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December 13, 2018

The evidence-backed way to cut harmful medical errors by nearly 40%

Daily Briefing

    Hospital rounds are often viewed as a provider activity, but getting patients and their families involved in the conversations can increase communication and significantly reduce harmful medical errors, according to a study published last week in BMJ.

    Study details

    The study examined the effectiveness of a program called I-PASS, which originated at Boston Children's Hospital's Patient and Family Center, STAT News reports. According to the Boston Globe, the program encourages family-centered rounds, which are designed to involve patients and families in medical conversations. During such rounds, providers are encouraged to limit their use of medical jargon and discuss patients' treatment plans, the Globe reports.

    Alisa Khan—a pediatrician at Boston Children's, a Harvard Medical School professor, and the leader of the study—taught the I-PASS intervention program to seven academic medical centers. Patients and their families also were given an overview of the program, along with a brochure on the program when the patient was admitted.

    To measure the program's efficacy, researchers searched patients' medical charts and hospitals' incident reporting systems for medical errors. Researchers also interviewed families every seven days and asked about medical errors.

    The results

    According to the researchers, the study "highlights ... that including patients and families in shared decision-making during rounds not only increases patient and family satisfaction, but also improves patient safety" without detracting from physicians' daily schedules.

    The researchers found that the rate of total medical errors at hospitals involved in the study did not change after implementing I-PASS. However, they found that the rate of harmful medical errors decreased by 38%, from 20.7 per 1,000 patient days before implementing I-PASS to 12.9 per 1,000 patient days within three months after implementing the practice, the Globe reports.

    'A big culture change'

    The study is "the first multi-center study showing that when families get actively engaged, safety improves," according to Christopher Landrigan, a senior author of the study and research director of inpatient pediatrics at Boston Children's.

    However, family centered rounds are still uncommon in most hospitals as doctors often fear that the change will be more time-consuming the Globe reports.

    Beth Lown, CMO at the Schwartz Center for Compassionate Healthcare in Boston, said, "[Physicians] have a decision to make." She added, "If I ask this question am I going to end up in a deep conversation? Do I have that time? How many people are waiting in the waiting room? How many discharges do I have."

    But, according to the Globe, the study showed that while families were more likely to share concerns during the family-centered rounds, the new rounds did not take significantly longer to conduct than traditional rounds.

    Other physicians are not averse to family-centered rounds, but such rounds are "just not on their radar," since they are used to conducting rounds separate from the families, Landrigan said.

    "It's a big culture change to say that rounds are not just for physicians, but about the patient and the family," Khan said. "Families are a really valuable, but sometimes under recognized, part of care," she said (Kowalczyk, Boston Globe, 12/7; Thielking, STAT News, 12/6; Uniformed Services University of the Health Sciences release; Khan et al., BMJ, 12/5).

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