Bedside Notes: A Multicenter Trial to Improve Family Clinical Note Access and Outcomes for Hospitalized Children

Hospitalized children experience harm from medical errors at a rate three times higher than adults, highlighting the urgent need for clinicians and caregivers to collaborate in sharing information to prevent potential errors. Clinical notes, which detail a child’s diagnoses, treatments, and contingency plans, can help caregivers identify safety issues. Yet, fewer than 10 percent of caregivers access these notes during their child’s hospitalization. Caregivers are uniquely positioned to identify emerging concerns and can play a vital role in ensuring their child’s safety. However, their engagement is often limited by challenges such as sleep deprivation, unfamiliarity with clinical staff, and the overwhelming amount of information provided during brief interactions with clinicians. Despite the 21st Century Cures Act mandating the sharing of clinical notes, barriers such as limited technology access, awareness, and usability impede utilization. To address these issues, researchers developed the Bedside Notes intervention, providing real-time access to clinical notes via a bedside tablet and an orientation video. This intervention has been associated with a more than tenfold increase in caregiver access to notes and improved hospital experience, while also leading to identification of unique and actionable safety concerns in pilot studies. This study builds on prior research and refines the Bedside Notes intervention by expanding its testing across three diverse hospital sites with multiple electronic health record (EHR) vendors and including Spanish-speaking caregivers, allowing for a more comprehensive evaluation of its impact on note access, caregiver engagement, hospital experience, and identification of safety issues.

The specific aims of the research are as follows:

• Assess the impact of the Bedside Notes intervention on caregiver access to clinical notes.
• Evaluate the effectiveness of note access to improve caregiver engagement, overall inpatient experience, anxiety, and identification of safety concerns.
• Identify contextual factors contributing to caregiver use of and hospital staff receptivity to the Bedside Notes intervention.

The researchers will conduct a randomized controlled trial (RCT) to evaluate the effectiveness of the Bedside Notes intervention. The study will include English- and Spanish-speaking caregivers of children under 12 years old who are admitted to pediatric services at three hospitals. Caregivers will be randomized into two groups: one group accessing clinical notes on their personal devices through the patient portal, and the other accessing notes via a bedside tablet with an orientation video. Using a mixed-methods approach, including EHR audit reports, surveys, and interviews, the study will assess parent engagement, experiences and identification of inpatient safety issues, providing insights to guide broader implementation.

This research aims to advance pediatric inpatient care by leveraging digital health tools to reduce medical errors and associated harm in children. As the first RCT of its kind, the study will assess the effectiveness of the Bedside Notes intervention in increasing caregivers’ access to clinical notes and its influence on caregiver involvement, hospital experiences, and identification of unique and actionable safety issues in pediatric hospitals. With an innovative design featuring a multisite RCT, integration with major EHR systems (Epic and Cerner), and guidance from a national Pediatric OpenNotes advisory group, the study ensures scalability and broad applicability. Building on preliminary work, the researchers hypothesize that improving caregivers access to clinical notes will enhance hospital experience, increase caregiver engagement, and support the identification of actionable safety issues that can be used to reduce medical harm in children. Researchers will disseminate their findings through peer-reviewed publications, national conferences, and a publicly accessible toolkit, as they aim to reshape family-centered care practices and guide future digital health innovations for safer, higher-quality pediatric care.