Making Acute Care More Patient-Centered

Principal Investigator: David Bates, M.D., Brigham & Women’s Hospital, Boston, MA
AHRQ Grant No.: HS23535
Project Period: 09/30/14–09/29/19

Description: The goal of this learning laboratory was to develop tools to engage patients, families, and professional care team members by reliably identifying, assessing, and reducing patient safety threats in real time, before they manifested in actual harm.

The project aims were to:

1. Engage patients and their family caregivers in the design of health information technology (IT) tools to prevent patient falls and related injuries during an acute hospitalization.
2. Engage healthcare providers and patients in the design and development of a Patient Safety Checklist Tool to improve patient safety and quality outcomes, provider efficiency, and team communication.
3. Iteratively develop and evaluate the impact of a patient safety reporting system on patient safety and foster a learning health system.

This PSLL created and implemented English and Spanish versions of the Fall TIPS (Tailoring Interventions for Patient Safety) toolkit, which reduced falls by 25 percent in acute care hospitals.^1-3 Today, it is used in more than 100 hospitals across the United States and internationally.⁴ A website, bedside screensaver display, and Fall TIPS collaborative were created to support continued dissemination of the toolkit. In addition, a Fall Prevention Knowledge Test (FPKT) was created and implemented to assess nurses’ knowledge of fall prevention so that educational programs could be improved.⁵

The lab produced the Patient SatisfActive® Model, a structured and proactive program that incorporates a patient-centered care approach into clinicians’ daily routine and enhances the patient and family experience in real time.^4,6,7 Four technologies were created to make this program successful:

• Health-ITUES dashboard, a hands-on, easy-to-use electronic interface that helps providers make rapid decisions about patient care.⁴ A single screen displays data for several patient safety domains (e.g., vital signs, test results, and medications). The team implemented this technology at 12 acute care hospital units and 3 medical services (oncology, neurology, and general medicine). Users reported that completing a task in the dashboard took less time, fewer clicks, and less mouse movement than completing the same task in the electronic health record (EHR). Users perceived the dashboard as moderately usable, with usability scores generally in the 3 to 4 range on a 5-point scale. Drawing on lessons from this project, the PSLL developed a new “productized” version of Health-ITUES to integrate into the EHR—for system-wide use at Brigham and Women’s Hospital and standard use in other hospital systems.
• A bedside display that allows patients, their families, and providers to access information about the patient’s specific care and safety measures. It also provides safety information, fall prevention tips, and other reminders to help the patient take part in staying safe.⁸
• An EHR-integrated patient portal patients are given access to when admitted. It allows patients to see their care plan, recovery goal, care team, test results and trends, medication list, and reminders about safety.⁷
• A dashboard display that provides weekly updates on the SatisfActive® program’s use and effectiveness. These reports give hospital staff a clear understanding of their communication, attentiveness, and responsiveness to patients. They also make staff aware of patients’ and families’ level of engagement in their care, safety, and decision making.⁴

The PSLL also developed MySafeCare, a web-based, mobile-enabled application offered in English and Spanish, which allows patients and families to submit safety concerns and events in real time.⁹ In addition, the PSLL created a MySafeCare clinical dashboard for unit leadership to view submission details. The application was implemented in three hospital units, with an average submission rate of 1.7 submissions per 1,000 patient days—more than what was reported via traditional means, suggestive of enhanced patient activation.¹⁰

This PSLL’s work has resulted in:

• At least 23 peer-reviewed journal publications, with more than 150 citations in other publications.
• More than 12 presentations at institutions and conferences across the United States to help other organizations bridge the gap between health IT and patient and provider needs.
• Two new websites (http://www.patientsafetyresAearch.org/PSLL/home.html and http://www.falltips.org/); and
• Laminated posters and paper tools to meet the needs of diverse hospital environments.

References

1. Duckworth M, et al. Assessing the effectiveness of engaging patients and their families in the three-step fall prevention process across modalities of an evidence-based fall prevention toolkit: an implementation science study. J Med Internet Res 2019;21(1):e10008. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360379/. Accessed June 11, 2020.
2. About Fall TIPS. Fall T.I.P.S.: Tailoring Interventions for Patient Safety. https://www.falltips.org/about-fall-tips/. Accessed June 11, 2020.
3. Fall TIPS Successes. Fall T.I.P.S.: Tailoring Interventions for Patient Safety. https://www.falltips.org/fall-tips-successes/. Accessed June 11, 2020.
4. AFYA. Internal Communication. PSLL Learning Network Webinar #7 Report. AHRQ, Rockville, MD, 2019.
5. Dykes P.C, et al. Development and validation of a fall prevention knowledge test. J Am Geriatr Soc 2019;67(1):133-38. https://pubmed.ncbi.nlm.nih.gov/30300920/. Accessed June 11, 2020.
6. AFYA. Internal Communication. PSLL Learning Network Webinar #2 Report. AHRQ, Rockville, MD, 2017.
7. Schnock KO, et al. Acute care patient portal intervention: portal use and patient activation. J Med Internet Res 2019;21(7):e13336. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6670280/. Accessed June 11, 2020.
8. Duckworth M, et al. Nurse, patient, and care partner perceptions of a personalized safety plan screensaver. J Gerontol Nurs 2017;43(4):15-22. https://pubmed.ncbi.nlm.nih.gov/28358972/. Accessed June 11, 2020.
9. Couture B, et al. Applying user-centered design methods to the development of an mHealth application for use in the hospital setting by patients and care partners. Appl Clin Inform 2018;9(2):302-12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943079/. Accessed June 11, 2020.
10. Collins S.A, et al. Mixed-methods evaluation of real-time safety reporting by hospitalized patients and their care partners: the MySafeCare application. J Patient Saf 2018. https://pubmed.ncbi.nlm.nih.gov/29781978/. Accessed June 11, 2020.

