314 - FACES: A Mobile Family Safety Reporting Intervention for Hospitalized Children with Medical Complexity

Poster Number: 314
Publication Number: 314.322

Alisa Khan, Boston Children's Hospital, Cambridge, MA, United States; Jennifer Baird, Children's Hospital Los Angeles, Los Angeles, CA, United States; Sangeeta Mauskar, Boston Children's Hospital, Southborough, MA, United States; Helen W. Haskell, Mothers Against Medical Error, Macon, GA, United States; Alexandra Mercer, Boston Children's Hospital, Boston, MA, United States; Tiffany Ngo, Boston Children's Hospital, Chelsea, MA, United States; Jay Berry, Boston Children's Hospital, Boston, MA, United States; Katherine Copp, Boston Children's Hospital, Boston, MA, United States; Karen Hennessy, Boston Children's Hospital, Andover, MA, United States; Kate E. Humphrey, Boston Children's Hospital, Vero Beach, FL, United States; Donna Luff, Boston Children's Hospital Simulator Program, Boston, MA, United States; Nandini Mallick, Boston Children's Hospital, Newton, MA, United States; Susan Matherson, Boston Children's Hospital, South Boston, MA, United States; Amanda MCGeachey, Maine Medical Partners, Saco, ME, United States; Patrice Melvin, Boston Children's Hospital, Boston, MA, United States; Amy Pinkham, Boston Children's Hospital, Boston, MA, United States; Bianca Quinones-Perez, Boston Children's Hospital, San Diego, CA, United States; Jayne E. Rogers, Boston Children's Hospital, Natick, MA, United States; Sara J. Singer, Stanford University School of Medicine, Stanford, CA, United States; K. Vish Viswanath, Harvard/Dana-Farber, Boston, MA, United States; David N. Williams, boston childrens hospital / harvard medical school, Boston, MA, United States; Mark Schuster, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States; Christopher P. Landrigan, Boston Children's Hospital, Harvard Medial School, Boston, MA, United States

Background: Hospitals do not include families in safety reporting, relying instead on staff voluntary incident reports (VIR). VIR underdetect events overall (in < 1-10% patients) and particularly in patients with language barriers. Families of hospitalized children with medical complexity (CMC) report high rates of safety events. However, families with lower education report 1/3-1/5 as often and families with language barriers report 1/2 as often.

Objective: To develop, implement, and evaluate a safety reporting intervention for families of hospitalized CMC

Design/Methods: Parents, nurses, physicians, and hospital leaders coproduced the FACES intervention (Family Activation and Communication about Errors and Safety; Figure 1). FACES involved (1) an English and Spanish mobile (email/text) family safety comment card (Figure 2), (2) staff and family education, and (3) a process for sharing comments in real-time with unit/hospital leaders. We implemented FACES on a complex care service spanning 5 units at a pediatric tertiary care hospital, enrolling English- and Spanish-speaking families 1 day after admission. Comments underwent real-time and biweekly review by a parent-nurse-physician team with chart review and discussion about actions taken and potential QI projects. 2 physicians with patient safety expertise subsequently reviewed and classified events as errors (harmful/nonharmful), hazards, non-safety-related quality issues, or other.

Results: We enrolled 179 families from 12/2020-12/2021 (87% consented). Overall, 53 families (29.6%) reported 90 safety comments via the card (86% concerns [n=77], 14% compliments [n=13]). 21% of Spanish-speaking families and 26% of families with lower education commented. Among the 77 safety concerns, physicians coded 49.4% (n=38) medical errors (13 harmful; 25 nonharmful), 32.5% (n=25) non-safety-related quality issues, 7.8% hazards (n=6), and 3.9% other (n=3). Medications were the most reported category, followed by diagnosis (Table). The research team acted on concerns in 23% (n=18) of cases (eg, notifying subspecialist, implementing a QI project). 93.4% of families recommended the comment card be routinely available.Conclusion(s): A mobile family safety reporting tool for hospitalized CMC was highly utilized, well-received, and produced high levels of engagement, including from less educated and Spanish-speaking families. It identified high rates of medical errors and captured safety events at over 3x the rates captured through conventional staff-only VIR. Hospitals should proactively engage families in safety reporting to improve safety and quality and reduce disparities.
Figure 1
Figure 2