Partnering With a Family Advisor to Improve Communication in a Pediatric Intensive Care Unit

Abstract

Inadequate communication between medical teams and families can lead to errors and poor-quality care. The objective was to understand why communication between the clinical team and families was not occurring consistently in the pediatric intensive care unit and improve the system using a multidisciplinary improvement team including a family advisor. This improvement project used Lean Six Sigma. The team observed updates and collected documented communication, survey, interview, and focus group data from families and staff. Root causes of failures included lack of assigned responsibility, lack of defined daily update, and lack of a daily communication standard. Process changes were implemented, resulting in an increased mean documented communication rate from 13% pre intervention to 65% post intervention that was sustained for more than 2 years (P < .001). Including a family advisor as an equal member of an improvement team provides family empowerment and a greater chance of success in complex areas.

The sustainability of Lean in pediatric healthcare: a realist review

“…Of the 11 included documents, six were published primary research studies [ 42 , 43 , 45 , 47 – 49 ], two were published quality improvement case studies [ 44 , 46 ], and three were unpublished quality improvement case reports [ 50 – 52 ] found from our citation searching [ 51 ] and gray literature searching [ 50 , 52 ] (Table 1 ). Of the 11 documents, seven used Lean exclusively [ 44 , 45 , 48 – 52 ]; two used Lean and Six Sigma [ 42 , 43 ]; one used a combination of Lean, Six Sigma, and the Institute for Healthcare Improvement (IHI) Model for Improvement [ 46 ]; and another used Lean with “other” QI classic methods [ 47 ]. Improvements were targeted at the meso (e.g., unit or organization level) ( n = 8) [ 42 – 49 ] and macro (e.g., policy, system) ( n = 3) [ 50 – 52 ] levels of the healthcare system.…”

“…No improvement targeted the individual, micro level. Documents focused on a variety of problems, clinical ( n = 1) [ 42 ], process ( n = 2) [ 43 , 48 ], clinical and process (n = 1) [ 46 ], or process and system problems ( n = 7) [ 44 , 45 , 47 , 49 – 52 ].…”

“… Multi-disciplinary team, project leader (neuroradiologist), and a physician champion. Division of pediatric radiology and neuro radiology (meso) Czulada, 2015, USA [ 43 ] Multi-methods No mention at all Lean, Six Sigma, process Describes the inclusion of a family advisor on an improvement project team to increase communication opportunities. Multi-disciplinary team, medical director, nurse manager, family advisor.…”

“…All documents used a multi-disciplinary team approach to lead implementation [ 42 – 52 ], six of which also included a physician lead within the multi-disciplinary team [ 42 , 43 , 47 – 49 , 51 ]. Many reported organizational leadership involvement ( n = 8) [ 44 – 46 , 48 – 52 ] and/or clinical leadership involvement (n = 7) [ 43 , 45 – 47 , 50 – 52 ]. One reported patient involvement [ 43 ].…”

Empowerment of the mothers of children in a pediatric intensive care unit

“…The sharing of information must be directly associated with the care practice of the team, because parents need to have knowledge of the health situation of their children in order to minimize the fear and insecurity associated with their critical condition. Therefore, the development of strategies by healthcare teams is of utmost importance so that parents are more involved in care processes for the child hospitalized in the PICU (3,19,(21)(22) . For this purpose, dialogue between nursing teams and families must be established, not only to meet families' needs for information and questions, but to value their opinions in search of a comprehensive and individualized care (23) .…”