Grant Publications

All links below were accessed June 11, 2020.

2019

• Dykes PC, et al. The Fall TIPS (Tailoring Interventions for Patient Safety) Program: a collaboration to end the persistent problem of patient falls. Nurse Leader 2019;17(4):365-70.
• Dykes PC, et al. Development and validation of a fall prevention knowledge test. J Am Geriatr Soc 2019;67(1):133-38.
• Duckworth M, et al. Assessing the effectiveness of engaging patients and their families in the three-step fall prevention process across modalities of an evidence-based fall prevention toolkit: an implementation science study. J Med Internet Res 2019;21(1):e10008.
• Schnock KO, et al. Acute care patient portal intervention: portal use and patient activation. J Med Internet Res 2019;21(7):e13336.
• Dalal AK, et al. Systems engineering and human factors support of a system of novel EHR-integrated tools to prevent harm in the hospital. J Am Med Inform Assoc 2019;26(6):553-60.
• Dalal AK, et al. Potential of an electronic health record-integrated patient portal for improving care plan concordance during acute care. Appl Clin Inform 2019;10(3):358-66.

2018

• Dykes PC, et al. Preventing falls in hospitalized patients. American Nurse 2018;13(9):8-13. https://www.myamericannurse.com/preventing-falls-hospitalized-patients/.
• Hull S, et al, Patients as partners in the hospital setting: engagement methods in research, quality improvement and beyond. Stud Health Technol Inform 2018;250:26-27.
• Sittig DF, et al. Current challenges in health information technology-related patient safety. Health Informatics J 2018 Dec 11:1460458218814893.
• Grossman LV, et al. Implementation of acute care patient portals: recommendations on utility and use from six early adopters. J Am Med Inform Assoc 2018;25(4):370-79.
• Couture B, et al. Applying user-centered design methods to the development of an mHealth application for use in the hospital setting by patients and care partners. Appl Clin Inform 2018;9(2):302-12.
• Collins SA, et al. Mixed-methods evaluation of real-time safety reporting by hospitalized patients and their care partners: the MySafeCare application. J Patient Saf 2020 Jun;16(2):e75-e81.
• Collins S, et al. Implementation, evaluation, and recommendations for extension of AHRQ Common Formats to capture patient- and care partner-generated safety data. JAMIA Open 2018;1(1):20-25.

2017

• Leung WY, et al. Validating fall prevention icons to support patient-centered education. J Patient Saf 2017 Feb 22.
• Dykes PC, et al. Pilot testing Fall TIPS (Tailoring Interventions for Patient Safety): a patient-centered fall prevention toolkit. Jt Comm J Qual Patient Saf 2017;43(8):403-13.
• Duckworth M, et al. Nurse, patient, and care partner perceptions of a personalized safety plan screensaver. J Gerontol Nurs 2017;43(4):15-22.
• Dalal AK, et al. A web-based and mobile patient-centered ''microblog'' messaging platform to improve care team communication in acute care. J Am Med Inform Assoc 2017;24(e1):e178-e184.
• Couture B, et al. Towards analytics of the patient and family perspective: a case study and recommendations for data capture of safety and quality concerns. AMIA Annu Symp Proc 2017. 2017:615-24.

2016

• Katsulis Z, et al. Iterative user centered design for development of a patient-centered fall prevention toolkit. Appl Ergon 2016 Sep;56:117-26.
• Dalal AK, et al. A web-based, patient-centered toolkit to engage patients and caregivers in the acute care setting: a preliminary evaluation. J Am Med Inform Assoc 2016;23(1):80-7.
• Collins S.A, et al. Acute care patient portals: a qualitative study of stakeholder perspectives on current practices. J Am Med Inform Assoc 2016;24(e1):e9-e17.

2015

• Couture B, et al. User-Centered Design of MySafeCare Patient Safety Reporting System. New England Nursing Informatics Consortium Annual Conference: Trends in Clinical Informatics: A Nursing Perspective. 2015: Waltham, MA.
• Couture B, et al. User-centered design of theMySafeCare patient facing application. Computers Informatics Nursing: CIN 2015;33:225-6.