Family-Centered Care as a Strategy to Improve Quality

Terri L. Byczkowski, PhDTerri L. Byczkowski, PhD

Jane Knapp, MDJane Knapp, MD

The presenters have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity

The presenters do not intend to discuss an unapproved or investigative use of a commercial product/device in their presentation

DISCLOSURE:

Learning Objectives

Describe the best evidence regarding selected Describe the best evidence regarding selected components of family-centered care in pediatric components of family-centered care in pediatric emergency medicine.emergency medicine.

Recognize areas of opportunity to improve the quality of Recognize areas of opportunity to improve the quality of family-centered care.family-centered care.

Apply a creative method for generating ideas for quality Apply a creative method for generating ideas for quality improvement.improvement.

Generate testable interventions for improving the Generate testable interventions for improving the delivery of family-centered pediatric emergency care.delivery of family-centered pediatric emergency care.

Upon completion of this session you will be able to . . .

Workshop Agenda

IntroductionIntroduction

Participant survey and summaryParticipant survey and summary

Brief “state of the art” presentationBrief “state of the art” presentation

Creative exerciseCreative exercise

Report out and summarizeReport out and summarize

What is your principal pediatric work setting?

Ped

iatri

c ED in

a c

hil...

Sep

arat

e ped

iatri

c ED ..

Mix

ed a

dult/pe

diatri

c ED

0% 0%0%

1.1. Pediatric ED in a Pediatric ED in a children’s hospitalchildren’s hospital

2.2. Separate pediatric Separate pediatric ED in a general ED in a general hospitalhospital

3.3. Mixed Mixed adult/pediatric EDadult/pediatric ED

What is your title?

ED S

ectio

n or D

ivis

io...

Ass

ociat

e/Ass

ista

nt D...

Fel

lowsh

ip P

rogra

m ..

.

Fac

ulty M

ember

Oth

er

0% 0% 0%0%0%

1.1. ED Section or ED Section or Division ChiefDivision Chief

2.2. Associate/Assistant Associate/Assistant DirectorDirector

3.3. Fellowship Program Fellowship Program DirectorDirector

4.4. Faculty MemberFaculty Member

5.5. OtherOther

How long have you worked in PEM? (do not include fellowship)

Les

s th

an 5

yea

rs

5 –

9 y

ears

10

– 20

yea

rs

More

than

20

year

s

0% 0%0%0%

1.1. Less than 5 yearsLess than 5 years

2.2. 5 – 9 years5 – 9 years

3.3. 10 – 20 years10 – 20 years

4.4. More than 20 yearsMore than 20 years

Is a PEM physician a member of your hospital’s family advisory group?

Yes N

o

Do n

ot know

Hosp

ital h

as n

o ad

vi...

0% 0%0%0%

1.1. YesYes

2.2. NoNo

3.3. Do not knowDo not know

4.4. Hospital has no Hospital has no advisory groupadvisory group

Thinking about data transparency, which of the following statements best describes your ED?

We

gener

ally

do n

ot ...

We

som

etim

es s

hare

...

We

regula

rly s

hare

ou.

..

We

post p

erfo

rman

ce...

0% 0%0%0%

1.1. We generally do not share We generally do not share quality performance data with quality performance data with patients and family members.patients and family members.

2.2. We sometimes share quality We sometimes share quality performance data with performance data with patients and families.patients and families.

3.3. We regularly share our quality We regularly share our quality performance data with performance data with patients and families by patients and families by posting our data where posting our data where families can see it.families can see it.

4.4. We post performance data on We post performance data on our public website.our public website.

Which of the following statements describe your hospital’s ED discharge instructions and information?

We

have

the

abili

ty t.

..

We

have

proc

esse

s i..

.

1 a

nd 2

None

of the

abo

ve

0% 0%0%0%

1.1. We have the ability to We have the ability to customize discharge customize discharge information and information and instructions to reflect instructions to reflect patient and family patient and family preferences.preferences.

2.2. We have processes in We have processes in place to reinforce and place to reinforce and parental assess parental assess comprehension of comprehension of discharge instructions discharge instructions and information.and information.

