310 - “Bringing the Patient’s Voice”: Family and Provider Experiences with Inpatient Safety Reporting using Mobile Phone Technology

Poster Number: 310
Publication Number: 310.322

Naomi Bardach, UCSF School of Medicine, SF, CA, United States; Talia Mahony, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Annalisa Watson, University of California, Berkeley, Berkeley, CA, United States; Nikkolson N. Ang, University of California, San Francisco, School of Medicine, West Covina, CA, United States; Sunitha V. Kaiser, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: Rates of patient safety events in hospitals remain stubbornly high, and pediatric safety event rates are higher than adult rates. Prior studies have demonstrated that patients and caregivers observe safety events (adverse events, errors, near misses) that are not identified in medical record review or incident reporting systems. We developed a mobile phone-based approach, Family Input to Quality and Safety (FIQS) (Figure 1), which elicited de-identified safety reports daily from patients and families in a pediatric medical-surgical unit in a quaternary care children’s hospital from 2017-2018. We shared these reports in weekly on-unit quality huddles for use in quality and safety efforts.

Objective: To explore the acceptability and utility of the FIQs approach.

Design/Methods: We conducted semi-structured interviews with parents and patients, unit and hospital leaders, and staff. Interview domains included: the value of the FIQS approach, pros and cons of anonymous reporting, and integration of reports into hospital safety efforts. We used thematic analysis to analyze interview transcripts.  

Results: We conducted 27 interviews (18 parents/patients, 5 unit/hospital leaders, 4 staff). Interviewees felt the FIQS approach was valuable in the following ways: was a neutral feedback mechanism; was a novel source of safety information; increased timeliness of feedback; and was easy to use. Pros of anonymous reporting included: alleviated patient concerns about negative repercussions; led to more honest and frequent reporting; decreased potential for staff dismissing reports based on prior interactions with the family. Cons of anonymous reporting included: participants not knowing the effects of making the report; staff not being able to follow-up with families. Facilitators of integration with safety efforts included: weekly review; inclusion of positive comments; ability to respond quickly. Areas for improvement included: patient receipt of response to reports; staff follow-up ability; integration into existing safety improvement structures. See Table for illustrative quotes. Conclusion(s): The FIQS approach was acceptable and valuable to patients and caregivers, unit and hospital leaders, and staff. Potential modifications include: giving participants an option to make reports identifiable for response and follow-up; and integrating reports into the hospital incident report review system.
Figure 1. Family Input into Quality and Safety (FIQS) Tool Selected Screenshots.Participants were sent a daily text message eliciting reports, with a link to this mobile-responsive website (no application download required) for those wanting to submit a report. Screenshot 1 shows the categories for event reporting. Screenshots 2a and 2b show the screens subsequent to choosing either the Medication (2a) or Communication (2b) headings. Once a participant selects one of the sub-categories, the screen automatically scrolls to the bottom, where the participant can fill out the free text box depicted in screenshot 3.
Table. Themes from Interviews about the Acceptability and Usability of FIQs (page 1)