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

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Patient and Family Centered I-PASS (PFC I-PASS) improved communication and safety in pediatric hospitals. The Mentor-Trio approach enhanced nurse and family engagement, leading to reduced patient harms, particularly in larger facilities.

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Area of Science:

  • Healthcare quality improvement
  • Patient safety research
  • Implementation science in pediatrics

Background:

  • Patient and Family Centered I-PASS (PFC I-PASS) promotes family engagement, health literacy, and structured communication during family-centered rounds.
  • The I-PASS framework (Illness severity-Patient summary-Action items-Situational awareness-Synthesis by receiver) guides these rounds.
  • A novel "Mentor-Trio" implementation approach utilized multidisciplinary parent-nurse-physician teams to coach participating sites.

Purpose of the Study:

  • To assess the adherence, safety, and patient/family experience outcomes following the implementation of PFC I-PASS.
  • To evaluate the effectiveness of the Mentor-Trio implementation strategy across diverse pediatric hospitals.
  • To identify factors associated with improvements in safety and adherence.

Main Methods:

  • A Hybrid Type II effectiveness-implementation study was conducted from February 2019 to March 2022.
  • Data were collected from 21 US pediatric teaching hospitals, including community and tertiary centers.
  • Methods included direct observation of rounds and surveys of nurses, physicians, and patients/families across multiple languages.

Main Results:

  • Adherence to PFC I-PASS components, bedside rounding, and family/nurse engagement significantly improved post-implementation (13.0%-60.8% increase).
  • Resident-reported harms decreased in larger hospitals, those with greater nurse engagement, and higher I-PASS adherence.
  • Staff safety climate scores improved across all 12 measures, with no significant changes in patient/family experience or teaching.

Conclusions:

  • The Mentor-Trio approach was successful in implementing PFC I-PASS across pediatric hospitals.
  • Improvements in engagement, safety climate, and reduced harms were associated with hospital size, nurse engagement, and intervention adherence.
  • PFC I-PASS implementation did not negatively impact patient/family experience or teaching, suggesting a net benefit for patient safety and communication.