Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study

被引：123

作者：

Khan, Alisa ^{[1
,2
,3
]}

Spector, Nancy D. ^{[4
,5
]}

Baird, Jennifer D. ^{[6
]}

Ashland, Michele ^{[7
]}

Starmer, Amy J. ^{[1
,2
,3
]}

Rosenbluth, Glenn ^{[8
,9
]}

Garcia, Briana M. ^{[8
,10
,11
]}

Litterer, Katherine P. ^{[12
]}

Rogers, Jayne E. ^{[13
]}

Dalal, Anuj K. ^{[1
,14
]}

Lipsitz, Stuart ^{[1
,14
]}

Yoon, Catherine S. ^{[14
]}

Zigmont, Katherine R. ^{[14
]}

Guiot, Amy ^{[15
,16
]}

O'Toole, Jennifer K. ^{[15
,16
]}

Patel, Aarti ^{[17
,18
]}

Bismilla, Zia ^{[19
,20
]}

Coffey, Maitreya ^{[19
,20
]}

Langrish, Kate ^{[21
,22
]}

Blankenburg, Rebecca L. ^{[23
,24
]}

Destino, Lauren A. ^{[23
,24
]}

Everhart, Jennifer L. ^{[23
,24
]}

Good, Brian P. ^{[25
,26
]}

Kocolas, Irene ^{[25
,26
]}

Srivastava, Rajendu ^{[25
,26
]}

Calaman, Sharon ^{[4
,5
]}

Cray, Sharon ^{[27
]}

Kuzma, Nicholas ^{[4
,5
]}

Lewis, Kheyandra ^{[4
,5
]}

Thompson, E. Douglas ^{[4
,5
]}

Hepps, Jennifer H. ^{[28
,29
]}

Lopreiato, Joseph O. ^{[28
]}

Yu, Clifton E. ^{[28
,29
]}

Haskell, Helen ^{[30
]}

Kruvand, Elizabeth ^{[31
,32
]}

Micalizzi, Dale A. ^{[33
]}

Alvarado-Little, Wilma ^{[34
]}

Dreyer, Benard P. ^{[35
,36
]}

Yin, H. Shonna ^{[35
,37
,38
]}

Subramony, Anupama ^{[39
,40
]}

Patel, Shilpa J. ^{[41
,42
]}

Sectish, Theodore C. ^{[2
,3
]}

West, Daniel C. ^{[8
,9
]}

Landrigan, Christopher P. ^{[1
,2
,3
,43
]}

机构：

[1] Harvard Med Sch, Boston, MA USA

[2] Boston Childrens Hosp, Dept Med, Boston, MA USA

[3] Boston Childrens Hosp, Div Gen Pediat, Boston, MA USA

[4] Drexel Univ, Coll Med, Philadelphia, PA 19104 USA

[5] St Christophers Hosp Children, Dept Pediat, Philadelphia, PA 19133 USA

[6] Childrens Hosp Los Angeles, Inst Nursing & Interprofess Res, Los Angeles, CA 90027 USA

[7] Lucile Packard Childrens Hosp Stanford, Family Centered Care Dept, Palo Alto, CA USA

[8] Univ Calif San Francisco, Sch Med, San Francisco, CA USA

[9] Benioff Childrens Hosp, Dept Pediat, San Francisco, CA USA

[10] Boston Childrens Hosp, Dept Med, Boston, MA USA

[11] Boston Childrens Hosp, Div Gen Pediat, Boston, MA USA

[12] Boston Childrens Hosp, Off Experience, Boston, MA USA

[13] Boston Childrens Hosp, Inpatient Med, Boston, MA USA

[14] Brigham & Womens Hosp, Dept Med, Div Gen Med, Ctr Patient Safety Res, Boston, MA 02115 USA

[15] Univ Cincinnati, Coll Med, Cincinnati, OH USA

[16] Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Cincinnati, OH 45229 USA

[17] Univ Calif San Diego, Sch Med, San Diego, CA 92103 USA

[18] Rady Childrens Hosp San Diego, Div Pediat Hosp Med, San Diego, CA USA

[19] Univ Toronto, Pediat, Toronto, ON, Canada

[20] Hosp Sick Children, Dept Pediat, Toronto, ON, Canada

[21] Univ Toronto, Fac Nursing, Toronto, ON, Canada

[22] Hosp Sick Children, Div Pediat Hosp Med, Toronto, ON, Canada

[23] Stanford Sch Med, Palo Alto, CA USA

[24] Lucile Packard Childrens Hosp Stanford, Palo Alto, CA USA

[25] Univ Utah, Sch Med, Salt Lake City, UT USA

[26] Primary Childrens Med Ctr, Dept Pediat, Salt Lake City, UT USA

[27] St Christophers Hosp Children, Family Advisory Council, Philadelphia, PA 19133 USA

[28] Uniformed Serv Univ Hlth Sci, Walter Reed Natl Mil Med Ctr, Bethesda, MD 20814 USA

[29] Walter Reed Natl Mil Med Ctr, Bethesda, MD USA

[30] Mothers Med Error, Columbia, SC USA

[31] St Louis Childrens Hosp, Family Partner Program, St Louis, MO 63178 USA

[32] St Louis Childrens Hosp, St Louis, MO 63178 USA

[33] Task Force Global Hlth, Justins HOPE Project, Decatur, GA USA

[34] New York State Dept Hlth, New York, NY 10013 USA

[35] NYU, Sch Med, New York, NY USA

[36] NYU, Langone Med Ctr, Div Dev Behav Pediat, New York, NY USA

[37] NYU, Dept Pediat, Langone Med Ctr, New York, NY 10016 USA

[38] NYU, Dept & Populat Hlth, Langone Med Ctr, New York, NY USA

[39] Cohen Childrens Med Ctr, New York, NY USA

[40] Hofstra Northwell Sch Med, Queens, NY USA

[41] Univ Hawaii, John A Burns Sch Med, Honolulu, HI 96822 USA

[42] Hawai Pacific Hlth, Honolulu, HI USA

[43] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2018年 / 363卷

基金：

美国医疗保健研究与质量局;

关键词：

BLOOD-STREAM INFECTIONS; ADVERSE EVENTS; HOSPITALIZED-PATIENTS; MEDICATION ERRORS; INTENSIVE-CARE; OUTCOMES; RATES;

D O I：

10.1136/bmj.k4764

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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-intervention v 35.8 (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) v 12.9 (8.9 to 18.6), P=0.01) post-intervention. Non-preventable adverse events also decreased (12.6 (8.9 to 17.9) v 5.2 (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%) v 82.8% (64.9% to 92.6%), P=0.02). Family engagement 55.6% (32.9% to 76.2%) v 66.7% (43.0% to 84.1%), P=0.04) and nurse engagement (20.4% (7.0% to 46.6%) v 35.5% (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%) v 37.7% (17.6% to 63.3%), P=0.03) and reading back plans (4.7% (0.7% to 25.2%) v 26.5% (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.

引用

页数：17

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