3.3. 1 and 21 and 24.4. None of the aboveNone of the above

Does your hospital and/or ED have programs in place that address stress-reduction and wellness needs for the EM and EMS staff?

Yes N

o

0%0%

1.1. YesYes

2.2. NoNo

Are physicians in your ED evaluated on how well they deliver patient and family centered care?

Yes N

o

0%0%

1.1. YesYes

2.2. NoNo

There is a clear recognition in my ED that family involvement on quality improvement teams is critical to achieving improvement goals.

Stro

ngly a

gree

Agre

e so

mew

hat

Dis

agre

e so

mew

hat

Stro

ngly d

isag

ree

0% 0%0%0%

1.1. Strongly agreeStrongly agree

2.2. Agree somewhatAgree somewhat

3.3. Disagree somewhatDisagree somewhat

4.4. Strongly disagreeStrongly disagree

Which of the following statements best describes how your ED uses patient satisfaction data?

We

don’t

mea

sure

pa.

..

Pat

ient

sat

isfa

ctio

n re...

We

have

an im

prove

...

0% 0%0%

1.1. We don’t measure patient We don’t measure patient satisfaction on an ongoing satisfaction on an ongoing basis.basis.

2.2. Patient satisfaction results are Patient satisfaction results are shared with leadership and shared with leadership and staff, but there is no formal staff, but there is no formal process in place to respond to process in place to respond to resultsresults

3.3. We have an improvement team We have an improvement team that meets regularly to review that meets regularly to review data, develop and test data, develop and test improvement interventions.improvement interventions.

The 2008 AAP COPEM Technical Report on Patient and Family Centered Care specified the following priority areas. Please select the 3 most important areas that you feel in general need improvement in PEM:

Pat

ient

flow a

nd ED ..

.

Allo

wing fa

mily

pre

s...

Coord

inat

ion w

ith th

e...

Routin

e m

easu

rem

en...

Mode

ling p

atie

nt and

...

Pat

ient

and fa

mily

inpu.

..

0% 0% 0%0%0%0%

1.1. Patient flow and ED processes that do Patient flow and ED processes that do not limit the child’s access to family not limit the child’s access to family members or separate the child from members or separate the child from the familythe family

2.2. Allowing family presence during Allowing family presence during proceduresprocedures

3.3. Coordination with the patient’s medical Coordination with the patient’s medical homehome

4.4. Routine measurement and continual Routine measurement and continual assessment of pain, anxiety and assessment of pain, anxiety and comfortcomfort

5.5. Modeling patient and family centered Modeling patient and family centered care in the ED for traineescare in the ED for trainees

6.6. Patient and family input in ED policies Patient and family input in ED policies and proceduresand procedures

A Definition of Patient- and Family-Centered Care

Patient- and family-centered care is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. Patient- and family-centered care applies to patients of all ages, and it may be practiced in any health care setting.

Source: The Institute for Family Centered Care (2010)

Moving from Patient- to Family- Centered Care

Families play key role in the in the health & well-Families play key role in the in the health & well-being of their children (Eichner, 2003)being of their children (Eichner, 2003)

Most patients have a connection to or Most patients have a connection to or dependence on family or other support networks dependence on family or other support networks and these connections should be encouraged and these connections should be encouraged (Institute for Family Centered Care, 2010)(Institute for Family Centered Care, 2010)

Involving parents in health care decisions for Involving parents in health care decisions for their children is important, especially for children their children is important, especially for children with special healthcare needs (Institute of with special healthcare needs (Institute of Medicine, 2007)Medicine, 2007)

Principles of Patient-Centered Care

Respect for patients’ values, preferences and Respect for patients’ values, preferences and expressed needsexpressed needs Access to interpreter servicesAccess to interpreter services Patient and family satisfaction with care Patient and family satisfaction with care

Coordination and integration of careCoordination and integration of care Coordination with medical homeCoordination with medical home

Information and, communication and educationInformation and, communication and education Customized discharge planning instructionsCustomized discharge planning instructions

