding After a Family-Centered Nighttime Communication Intervention

Cited by 19 publications

References 36 publications

Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study

Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study

Parent-Provider Miscommunications in Hospitalized Children

Parent Perceptions of Real-time Access to Their Hospitalized Child’s Medical Records Using an Inpatient Portal: A Qualitative Study

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