Fellow: Joy Solano, Pediatric Hospital Medicine Fellow, Children's Mercy Kansas City
Article: Khan A, Spector ND, Baird JD, Ashland M et al. Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study. BMJ 2018: 363, k4764.
Summary: Khan et al. sought to determine whether medical errors, family experience and communication processes improved after implementation of a family-centered intervention on inpatient rounds at academic centers. The intervention, called Patient and Family Centered I-PASS, was co-produced by physicians, nurses and families of pediatric patients as well as experts in health literacy and communication. High reliability communication methods were used to structure rounds. Overall medical error rates did not change, but preventable adverse events (harmful medical errors) decreased by 38%.
Key Strengths: This study was strengthened by its multicenter design, systematic measurement of patient safety events across all hospitals and inclusion of a diverse parent population (multiple ethnicities and languages spoken). The complex intervention was produced with significant input from all stakeholders including physicians, nurses and most importantly families of pediatric patients. Additionally, the intervention was based on the I-PASS framework for physician handoff which is associated with improved communication amongst providers and decreased medical error rates.
Key Limitations: Causality cannot be established based on the study design, and adherence to key processes within the intervention never met 50%. Additionally, though authors comment that the frequency of teaching did not significantly change, it is unclear how this was measured.
Major Takeaway: A complex intervention focused on structured, high reliability, family-centered communication on inpatient rounds at academic centers may decrease harmful medical errors.
How this article should impact our practice: This research group has received a second PCORI (Patient-Centered Outcomes Research Institute) award to expand the intervention’s reach and further study its effects on patient safety. Academic centers should consider implementing a more robust communication structure for inpatient rounds with patients and families; one option is through participation in this study. Finally, further study of this intervention’s impact on medical student and resident education is required.
Article: Khan A, Spector ND, Baird JD, Ashland M et al. Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study. BMJ 2018: 363, k4764.
Summary: Khan et al. sought to determine whether medical errors, family experience and communication processes improved after implementation of a family-centered intervention on inpatient rounds at academic centers. The intervention, called Patient and Family Centered I-PASS, was co-produced by physicians, nurses and families of pediatric patients as well as experts in health literacy and communication. High reliability communication methods were used to structure rounds. Overall medical error rates did not change, but preventable adverse events (harmful medical errors) decreased by 38%.
Key Strengths: This study was strengthened by its multicenter design, systematic measurement of patient safety events across all hospitals and inclusion of a diverse parent population (multiple ethnicities and languages spoken). The complex intervention was produced with significant input from all stakeholders including physicians, nurses and most importantly families of pediatric patients. Additionally, the intervention was based on the I-PASS framework for physician handoff which is associated with improved communication amongst providers and decreased medical error rates.
Key Limitations: Causality cannot be established based on the study design, and adherence to key processes within the intervention never met 50%. Additionally, though authors comment that the frequency of teaching did not significantly change, it is unclear how this was measured.
Major Takeaway: A complex intervention focused on structured, high reliability, family-centered communication on inpatient rounds at academic centers may decrease harmful medical errors.
How this article should impact our practice: This research group has received a second PCORI (Patient-Centered Outcomes Research Institute) award to expand the intervention’s reach and further study its effects on patient safety. Academic centers should consider implementing a more robust communication structure for inpatient rounds with patients and families; one option is through participation in this study. Finally, further study of this intervention’s impact on medical student and resident education is required.