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Study Finds Harmful Medical Errors Fell 38% Following Implementation of a Multicenter Program to Improve Doctors’ and Nurses’ Communication with Families

December 7, 2018



Boston Children's Hospital press release:

Researchers from Boston Children’s Hospital and Harvard Medical School, in conjunction with the Patient and Family Centered I-PASS Study Group, found that harmful medical errors decreased by 38% following implementation of an intervention to improve communication between healthcare providers and patients and families. The study was published on December 6, 2018 in the British Medical Journal.

The intervention, Patient and Family Centered I-PASS, involved changes to verbal and written communication during morning rounds that emphasized family engagement, structured communication, and health literacy. “Rounds” are when healthcare providers (usually doctors, sometimes nurses) meet together to review the care plan for hospitalized patients. These often occur outside of patient rooms and with minimal patient involvement. In Patient and Family Centered I-PASS, rounds occurred at the bedside with patients and families present and actively engaged. The intervention also emphasized minimizing medical jargon on rounds, structuring communication, having families share concerns and questions at the start of rounds, and having families “read back” their understanding of rounds at the end.
 “Our study suggests that engaging families in hospital communication doesn’t just feel like the right thing to do. It can actually make care safer,” says lead author Alisa Khan, MD, MPH, a pediatric hospitalist and researcher at Boston Children’s Hospital and Harvard Medical School.
“Our prior research has shown that improving communication between providers improves safety. The present study suggests that improving communication with families may also be a critical means of improving patient safety, one that has previously been overlooked,” said senior author Christopher Landrigan, MD, MPH, Research Director of Inpatient Pediatrics at Boston Children’s Hospital and Professor of Pediatrics at Harvard Medical School. “Family centered rounds are increasingly considered a standard of care in pediatrics, but until now, evidence that they could actually improve safety was limited,” Landrigan added.

In addition to improvements in safety, the researchers found that multiple aspects of hospital experience and communication improved. Families and nurses were significantly more engaged in the process. Rounds did not take any longer or involve less education of resident-physicians and medical students. 

“A truly unique aspect of our study was that every stage of the project--from developing the intervention to the science to measure its effectiveness--involved families, nurses, and physicians working together as equal partners,” added Dr. Khan.  “This study provided an opportunity for nurses to be fully engaged in the design and implementation of a family-centered team communication intervention, demonstrating…the impact that nursing input can have on implementation of complex team-based interventions” said Jennifer Baird, RN, PhD, MPH, Director, Institute for Nursing and Interprofessional Research at Children's Hospital Los Angeles and co-chair of the study’s Nurse Advisory Council.

“There’s no substitute for the partnership that parents of hospitalized children need with their healthcare providers. We are supremely focused on our children being as safe and healthy as possible. We always want to be a part of contributing to and supporting the healthcare system to be its best for our children,” said Michele Ashland, Lead Parent in Family Centered Care at Stanford Children’s Hospital, and member of the study’s Family Advisory Council.

The Patient Centered Outcomes Research Institute supported this study, with additional support for some researchers provided by the Agency for Healthcare Research and Quality.

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