Engaging Families in Bedside Rounds to Promote Pediatric Patient Safety

背景：美国每年有700万儿童住院，使他们面临医疗错误的风险。2儿童遭受的医疗错误是成人患者的三倍。由于儿童不完全能够采用推荐给成年患者的沟通技巧来减少错误，因此他们的家人参与他们的医疗保健至关重要。为了促进家属参与，建议的做法是在家属在场的情况下在病房进行床边查房。最近，更多的机构在孩子的床边进行巡回检查，试图让家庭参与进来。然而，据我们所知，没有7个机构客观地评估这些轮次是否成功地提高了安全性或吸引了8个家庭。目标：本研究的总体目标是利用家庭参与床边查房9来提高为住院儿童提供护理的安全性。基于PI的K08患者安全奖10，该项目将1）评估床边查房期间实现的家庭参与如何影响11名住院儿童的安全，2）使用系统工程方法实施干预措施以促进12家庭参与，3）比较干预前后床边查房的有效性13关于安全和家庭参与，以及4）评估家庭参与如何介导14项干预措施对安全性的任何影响。研究计划：将在入院后15天和出院时收集干预前150个家庭（75个来自干预医院单元，16个对照单元75个）和干预后150个家庭（每个单元75个）的床边查房视频和调查数据，得到600个17床边查房视频和调查数据样本。与常见儿科住院相关的安全性指标18包括安全实践（手部卫生和药物意识）和父母对安全的看法，这些指标通过临床数据或家庭调查进行评估19。家庭参与特定床边查房沟通任务20（关系建立、信息交流和审议），将使用PI的有效措施，从视频中客观评估21。将使用公认的系统工程方法（刺激回忆和主动风险评估）来生成和优先考虑解决我们床边查房中家庭参与的已知障碍和促进因素的策略。我们将把安全与家庭参与联系起来，比较安全24和干预前后的家庭参与，并评估25项干预措施与安全之间是否存在任何关系。分析将包括定性技术、26个描述性统计量和调整协变量和观察聚类的路径分析。27意义：这项工作将为改善家庭参与的干预措施的实施提供信息，并将讨论家庭参与是否以及如何改善患者安全。此外，研究结果将为医疗保健提供者的教育提供信息，指导儿科住院期间的护理政策，并支持未来对干预措施的评估，以改善家庭参与和儿科患者的安全。每年有700万美国儿童住院，使他们面临不成比例的高医疗错误率。在某种程度上，这是因为儿童无法利用减少错误的沟通技巧。因此，家庭参与儿童的医疗保健接触已被建议作为一种手段，以提高安全性。为了让家庭参与护理，建议的做法是在家人在场的情况下在孩子的床边进行查房。通过调查床边查房期间家庭参与与医院安全之间的关系，同时也进行干预以促进家庭参与，这项工作旨在为改善儿科患者安全和支持家庭参与儿童医疗保健的干预措施和政策提供信息。

DESCRIPTION (provided by the applicant): Background: Each year, 7 million children are hospitalized in the US, putting them at risk for medical errors. 2 Children suffer three times as many medical errors as adult patients. Because children are not fully capable 3 of employing the communication techniques recommended to adult patients to reduce errors, engagement of 4 their families in their healthcare is essential. To facilitate family engagement, recommended practice is to 5 conduct bedside rounds in patients' rooms with the family present. Recently, more institutions are 6 conducting rounds at the child's bedside, attempting to engage families. However, to our knowledge, no 7 institutions have objectively assessed whether these rounds are successful in improving safety or engaging 8 families. Objective: The overarching goal of this study is to leverage family engagement in bedside rounds 9 to improve the safety of care provided to hospitalized children. Building on the PI's K08 patient safety award, 10 this project will 1) evaluate how family engagement achieved during bedside rounds influences safety for 11 hospitalized children, 2) use systems engineering approaches to implement an intervention to foster 12 engagement of families, 3) compare the effectiveness of pre- and post-intervention bedside rounds with 13 regard to safety and family engagement, and 4) assess how family engagement mediates any effect of the 14 intervention on safety. Research Plan: Videos of bedside rounds and survey data will be collected on the 15 day after admission and at discharge for 150 families before (75 from the intervention hospital unit and 75 on 16 a control unit) and 150 families after (75 from each of unit) the intervention, resulting in a sample of 600 17 bedside rounds videos and survey data. Safety indicators relevant to common pediatric hospitalizations 18 include safe practices (hand hygiene and medication awareness) and parent perceptions of safety, assessed 19 from clinical data or family surveys. Family engagement in specific bedside rounds communication tasks 20 (relationship building, information exchange, and deliberation), will be objectively assessed from the videos, 21 using the PI's validated measures. Accepted systems engineering methods (stimulated recall and proactive 22 risk assessment) will be used to generate and prioritize strategies addressing known barriers and facilitators 23 of family engagement in our bedside rounds. We will relate safety to family engagement, compare safety 24 and family engagement pre- and post-intervention, and assess whether any relationship between the 25 interventions and safety occurs through family engagement. Analyses will include qualitative techniques, 26 descriptive statistics, and path analyses that adjust for covariates and clustering of observations. 27 Significance: This work will inform implementation of interventions to improve family engagement and will 28 addresses whether and how family engagement can improve patient safety. In addition, findings will inform the 29 education of healthcare providers, guide policies for care provision during pediatric hospitalizations, and 30 support future evaluations of interventions to improve family engagement and pediatric patient safety. Each year, 7 million US children are hospitalized, placing them at risk for disproportionately high rates of medical error. In part, this is because children cannot avail themselves of error-reducing communication techniques. Thus, family engagement in children's healthcare encounters has been suggested as a means to improve safety. To engage families in care, recommended practice is to conduct rounds at the child's bedside with the family present. By investigating the relationship between family engagement during bedside rounds and hospital safety, while also intervening to foster family engagement, this work aims to inform interventions and policies that improve pediatric patient safety and support family engagement in children's healthcare.