When I think about quality improvement (QI), I usually think of it as improving patient safety in the narrowest way. For instance, you can use QI to decrease the number of medication errors or to improve the proportion of patients who have their blood pressure checked manually if the original blood pressure is abnormal.
An article that approaches QI to improve patient and family involvement in family-centered rounds looks at QI in a broader sense than I had considered it. This week, Pediatrics is early releasing this Quality Report entitled, “Using Quality Improvement Science to Promote Reliable Communication During Family-Centered Rounds,” by Dr. Alexander Glick and colleagues at New York University Langone Health (10.1542/peds.2021-050197).
When you think about it, a large part of QI is improving communication. When the pharmacist, nurse, and I communicate well with each other, either through the medical record or verbally, there is less chance of a medication error.
Also, when you think about it, good communication with the family, so that they know what we are concerned about and vice versa, improves patient care and safety.
Therefore, using QI to improve communication during family-centered rounds makes total sense.
This team used QI processes (Plan-Do-Study-Act cycles) to improve in 3 areas, with the goal of incorporating these into family-centered rounds at least 80% of the time:
- Discussing with the family risk factors and strategies to prevent hospital-acquired conditions. Examples include pressure ulcers, thromboembolisms, and patient falls.
- Discussing discharge planning with the family, so that the family understood what was required before the patient could be discharged. For example, the patient needs to have a certain number of doses of antibiotics, or home nursing needs to be arranged.
- Asking families if they have questions.
While we cannot go into all of the details in this blog, the team used strategies such as education of providers, standardization of note templates, and weekly feedback to improve their processes.
The results of this QI project are impressive. They achieved their goals at well over 85% of rounds, and >90% of parents interviewed said that the team spoke in understandable language. There was also no prolongation of the duration of rounds.
The authors do note that, approximately 40% of the time, parents were not present when the team came to round on the patient. There are also challenges that were not necessarily reflected in the metrics used for this study. For instance, some families may not feel empowered to ask questions (even when asked) or may think of questions after the team has left. Some families may have limited proficiency in English. At our hospital, there is a white board in each patient’s room, where parents can write questions as they think of them, and where the team can write notes about the plan for the day or discharge planning goals.
Think about what happens when you round on patients. Talk with your team about ways that you can improve communication with your patients and families. Can you use QI to help you improve these processes?