Implementing a Family-Centered Rounds Intervention Using Novel Mentor-Trios

Author:

Khan Alisa12,Patel Shilpa J.34,Anderson Michele56,Baird Jennifer D.7,Johnson Tyler M.1,Liss Isabella1,Graham Dionne A.28,Calaman Sharon9,Fegley April E.10,Goldstein Jenna10,O’Toole Jennifer K.11,Rosenbluth Glenn1213,Alminde Claire14,Bass Ellen J.15,Bismilla Zia16,Caruth Monique6,Coghlan-McDonald Sally613,Cray Sharon617,Destino Lauren A.1819,Dreyer Benard P.20,Everhart Jennifer L.1819,Good Brian P.21,Guiot Amy B.22,Haskell Helen623,Hepps Jennifer H.24,Knighton Andrew J.25,Kocolas Irene21,Kuzma Nicholas C.2627,Lewis Kheyandra2627,Litterer Katherine P.628,Kruvand Elizabeth629,Markle Peggy630,Micalizzi Dale A.6,Patel Aarti31,Rogers Jayne E.32,Subramony Anupama33,Vara Tiffany46,Yin H. Shonna34,Sectish Theodore C.12,Srivastava Rajendu2125,Starmer Amy J.12,West Daniel C.3536,Spector Nancy D.262737,Landrigan Christopher P.123839,

Affiliation:

1. aDivision of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts

2. bDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts

3. cDepartment of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii

4. dKapi‘olani Medical Center for Women and Children, Hawaii Pacific Health, Honolulu, Hawaii

5. eFamily Centered Care Department, Lucile Packard Children’s Hospital Stanford, Palo Alto, California

6. fPatient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts

7. gInstitute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, Los Angeles, California

8. hProgram for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts

9. iDivision of Pediatric Critical Care, NYU Langone Health/Hassenfeld Children’s Hospital, NYU Grossman School of Medicine; New York City, New York

10. jCenter for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania

11. kDepartments of Pediatrics and Internal Medicine, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio

12. lDepartment of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California

13. mBenioff Children’s Hospital, San Francisco, University of California San Francisco School of Medicine, San Francisco, California

14. nDepartment of Nursing, St Christopher’s Hospital for Children, Philadelphia, Pennsylvania

15. oDepartment of Information Science in the College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania

16. pDepartments of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

17. qPatient Safety and Quality Improvement Committee, St Christopher’s Hospital for Children, Philadelphia, Pennsylvania

18. rDepartment of Pediatrics, Stanford University School of Medicine, Palo Alto, California

19. sLucile Packard Children’s Hospital Stanford, Palo Alto, California

20. tDepartment of Pediatrics, New York University Grossman School of Medicine, New York, New York

21. uDepartment of Pediatrics, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, Utah

22. vCincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio

23. wMothers Against Medical Error, Columbia, South Carolina

24. xDepartment of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland

25. yHealthcare Delivery Institute, Intermountain Health, Murray, Utah

26. zDepartment of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania

27. aaDepartment of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania

28. bbOffice of Experience, Boston Children’s Hospital, Boston, Massachusetts

29. ccSSM Health Cardinal Glennon Children’s Hospital, St Louis, Missouri

30. ddWalter Reed National Military Medical Center, Bethesda, Maryland

31. eeDepartment of Pediatrics, University of California San Diego, Rady Children’s Hospital, San Diego, California

32. ffDepartment of Nursing, Boston Children’s Hospital, Boston, Massachusetts

33. ggDepartment of Pediatrics, Cohen Children’s Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, New York

34. hhDepartments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, New York

35. iiDepartment of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

36. jjPerelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

37. kkThe Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program, Philadelphia, Pennsylvania

38. llDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts; and

39. mmDivision of Sleep Medicine, Harvard Medical School, Boston, Massachusetts

Abstract

BACKGROUND AND OBJECTIVES: Patient and Family Centered I-PASS (PFC I-PASS) emphasizes family and nurse engagement, health literacy, and structured communication on family-centered rounds organized around the I-PASS framework (Illness severity-Patient summary-Action items-Situational awareness-Synthesis by receiver). We assessed adherence, safety, and experience after implementing PFC I-PASS using a novel “Mentor-Trio” implementation approach with multidisciplinary parent-nurse-physician teams coaching sites. METHODS: Hybrid Type II effectiveness-implementation study from 2/29/19-3/13/22 with ≥3 months of baseline and 12 months of postimplementation data collection/site across 21 US community and tertiary pediatric teaching hospitals. We conducted rounds observations and surveyed nurses, physicians, and Arabic/Chinese/English/Spanish-speaking patients/parents. RESULTS: We conducted 4557 rounds observations and received 2285 patient/family, 1240 resident, 819 nurse, and 378 attending surveys. Adherence to all I-PASS components, bedside rounding, written rounds summaries, family and nurse engagement, and plain language improved post-implementation (13.0%–60.8% absolute increase by item), all P < .05. Except for written summary, improvements sustained 12 months post-implementation. Resident-reported harms/1000-resident-days were unchanged overall but decreased in larger hospitals (116.9 to 86.3 to 72.3 pre versus early- versus late-implementation, P = .006), hospitals with greater nurse engagement on rounds (110.6 to 73.3 to 65.3, P < .001), and greater adherence to I-PASS structure (95.3 to 73.6 to 72.3, P < .05). Twelve of 12 measures of staff safety climate improved (eg, “excellent”/“very good” safety grade improved from 80.4% to 86.3% to 88.0%), all P < .05. Patient/family experience and teaching were unchanged. CONCLUSIONS: Hospitals successfully used Mentor-Trios to implement PFC I-PASS. Family/nurse engagement, safety climate, and harms improved in larger hospitals and hospitals with better nurse engagement and intervention adherence. Patient/family experience and teaching were not affected.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference55 articles.

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