Family Centered Hospital Communications: Not Just for Pediatric Patients
At different points in my caregiving journey with my parents, the thought has crossed my mind that this role is very much like caring for children. I don't mean this in a pejorative or demeaning way. I believe that many approaches to child care can be applied productively to other vulnerable populations, such as individuals with dementia and Alzheimer's disease. Yet, it seems like multi-generational, "cross-pollination" of best practices hasn’t occurred widely.
I recently learned about a study at Boston Children's Hospital which is described as a family-centered hospital rounding process. One of the premises of the I-PASS study is that family-centered communication could reduce medical errors in the pediatric setting. Traditionally, doctors' rounds occur without directly involving young patients or their parents.
Family Centered Hospital Communications & Seniors
As I read more about this work that was funded by the Patient-Centered Outcomes Institute (PCORI), I found myself thinking that the I-PASS program would have been a godsend for me when both of my parents were hospitalized for various issues.
If family-centered communications can reduce medical errors for children, why not for older patients? Think about it from the seat of an adult child caregiver – Your elderly mother or father is in the hospital. They have dementia or Alzheimer's and are unable to reliably convey their medical history. They may or may not be able to communicate accurately about their current condition. You have a job and you can't sit bedside around the clock, but the doctors often make their rounds early in the morning or late in the day. How do you get comprehensive, consistent updates about your parent's condition? In my case, I did spend hours and hours sitting at by my Mom's or Dad's bedside, waiting to talk to the doctors.
Key Components of the I-PASS Program
The I-PASS program at Boston Children's is designed around the concept of family-centered rounds. It has four key components:
Checks to ensure that the rounding process includes patients and parents.
Each day, the clinical team discusses the important aspects of the patient's care.
Each day, parents receive a write-up, summarizing the findings of the daily rounds.
Staff are trained on how to conduct family-centered rounds.
The I-PASS process focuses on five stages:
Illness severity: The family provides input about their child's current condition, compared to the prior day. Nurses also provide information.
Patient summary: The clinical team provides a synopsis of the patient's condition.
Action list: The clinical team shares the care plan for the day.
Situation awareness and contingency planning: Family members and the care team discuss what they should look for with regard to the patient's condition. The group also shares information about potential developments.
Synthesis by the receiver: Family members read back the key points of the day's care plan.
I-PASS: Implications for Adult Caregivers and Medicare Populations
Again, reflecting back on my experience as a caregiver, I think this process would have dramatically improved the hospital experience.
Taking a collaborative approach to patient care breaks down barriers between families and the clinical team. Rather than feeling like they are at the mercy of the clinical team's schedule, families become active participants in the care team and feel more in control.
Feedback from the family about the patient's condition is also valuable to clinicians.
Ensuring that family members understand the care plan for the day ensures that everyone is "on the same page" in terms of what will happen over the next 24 hours.
The results of the Boston Children's I-PASS program have been encouraging:
Harmful medical errors which are defined as preventable adverse effects decreased by 38%. Improved patient safety is a desirable outcome for all types of populations. If hospitals applied I-PASS to elderly patient populations, it might be possible to reduce hospital readmissions which result in Medicare reimbursement penalties.
The rounding process took approximately the same amount of time as before. This finding should lower institutional resistance to adopting I-PASS more widely.
Families at Boston Children's reported an improvement in their hospital experience and in the hospital's communication processes. This could pay dividends for hospitals if they expanded I-PASS to geriatric patient populations. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is required by the Centers for Medicare and Medicaid Services for all U.S. hospitals. This patient satisfaction survey includes questions related to various factors, including doctor and nurse communication. The survey results have a direct impact on hospital reimbursements for Medicare services. It's highly likely that families of dementia and Alzheimer's patients complete this survey for their relatives. Implementing I-PASS for these populations could improve family and patient satisfaction, patient outcomes, and the bottom line for hospitals.
It is my sincere hope that hospitals will begin applying family-centered care and communication principles to vulnerable patients in all demographic groups. With I-PASS, for example, there are no "losers" – families and patients win and hospitals have the potential to improve Medicare reimbursements through higher patient satisfaction ratings and better patient outcomes.
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