A new way to curb harmful medical errors: talk more to patients and families

A new study suggests a simple idea could go a long way toward curbing dangerous medical errors: looping in patients and families about what’s happening with their care.

It’s the latest evidence on the benefits of a long-running program to improve and streamline communications in hospitals. Called I-PASS, it was born at Boston Children’s Hospital and has since spread to dozens of hospitals around the country.

Previous studies have shown that the intervention can reduce medical errors when one provider hands off a patient’s care to another provider at the end of a shift. Now, a study published Thursday in the BMJ finds that after that idea was extended to communication with patients and their families, harmful medical errors fell by 38 percent.

“Families are a really valuable, but sometimes underrecognized, part of care,” said Dr. Alisa Khan, a Boston Children’s pediatrician and Harvard Medical School professor who led the study.

The Patient and Family Center I-PASS intervention focuses on rounds, daily meetings when physicians, doctors-in-training, and sometimes nurses talk about a hospitalized patient’s condition and the plan for care. It starts with heading to a patient’s bedside and right off the bat, asking if the patient or family has any questions or concerns. Then, health care providers are supposed to give updates and go over the treatment plan in a way that minimizes medical jargon and makes everything clear. There’s a structure for that conversation set out, and at the end, patients and families are asked to “read back” what they understood about the care plan.

“We often assume understanding without confirming it,” Khan said.

Khan and her colleagues taught providers at seven academic medical centers in the U.S. the ins and outs of the program. Families were introduced to the idea with a brochure and an explanation, often when a patient was admitted.

Then, they set out to see whether it might make a difference. Research clinicians combed through the charts of each patient and reviewed them for medical errors, asked staff about any errors they observed, and reviewed the hospital’s incident reporting system. And true to the I-PASS mission, they also got families in on the effort. A research assistant interviewed families about medical errors before discharge, or for longer-term patients, every seven days.

The overall rate of medical errors — both harmful and non-harmful errors — didn’t change. But the rate of harmful errors — also known as preventable adverse events — fell by 38 percent in the three months after the intervention was implemented. Those errors can range from incorrect drug doses and lost patient samples to delays in consultations with specialists. There were roughly 20 harmful errors in the time frame studied before the intervention, compared to roughly 13 in the three months after the implementation period.

Families were also more likely to share concerns, and nurses were more engaged in rounds. More people felt like they were part of the care team, Khan said.

And despite concerns the process might make rounds take longer, Khan and her colleagues didn’t find any evidence that was the case.

The researchers are hopeful the intervention could help cut the rate of medical errors in other hospitals. But making that happen requires a shift in thinking, she said.

“It’s a big culture change to say that rounds are not just for physicians,” she said, “but about the patient and the family.”