Implementing a Family-Centered Rounds Intervention Using Novel Mentor-Trios.
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Khan Alisa, Patel Shilpa J, Anderson Michele, Baird Jennifer D, Johnson Tyler M, Liss Isabella, Graham Dionne A, Calaman Sharon, Fegley April E, Goldstein Jenna, O'Toole Jennifer K, Rosenbluth Glenn, Alminde Claire, Bass Ellen J, Bismilla Zia, Caruth Monique, Coghlan-McDonald Sally, Cray Sharon, Destino Lauren A, Dreyer Benard P, Everhart Jennifer L, Good Brian P, Guiot Amy B, Haskell Helen, Hepps Jennifer H, Knighton Andrew J, Kocolas Irene, Kuzma Nicholas C, Lewis Kheyandra, Litterer Katherine P, Kruvand Elizabeth, Markle Peggy, Micalizzi Dale A, Patel Aarti, Rogers Jayne E, Subramony Anupama, Vara Tiffany, Yin H Shonna, Sectish Theodore C, Srivastava Rajendu, Starmer Amy J, West Daniel C, Spector Nancy D, Landrigan Christopher P, Patient and Family Centered I-PASS SCORE Study Group
Аннотация
METHODS: Hybrid Type II effectiveness-implementation study from 2/29/19-3/13/22 with ≥3 months of baseline and 12 months of postimplementation data collection/site across 21 US community and tertiary pediatric teaching hospitals. We conducted rounds observations and surveyed nurses, physicians, and Arabic/Chinese/English/Spanish-speaking patients/parents.
RESULTS: We conducted 4557 rounds observations and received 2285 patient/family, 1240 resident, 819 nurse, and 378 attending surveys. Adherence to all I-PASS components, bedside rounding, written rounds summaries, family and nurse engagement, and plain language improved post-implementation (13.0%-60.8% absolute increase by item), all P < .05. Except for written summary, improvements sustained 12 months post-implementation. Resident-reported harms/1000-resident-days were unchanged overall but decreased in larger hospitals (116.9 to 86.3 to 72.3 pre versus early- versus late-implementation, P = .006), hospitals with greater nurse engagement on rounds (110.6 to 73.3 to 65.3, P < .001), and greater adherence to I-PASS structure (95.3 to 73.6 to 72.3, P < .05). Twelve of 12 measures of staff safety climate improved (eg, "excellent"/"very good" safety grade improved from 80.4% to 86.3% to 88.0%), all P < .05. Patient/family experience and teaching were unchanged.
CONCLUSIONS: Hospitals successfully used Mentor-Trios to implement PFC I-PASS. Family/nurse engagement, safety climate, and harms improved in larger hospitals and hospitals with better nurse engagement and intervention adherence. Patient/family experience and teaching were not affected.