Stories about: patient safety

Quick Note: Improving nighttime communications in the hospital

hospital communications

It’s now well known that breakdowns in communications are a leading cause of hospital medical errors, contributing to more than 60 percent of serious adverse events. Efforts such as I-PASS, which standardize communications during patient “handoffs,” have cut harmful medical errors by 30 percent.

But nighttime care, which evidence suggests is particularly error-prone, has been somewhat overlooked. Researchers at Boston Children’s Hospital, led by Alisa Khan, MD, MPH and Christopher Landrigan, MD, MPH, also wanted to incorporate parents’ experience, which had been missing in nighttime communications when families were asleep. In this study in Academic Pediatrics, Khan, Landrigan and colleagues prospectively evaluated a family-centered, multidisciplinary nighttime communication intervention.

The intervention was developed with input from parents, nurses and medical residents, as well as the hospital’s Family Advisory Council, residency program and nursing leadership. It consisted of a short, early-evening nurse–physician briefing session at about 7:30 p.m.; a bedside, family-centered huddle in I-PASS format between 8 and 9 p.m.; and, for selected patients, a nightly family update sheet.

The team prospectively followed patients, parents and nighttime providers on two pediatric inpatient units at Boston Children’s. They surveyed parents and providers both pre-intervention (May-October 2013) and post-intervention (May-October 2014) and compared their answers.

The intervention wasn’t fully adopted by staff, but it did improve some aspects of communication. Providers’ experience improved in several domains. Parents reported more of a sense of shared understanding with nurses and a better experience communicating with nighttime doctors.

But several communication parameters did not improve, highlighting the importance of continued family involvement in research and design of the interventions. The ongoing multicenter Patient and Family Centered I-PASS Study is now testing several enhancements.

New study finds gun laws save lives: Q & A with lead author

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Firearm legislation is a contentious issue in this country. But researchers at Boston Children’s Hospital hope their new study may help shed some light on the topic. The narrative review, published in the November 14 issue of JAMA Internal Medicine found that stronger firearm laws are associated with reductions in firearm homicide rates.

Notes sat down with lead author Lois Lee, MD, MPH, of Boston Children’s Hospital’s Division of Emergency Medicine and Harvard Medical School to discuss the study’s findings and the implications of firearm safety on pediatric practice.

Q: What was the main takeaway of your study?

Lee: Overall, we found evidence that stronger firearm laws are associated with decreased homicides due to firearms. We grouped the laws into five general categories:

  • Laws that strengthened background checks
  • Laws that curbed firearm trafficking
  • Laws that improved child safety, including child access laws, laws requiring trigger mechanisms, and laws that imposed age restrictions for gun purchases and use
  • Laws banning military-style assault weapons
  • Laws restricting firearms in public places

Specifically, the laws that seemed to have the most effect were those that strengthened background checks and those that required a permit to purchase a firearm. …Read More

Does this nurse know my child? Continuity of nursing care in the PICU: Challenges and opportunities

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When Jennifer Baird, PhD, MSW, RN, set out to study best practices in nursing in the pediatric intensive care unit (PICU), she didn’t know where the project would take her. “I intentionally left it open-ended,” she explains. “It was essentially an ethnographic study; I observed interactions between nurses and families over the course of a year, and also interviewed them separately.”

Baird, who is finishing up her Harvard-Wide Pediatric Health Services Research Fellowship at Boston Children’s Hospital, conducted her research in 2013 at a hospital in the Los Angeles, California area. Even though it wasn’t an explicit question, every single family brought up the subject of nursing continuity. “There was a story there,” says Baird, who published her findings this spring in Nursing Research, “And I needed to follow it.”

The story turned out to be complicated. …Read More

The patient’s bedside is no place for the passive voice

boy holding hands over his ears passive voice medical communications
(Sabphoto/Shutterstock)

Read a medical journal, guideline or progress note and most often you will find yourself reading sentences in the passive voice. “The infant is placed in the lateral decubitus position.” “The catheter should be removed as soon as it is no longer necessary.” “The treatment options were explained to the patient.” These snippets are typical examples of how the medical community has been taught to write, purportedly serving to protect anonymity and set an impassive, professional tone.

While this stylistic standard may have its role in formal medical writing, it introduces a host of concerns at the bedside. Compared to the active voice, the passive voice tends to be less interesting, less forceful and most importantly for patient safety and quality of care, less clear. …Read More

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