A study of interactions between families and healthcare providers published in the BMJ this month sparked my interest. It showed that improving communication between the two groups reduced harmful medical errors by 39%.
As if that vast reduction in medical errors weren’t enough, it was caused by harnessing the input of team members who don’t cost facilities a penny. In an era of intense financial pressures for the industry, free team members are a gift that shouldn’t be overlooked.
According to the researchers, the study “indicates that improving communication between families and healthcare providers doesn’t just feel good, it can help improve the safety and quality of care.”
In Editor Jim Berklan’s excellent blog post last month, he points out research that shows that families “don’t know what they’re talking about” when it comes to loved ones’ end-of-life care preferences. (If that’s so, we as experts should be facilitating Care Conversations.)
While family members may fall short on end-of-life wishes, they’re generally more expert than we are on their parents’ medical history and behavior. They know that their father didn’t react well to a particular medication when he took it at home or that Mom is “acting funny,” even if they don’t know why.
I myself have gone to the nursing station with the complaint that a resident is “off” somehow and been dismissed in my concerns, to the detriment of the resident’s health. Over the years, I’ve learned that I should phrase it as a “change in mental status” and to speak in a tone that conveys the depth of my experience and the seriousness of my observations, but basically I’m saying that the resident is “acting funny” and it seems physical, not psychological. I’ve detected sepsis, strokes and other emergencies this way.
If the nurses aren’t receptive to perhaps poorly-phrased information from psychologists, recreation therapists and other non-medical personnel, they may also be missing valuable information from families.
The BMJ study shows how we can train staff to be more responsive to family input.
The research took place in a pediatric hospital unit, an environment similar to today’s rehab units in that patients/residents may be very ill and family members tend to be present and involved.
They created “family-centered rounds” based on the acronym I-PASS. The rounds were a structured conversation between families, nurses, doctors and other staff members that focused on:
I – Illness severity (family reports if patient was better, worse, or same); nurse input solicited
P – Patient summary (brief summary of patient presentation, overnight events, plan)
A – Action list (to-dos for day)
S – Situation awareness and contingency planning (what family and staff should look out for and what might happen)
S – Synthesis by receiver (family reads back key points of plan for day, prompted by presenter, supported by nurse as needed)
Of note in these discussions was that the families spoke first, plain language rather than medical terminology was used (for example, fever versus febrile), and a written synopsis was provided. Researchers found that the structured conversations didn’t take longer than the format they had previously used.
While the research intervention was developed for children and their parents, family-centered rounds on a rehab unit should consider that the resident is an adult and often perfectly capable of being the team member who speaks first, provides information and delivers the concluding synthesis of the discussion.
Family-centered rounds seem not only doable but also essential on short-term rehab units where residents may be in a period of acute illness and have not yet established the types of relationships with staff members where changes in behaviors are immediately noticeable.
If you were hoping for a great holiday present this year, family-centered rounds might be just that gift. They’re a way to get free help, reduce harmful medical errors and their attendant lawsuits, and to partially compensate for the high turnover that makes such errors more likely to occur. If you’re intrigued, check out the four-minute video about the project on the BMJ website.
Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with over 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.