Harmful medical errors can cause serious damage to a patient’s health and may result in a medical malpractice suit for the physician. Patients or family members can sue a physician or hospital over a number of errors, including failure to accurately diagnose or treat illness, or even errors in patient management, according to the American Board of Professional Liability Attorneys. However, a study published in BMJ, outlines an intervention method that proved to significantly reduce harmful medical errors in institutions where it was implemented. Mid-shift afternoon and overnight nurse-physician huddles were scheduled to address patient care issues and family concerns. Improved communication between physicians, nurses, and patient families may reduce the incidence of harmful medical errors and perhaps lower the risk of malpractice claims. Researchers tested an intervention designed to do exactly this in seven academic hospitals throughout North America and found that their intervention reduced the incidence of harmful medical errors by nearly 40%, without increasing the average time for morning rounds with each patient. They did this by increasing communication between healthcare staff and patients and family members through the implementation of the I-PASS method: I: Illness severity. Solicit both family reports on child’s illness (ie, whether the child is better, worse, or the same) and bedside nurse input. P: Patient summary. Provide a brief summary on how the patient presents, what happened overnight, and plans for the day. A: Action list. Present a list of action items planned for the day. S: Situation awareness and contingency planning. Explain to family and staff what to look for and what may happen. S: Synthesis by receiver. Family is asked to read back the key points of the plan for the day by the health care provider, with support from the bedside nurse as needed. “Our study highlights what we in Pediatrics have always suspected—that including patients and families in shared decision-making during rounds not only increases patient and family satisfaction, but also improves patient safety,” said co-author Army Maj. Jennifer H. Hepps, MD, associate professor, Department of Pediatrics, Uniformed Services University of the Health Sciences (USU), primary investigator, Walter Reed National Military Medical Center (WRNMMC), and director, National Capital Consortium Transitional Internship Program, Bethesda, MD. According to a study done in 2016 by researchers from Johns Hopkins University, Baltimore, MD, 10% of all US deaths are due to medical errors. Furthermore, the third highest cause of death in the United States is medical errors. In addition, statistic show that approximately 15,000 to 19,000 medical malpractice suits are filed each year, and researchers at Massachusetts General Hospital, Boston, MA, found that most medical doctors will face a lawsuit during their professional careers. Consequently, any strategy or plan to reduce medical errors would be welcomed. Medical errors are a significant cause of mortality and patient harm, and faulty communications can be significant contributing factors to errors. Dr. Hepps and colleagues, therefore, hypothesized that improved communications between physicians, nurses, and families may improve the overall understanding of patients and their conditions among team members. Thus, USU and WRNMMC researchers developed the intervention, called the Patient and Family Centered I-PASS, in conjunction with the Patient and Family Centered I-PASS Study Team. Morning rounds, typically done outside of patients’ rooms each day to review care plans and with minimal patient involvement, were the focus. Family engagement, structure communications, and health literacy, with minimal medical jargon became the emphasis during rounds between doctors, nurses, and patient families. Researchers conducted the study in the general pediatric inpatient units of seven academic hospitals in North America from December 2014 to January 2017. The 9-month intervention was comprised of changes to both verbal and written communications during morning round reviews. Structured communications during rounds were based on the I-PASS mnemonic, outlined above. Mid-shift afternoon and overnight nurse-physician huddles were scheduled to address patient care issues and family concerns. Data from 3,106 patient admissions, 2,148 parents, 435 nurses, 586 residents, and 203 medical students were included, as well as 2,034 family safety interviews, 1,224 family experience surveys, and 654 observations of rounds. Although the overall medical error rate did not change significantly (P=0.21), the rate of harmful medical errors decreased significantly by 38% after the I-PASS program was implemented, from 20.7 to 12.9 per 1,000 patient days (P=0.01). Non-preventable adverse events also decreased significantly (12.6 vs 5.2 per 1,000 patient days; P=0.003). In addition, several aspects of patient hospital experiences and communication improved, and families and nurses became significantly more engaged. Family assessment of understanding on rounds improved from 53.9% to 62.8% (P=0.03), as did their understanding of written updates (46.5% to 57.9%; P=0.04). Family experience with nurses also improved, but there were no significant improvements in family experience with physicians. Interestingly, family-centered rounds occurred more frequently after the intervention (72.2% vs 82.8%; P=0.02), but the average duration of rounds per patient did not change significantly (8.5 vs 10.2 minutes; P=0.13). “Our findings suggest that implementing a standardized, structured program to improve communication with patients, families, and the interprofessional team on rounds could improve patient safety and other outcomes. Our findings also provide an evidence base that supports calls by physician, nursing, and family advocacy organizations to improve the family centeredness of care,” concluded Dr. Hepps and colleagues. This study was supported by the Patient Centered Outcomes Research Institute. Source
