Bringing I-PASS to the Bedside: A Communication Bundle to Improve Patient Safety and Experience
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Communication
- Sponsor
- Boston Children's Hospital
- Enrollment
- 6478
- Locations
- 7
- Primary Endpoint
- Rate of Medical Errors
- Status
- Completed
- Last Updated
- 5 years ago
Overview
Brief Summary
Patient and Family-Centered I-PASS is a bundle of communication interventions to improve the quality of information exchange between physicians, nurses, and families, and to better integrate families into all aspects of daily decision making in hospitals. This project tests the hypothesis that rates of medical errors and adverse events (primary outcome), hospital experience, communication, and shared understanding will improve following implementation of Patient and Family Centered I-PASS, as compared with current practice.
Detailed Description
We conducted an intervention study on pediatric inpatient units in seven North American hospitals. Each site was assigned to one of 3 staggered waves of implementation and data collection. The Patient and Family Centered I-PASS intervention included a health literacy-informed, structured communication framework for family-centered rounds; written rounds summaries for families; a training and learning program; and strategies to support teamwork and implementation. We measured errors and adverse events (AEs) via an established systematic surveillance methodology, family experience via pre-discharge surveys, and communication processes via direct observations.
Investigators
Christopher Landrigan
Professor of Pediatrics, Harvard Medical School; Research and Fellowship Director, Boston Children's Hospital Inpatient Pediatrics Service
Boston Children's Hospital
Eligibility Criteria
Inclusion Criteria
- •All patients admitted to the pediatric inpatient study units of participating hospitals
- •Parents/caregivers of patients less than 18 years of age who speak English, Chinese, Arabic, Russian, or Spanish
- •Nurses working on these units
- •Residents working on these units
- •Medical students working on these units
Exclusion Criteria
- •Parents/caregivers who do not speak a study language (decided based on the 5 most commonly spoken languages across study sites; study languages include: English, Chinese, Arabic, Russian, Spanish)
- •Parents/caregivers of patients greater than 18 years of age
Outcomes
Primary Outcomes
Rate of Medical Errors
Time Frame: 6 months (3 months pre, 3 months post) per site (7 sites total)
Our primary outcome was the rate of medical errors, including harmful errors (preventable adverse events) and non-harmful errors. Medical errors and adverse events were measured per 1000 patient-days before and after implementation of Patient and Family Centered I-PASS using an established systematic safety surveillance methodology. Trained research clinicians reviewed patient medical charts, hospital incident reports, family safety interviews, and staff reports for potential errors and adverse events. Trained physician-reviewers blinded to pre- vs. post-intervention status then categorized all suspected incidents as either adverse events, non-harmful errors, or exclusions. Adverse events that were clearly caused by a medical error were subsequently deemed preventable and all other cases were categorized as non-preventable.
Secondary Outcomes
- Rate of Non-Preventable Adverse Events(6 months (3 months pre, 3 months post) per site (7 sites total))
- Family Experience With Care(6 months (3 months pre, 3 months post) per site (7 sites total))
- Quality of Communication on Rounds(6 months (3 months pre, 3 months post) per site (7 sites total))
- Shared Understanding Between Parent, Resident, and Nurse(6 months (3 months pre, 3 months post) per site (7 sites total))