Kelly Michelle M, Xie Anping, Li Yaqiong, Cartmill Randi, Cox Elizabeth D, Brown Roger L, Wetterneck Tosha, Carayon Pascale
Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wis.
Pediatr Qual Saf. 2019 Jul 30;4(4):e196. doi: 10.1097/pq9.0000000000000196. eCollection 2019 Jul-Aug.
Checklists are used to operationalize care processes and enhance patient safety; however, checklist implementation is difficult within complex health systems. A family-centered rounds (FCR) checklist increased physician performance of key rounding activities, which were associated with improved parent engagement, safety perceptions, and behaviors. To inform FCR checklist implementation and dissemination, we assessed physician compliance with this checklist and factors influencing its use.
Guided by a recognized human factors and systems engineering approach, rounding observations and ad hoc resident and attending physician interviews were conducted at a tertiary children's hospital. Rounding observers documented 8-item checklist completion (nurse presence, family preference, introductions, assessment/plan, discharge goals, care team questions, family questions, and read back orders) and then interviewed physicians to elicit their perceptions of challenges and facilitators to FCR checklist use. We performed a directed content analysis of interview notes, iteratively categorizing data into known hospital work system components.
Of 88 individual patient rounds observed after checklist implementation, 90% included the nurse, and 77% occurred at the bedside. In an average patient rounding session, staff performed 82% of checklist items. Factors influencing checklist use were related to all hospital work system components, eg, physician familiarity with checklist content (people), visibility of the checklist (environment), providing schedules for rounding participants (organization), and availability of a mobile computer during rounds (technology).
Multiple factors within hospital systems may influence FCR checklist use. Strategies, such as providing rounding schedules and mobile computers, may promote optimal engagement of families during rounds and promote pediatric patient safety.
检查表用于规范护理流程并提高患者安全；然而，在复杂的卫生系统中实施检查表很困难。以家庭为中心的查房（FCR）检查表提高了医生关键查房活动的执行情况，这与改善家长参与度、安全认知和行为有关。为了为FCR检查表的实施和推广提供信息，我们评估了医生对该检查表的依从性以及影响其使用的因素。
在一种公认的人为因素和系统工程方法的指导下，在一家三级儿童医院进行了查房观察以及对住院医师和主治医师的临时访谈。查房观察员记录了8项检查表的完成情况（护士在场、家庭偏好、介绍、评估/计划、出院目标、护理团队问题、家庭问题和复述医嘱），然后采访医生，以了解他们对FCR检查表使用的挑战和促进因素的看法。我们对访谈记录进行了定向内容分析，将数据反复分类到已知的医院工作系统组件中。
在检查表实施后观察的88次个体患者查房中，90%有护士在场，77%在床边进行。在平均一次患者查房过程中，工作人员完成了82%的检查表项目。影响检查表使用的因素与医院工作系统的所有组件相关，例如医生对检查表内容的熟悉程度（人员）、检查表的可见性（环境）、为查房参与者提供时间表（组织）以及查房期间移动计算机的可用性（技术）。
医院系统中的多个因素可能会影响FCR检查表的使用。提供查房时间表和移动计算机等策略可能会促进查房期间家庭的最佳参与度，并提高儿科患者的安全性。
