Implementing a Family-Centered Rounds Intervention Using Novel Mentor-Trios

Alisa Khan; Shilpa J Patel; Michele Anderson; Jennifer D Baird; Tyler M Johnson; Isabella Liss; Dionne A Graham; Sharon Calaman; April E Fegley; Jenna Goldstein; Jennifer K O'Toole; Glenn Rosenbluth; Claire Alminde; Ellen J Bass; Zia Bismilla; Monique Caruth; Sally Coghlan-McDonald; Sharon Cray; Lauren A Destino; Benard P Dreyer; Jennifer L Everhart; Brian P Good; Amy B Guiot; Helen Haskell; Jennifer H Hepps; Andrew J Knighton; Irene Kocolas; Nicholas C Kuzma; Kheyandra Lewis; Katherine P Litterer; Elizabeth Kruvand; Peggy Markle; Dale A Micalizzi; Aarti Patel; Jayne E Rogers; Anupama Subramony; Tiffany Vara; H Shonna Yin; Theodore C Sectish; Rajendu Srivastava; Amy J Starmer; Daniel C West; Nancy D Spector; Christopher P Landrigan; Patient and Family Centered I-PASS SCORE Study Group

doi:10.1542/peds.2023-062666

Implementing a Family-Centered Rounds Intervention Using Novel Mentor-Trios

Pediatrics. 2024 Jan 1;153(2):e2023062666. doi: 10.1542/peds.2023-062666.

Authors

Alisa Khan^#^{1

2}, Shilpa J Patel^#^{3

4}, Michele Anderson^{5

6}, Jennifer D Baird⁷, Tyler M Johnson¹, Isabella Liss¹, Dionne A Graham^{2

8}, Sharon Calaman⁹, April E Fegley¹⁰, Jenna Goldstein¹⁰, Jennifer K O'Toole¹¹, Glenn Rosenbluth^{12

13}, Claire Alminde¹⁴, Ellen J Bass¹⁵, Zia Bismilla¹⁶, Monique Caruth⁶, Sally Coghlan-McDonald^{6

13}, Sharon Cray^{6

17}, Lauren A Destino^{18

19}, Benard P Dreyer²⁰, Jennifer L Everhart^{18

19}, Brian P Good²¹, Amy B Guiot²², Helen Haskell^{6

23}, Jennifer H Hepps²⁴, Andrew J Knighton²⁵, Irene Kocolas²¹, Nicholas C Kuzma^{26

27}, Kheyandra Lewis^{26

27}, Katherine P Litterer^{6

28}, Elizabeth Kruvand^{6

29}, Peggy Markle^{6

30}, Dale A Micalizzi⁶, Aarti Patel³¹, Jayne E Rogers³², Anupama Subramony³³, Tiffany Vara^{4

6}, H Shonna Yin³⁴, Theodore C Sectish^{1

2}, Rajendu Srivastava^{21

25}, Amy J Starmer^{1

2}, Daniel C West^{35

36}, Nancy D Spector^{26

27

37}, Christopher P Landrigan^{1

2

38

39}; Patient and Family Centered I-PASS SCORE Study Group

Affiliations

¹ Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
² Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
³ Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii.
⁴ Kapi'olani Medical Center for Women and Children, Hawaii Pacific Health, Honolulu, Hawaii.
⁵ Family Centered Care Department, Lucile Packard Children's Hospital Stanford, Palo Alto, California.
⁶ Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts.
⁷ Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California.
⁸ Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts.
⁹ Division of Pediatric Critical Care, NYU Langone Health/Hassenfeld Children's Hospital, NYU Grossman School of Medicine; New York City, New York.
¹⁰ Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania.
¹¹ Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio.
¹² Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California.
¹³ Benioff Children's Hospital, San Francisco, University of California San Francisco School of Medicine, San Francisco, California.
¹⁴ Department of Nursing, St Christopher's Hospital for Children, Philadelphia, Pennsylvania.
¹⁵ Department of Information Science in the College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania.
¹⁶ Departments of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
¹⁷ Patient Safety and Quality Improvement Committee, St Christopher's Hospital for Children, Philadelphia, Pennsylvania.
¹⁸ Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
¹⁹ Lucile Packard Children's Hospital Stanford, Palo Alto, California.
²⁰ Department of Pediatrics, New York University Grossman School of Medicine, New York, New York.
²¹ Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah.
²² Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
²³ Mothers Against Medical Error, Columbia, South Carolina.
²⁴ Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
²⁵ Healthcare Delivery Institute, Intermountain Health, Murray, Utah.
²⁶ Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania.
²⁷ Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania.
²⁸ Office of Experience, Boston Children's Hospital, Boston, Massachusetts.
²⁹ SSM Health Cardinal Glennon Children's Hospital, St Louis, Missouri.
³⁰ Walter Reed National Military Medical Center, Bethesda, Maryland.
³¹ Department of Pediatrics, University of California San Diego, Rady Children's Hospital, San Diego, California.
³² Department of Nursing, Boston Children's Hospital, Boston, Massachusetts.
³³ Department of Pediatrics, Cohen Children's Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, New York.
³⁴ Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, New York.
³⁵ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
³⁶ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
³⁷ The Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program, Philadelphia, Pennsylvania.
³⁸ Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts.
³⁹ Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts.

^# Contributed equally.

PMID: 38164122
DOI: 10.1542/peds.2023-062666

Abstract

Background and objectives: Patient and Family Centered I-PASS (PFC I-PASS) emphasizes family and nurse engagement, health literacy, and structured communication on family-centered rounds organized around the I-PASS framework (Illness severity-Patient summary-Action items-Situational awareness-Synthesis by receiver). We assessed adherence, safety, and experience after implementing PFC I-PASS using a novel "Mentor-Trio" implementation approach with multidisciplinary parent-nurse-physician teams coaching sites.

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.

MeSH terms

Child
Communication
Hospitals, Teaching
Humans
Language
Mentors*
Parents
Teaching Rounds*