Physical ComfortPhysical Comfort Routine measurement of painRoutine measurement of pain Physical space that will accommodate familiesPhysical space that will accommodate families

Sources: The Picker Institute (2010), O’Malley et al (2008)

Principles of Patient-Centered Care

Emotional Support and alleviation of fear and Emotional Support and alleviation of fear and anxietyanxiety Routine assessment of anxietyRoutine assessment of anxiety

Involvement of family and friendsInvolvement of family and friends Family presence during invasive proceduresFamily presence during invasive procedures Patient flow that does not limit family access to childPatient flow that does not limit family access to child Family input on policies and proceduresFamily input on policies and procedures

Continuity and transitionContinuity and transition Coordination with medical homeCoordination with medical home

Access to careAccess to care ED OvercrowdingED Overcrowding

Source: The Picker Institute (2010), O’Malley et al (2008)

Challenges to Delivering Patient- and Family-Centered Care in PEM

Overcrowding and acuity can disrupt careOvercrowding and acuity can disrupt care Previous relationships between healthcare Previous relationships between healthcare

providers and families are lackingproviders and families are lacking Acute nature of the visit limits ability to create Acute nature of the visit limits ability to create

effective partnershipseffective partnerships Children can arrive without familyChildren can arrive without family Child and parents can disagree on plan of Child and parents can disagree on plan of

treatmenttreatment Critical events or deathCritical events or death

Source: American Academy of Pediatrics (2006), O’Malley et al (2008)

Creative Exercise

ObjectiveObjective To develop testable ideas for improving patient- To develop testable ideas for improving patient-

and family-centered care in pediatric emergency and family-centered care in pediatric emergency medicinemedicine

Ground Rules*Ground Rules* Criticism is ruled outCriticism is ruled out Encourage wild ideasEncourage wild ideas Go for quantityGo for quantity Build on the ideas of othersBuild on the ideas of others One conversation at a timeOne conversation at a time

*Source: Maher et al (2007)

References

American Academy of Pediatrics. (2006). Patient- and family-centered American Academy of Pediatrics. (2006). Patient- and family-centered care and the role of the emergency physician providing care to a care and the role of the emergency physician providing care to a child in the emergency department. child in the emergency department. Pediatrics, 118Pediatrics, 118(5), 2242-2244.(5), 2242-2244.

Eichner, J., Neff, J., Hardy, D., Klein, M., Percelay, M., Sigrest, T., et al. Eichner, J., Neff, J., Hardy, D., Klein, M., Percelay, M., Sigrest, T., et al. (2003). Family-centered care and the pediatrician's role. (2003). Family-centered care and the pediatrician's role. Pediatrics, Pediatrics, 112112(3 Pt 1), 691-697. (3 Pt 1), 691-697.

Institute of Medicine. (2007). Institute of Medicine. (2007). Emergency care for children : Growing Emergency care for children : Growing painspains. Washington, D.C.: National Academies Press.. Washington, D.C.: National Academies Press.

Institute for Family-Centered Care (2010). Retrieved March 2010 from Institute for Family-Centered Care (2010). Retrieved March 2010 from http://familycenteredcare.orghttp://familycenteredcare.org

Maher L, Plsek P, Garrett S, Bevan H, Maher L, Plsek P, Garrett S, Bevan H, Thinking DifferentlyThinking Differently, NHS , NHS Institute for Innovation and Improvement, 2007. Institute for Innovation and Improvement, 2007.

O'Malley, P. J., Brown, K., & Krug, S. E. (2008). Patient- and family-O'Malley, P. J., Brown, K., & Krug, S. E. (2008). Patient- and family-centered care of children in the emergency department. centered care of children in the emergency department. Pediatrics, Pediatrics, 122122(2), e511-521 (2), e511-521

Picker Institute. (2010). Retrieved March 2010 from Picker Institute. (2010). Retrieved March 2010 from http://www.pickerinstitute.org/about/about.htmlhttp://www.pickerinstitute.org/about/about.html