A Multicenter Randomized Controlled Trial of a Patient Safety Reporting Intervention for Families to Improve Medical Error Detection and Reduce Inequities

项目摘要/摘要 医院依靠自愿事件报告(VIR)来低效地检查其流程的安全性 临床工作人员超负荷工作，不敢报告。VIR仅捕获1%-10%的事件，不包括患者 和家庭，并低估了弱势群体中的事件，如语言障碍患者。患者和 家庭是护理中警惕的伙伴，他们擅长识别错误和不良事件。未能积极纳入PA- 安全报告中的个人和家庭，而不是依赖有缺陷的VIR，带来了一个重要的错过机会- 以提高安全性。为了改善医院安全，迫切需要联合制作(合作创建 对于家庭)有效的系统来识别未捕获的错误。如果没有这些信息，医院就会受到阻碍 他们提高病人安全的能力。与不同的家庭、护士、医生和医院领导合作- 急诊室，我们创建了一个多成分的沟通干预措施，让住院儿童的家庭参与到 安全报告。被称为Face(关于错误和安全的家庭激活和沟通)，In- 本发明包括3个要素：(1)西班牙语和英语手机(电子邮件、文本和二维码)人脸报告 促使家庭分享对安全的关注和建议的工具，(2)家庭/员工教育，以及(3)a 与单位和医院共享家庭报告的流程，以便解决系统性问题。在飞行员之后- 在一个住院病房里，我们看到家庭安全报告有了显著的改善，疾病减少了。 父母的教育程度和语言在报道中的平价。我们现在建议在4个月中进行人脸RCT 不同地域、种族和语言的医院。我们的具体目标是：(1)评估效果-- 人脸在改进错误检测和其他安全结果方面的有效性，(2)评估人脸对 报告方面的差异，以及(3)了解有助于成功实施 面孔。如果有效，FACES将通过以下方式做出贡献：(1)增加患者/家属对报告的参与度，特别是- (2)识别其他未被识别的事件，以及(3)使医院能够- TER以360度的方式了解安全问题，并设计更有效的、以患者为中心的解决方案。 这一点意义重大，因为医院需要可靠地识别医疗差错，以提高患者的安全。 这项拟议的研究具有创新性，因为它将家庭安全报告从研究扩展到操作员- 国家现实环境；将患者/家庭安全报告与有缺陷的现有VIR进行比较；并由 联合制作原则、传播学、健康素养和组织行为学。它还涉及到 一种分享经验教训的新战略，确保以一种方式采取行动改善患者安全 这对患者和家属来说很重要。最后，它关注的是安全和公平之间的交集。这 研究将达到我们的长期目标，与家庭共同制定以证据为基础的策略，使住房- 医院护理更安全、更高质量、更公平，符合AHRQ的使命。它涉及多个优先事项 AHRQ强调，包括儿童(优先人口)、安全和公平(SEN NOT-HS-21-014)。

PROJECT SUMMARY/ABSTRACT Hospitals ineffectively examine the safety of their processes by relying on voluntary incident reporting (VIR) by clinical staff who are overworked and afraid to report. VIR captures only 1-10% of events, excludes patients and families, and underdetects events in vulnerable groups like patients with language barriers. Patients and families are vigilant partners in care who are adept at identifying errors and AEs. Failing to actively include pa- tients and families in safety reporting and instead relying on flawed VIR presents an important missed oppor- tunity to improve safety. To improve hospital safety, there is a critical need to coproduce (create in partnership with families) effective systems to identify uncaptured errors. Without this information, hospitals are impeded in their ability to improve patient safety. In partnership with diverse families, nurses, physicians, and hospital lead- ers, we created a multicomponent communication intervention to engage families of hospitalized children in safety reporting. Known as FACES (“Family Activation and Communication about Errors and Safety”), the in- tervention includes 3 elements: (1) a Spanish and English mobile (email, text, and QR-code) FACES reporting tool prompting families to share concerns and suggestions about safety, (2) family/staff education, and (3) a process for sharing family reports with the unit and hospital so systemic issues can be addressed. After pilot- ing FACES in one inpatient unit, we saw marked improvements in family safety reporting and reductions in dis- parities in reporting by parent education and language. We now propose to conduct an RCT of FACES in 4 geographically, ethnically, and linguistically diverse hospitals. Our specific aims are to: (1) evaluate the effec- tiveness of FACES in improving error detection and other safety outcomes, (2) assess the impact of FACES on disparities in reporting, and (3) understand contextual factors contributing to successful implementation of FACES. If effective, FACES will contribute by: (1) increasing patient/family engagement in reporting, espe- cially from vulnerable groups, (2) identifying otherwise unrecognized events, and (3) enabling hospitals to bet- ter understand safety problems in a 360-degree manner and design more effective, patient-centered solutions. This is significant because hospitals need to identify medical errors reliably in order to improve patient safety. The proposed research is innovative because it extends family safety reporting from the research to the oper- ational real-world context; compares patient/family safety reporting to flawed existing VIR; and is informed by principles of coproduction, communication science, health literacy, and organizational behavior. It also involves a novel strategy to share learnings, ensuring concerns are acted upon to improve patient safety in a manner that matters to patients and families. Finally, it focuses on the intersection between safety and equity. This study will achieve our long-term objective to coproduce with families evidence-based strategies to make hos- pital care safer, higher quality, and more equitable, in line with AHRQ's mission. It intersects multiple priorities highlighted by AHRQ, including children (a priority population), safety, and equity (SEN NOT-HS-21-014).