Novel IT To Create Patient-Integrated Quality Improvement

Hospital safety remains a major issue in American health care. An estimated 400,000 premature deaths occur annually due to preventable harm, and adverse events occur in one-third of hospital admissions. Prior efforts to improve hospital quality have had relatively little impact, in part due to limited access to timely quality improvement data. Patients and family members are potential sources of meaningful patient safety data. They are often attentive observers of care, with their focus on only one plan of care for one person who is close to them.

This research developed FIQS, the Family Input to Quality and Safety tool, a mobile-responsive website for patient safety reporting. After usability testing, FIQS was pilot tested on the medical-surgical unit of a children’s hospital. Admitted patients 13 and older and their family members were texted daily during the child’s hospitalization to identify safety events they observed. The tool allows users to create safety reports in the categories of medication events, such as timing and dose; communication, such as poor patient-provider and team miscommunication; equipment, such as broken equipment; and unexpected events, such as blocked intravenous lines and tests done incorrectly. These reports were reviewed weekly during a multi-disciplinary on-unit team quality meeting.

The specific aims of the research were as follows:

• Determine the feasibility and acceptability of patient data collection and a provider dashboard. 
• Assess whether reporting patient- and caregiver-observed processes of care to providers leads to changes over time. 
• To assess participant experience with using the tool, with a specific focus on the role of being an observer and reporter of safety events, as well as assessing the pros and cons of making safety reports anonymous. 

Two hundred and thirty-five participants submitted 89 safety reports over the 10-month pilot, of which most were about medication or communication issues. Semi-structured interviews were conducted with a randomly selected sample of study participants and hospital staff, including leadership in healthcare quality. Results from the initial analyses found that, while participants preferred default anonymous reporting, there was general comfort with opting to be identified. Overall, the participants had a positive experience using the tool and endorsed its continued use.

Participant and staff engagement demonstrated the feasibility of using FIQS for collecting real-time safety reports from patient and family members. Additional work remains to understand differences in patient reporting and how to effectively incorporate these data into hospital safety improvement efforts. The researchers plan to translate the tool into Spanish, allow participants identify themselves when submitting a report if they are open to answering followup questions, test the tool in other contexts, and develop best practices regarding how to incorporate patient and family member safety reports into hospital safety efforts.