Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study
Authors: Khan Alisa , Spector Nancy D , Baird Jennifer D , Ashland Michele , Starmer Amy J , Rosenbluth Glenn , Garcia Briana M , Litterer Katherine P , Rogers Jayne E , Dalal Anuj K , Lipsitz Stuart , Yoon Catherine S , Zigmont Katherine R , Guiot Amy , O’Toole Jennifer K , Patel Aarti , Bismilla Zia , Coffey Maitreya , Langrish Kate , Blankenburg Rebecca L , Destino Lauren A , Everhart Jennifer L , Good Brian P , Kocolas Irene , Srivastava Rajendu , Calaman Sharon , Cray Sharon , Kuzma Nicholas , Lewis Kheyandra , Thompson E Douglas , Hepps Jennifer H , Lopreiato Joseph O , Yu Clifton E , Haskell Helen , Kruvand Elizabeth , Micalizzi Dale A , Alvarado-Little Wilma , Dreyer Benard P , Yin H Shonna , Subramony Anupama , Patel Shilpa J , Sectish Theodore C , West Daniel C , Landrigan Christopher P 
Published: December 2018

Objective

To 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.

Design

Prospective, multicenter before and after intervention study.

Setting

Pediatric inpatient units in seven North American hospitals, 17 December 2014 to 3 January 2017.

Participants

All patients admitted to study units (3106 admissions, 13171 patient days); 2148 parents or caregivers, 435 nurses, 203 medical students, and 586 residents.

Intervention

Families, 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 measures

Medical 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.

Results

The overall rate of medical errors (per 1000 patient days) was unchanged (41.2 (95% confidence interval 31.2 to 54.5) pre-interventionv35.8 (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)v12.9 (8.9 to 18.6), P=0.01) post-intervention. Non-preventable adverse events also decreased (12.6 (8.9 to 17.9)v5.2 (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%)v82.8% (64.9% to 92.6%), P=0.02). Family engagement 55.6% (32.9% to 76.2%)v66.7% (43.0% to 84.1%), P=0.04) and nurse engagement (20.4% (7.0% to 46.6%)v35.5% (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%)v37.7% (17.6% to 63.3%), P=0.03) and reading back plans (4.7% (0.7% to 25.2%)v26.5% (12.7% to 7.3%), P=0.02) increased. Trainee teaching and the duration of rounds did not change significantly.

Conclusions

Although 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 registration

ClinicalTrials.govNCT02320175.