Family-Centered Care as a Strategy to Improve Quality

1. Family-Centered Care as a Strategy to Improve Quality Terri L. Byczkowski, PhD Jane Knapp, MD

2. DISCLOSURE: The presenters have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activityThe presenters do not intend to discuss an unapproved or investigative use of a commercial product/device in their presentation

3. Learning Objectives Upon completion of this session you will be able to . . . • Describe the best evidence regarding selected components of family-centered care in pediatric emergency medicine. • Recognize areas of opportunity to improve the quality of family-centered care. • Apply a creative method for generating ideas for quality improvement. • Generate testable interventions for improving the delivery of family-centered pediatric emergency care.

4. Workshop Agenda • Introduction • Participant survey and summary • Brief “state of the art” presentation • Creative exercise • Report out and summarize

5. What is your principal pediatric work setting? • Pediatric ED in a children’s hospital • Separate pediatric ED in a general hospital • Mixed adult/pediatric ED

6. What is your title? • ED Section or Division Chief • Associate/Assistant Director • Fellowship Program Director • Faculty Member • Other

7. How long have you worked in PEM? (do not include fellowship) • Less than 5 years • 5 – 9 years • 10 – 20 years • More than 20 years

8. Is a PEM physician a member of your hospital’s family advisory group? • Yes • No • Do not know • Hospital has no advisory group

9. Thinking about data transparency, which of the following statements best describes your ED? • We generally do not share quality performance data with patients and family members. • We sometimes share quality performance data with patients and families. • We regularly share our quality performance data with patients and families by posting our data where families can see it. • We post performance data on our public website.

10. Which of the following statements describe your hospital’s ED discharge instructions and information? • We have the ability to customize discharge information and instructions to reflect patient and family preferences. • We have processes in place to reinforce and parental assess comprehension of discharge instructions and information. • 1 and 2 • None of the above

11. Does your hospital and/or ED have programs in place that address stress-reduction and wellness needs for the EM and EMS staff? • Yes • No

12. Are physicians in your ED evaluated on how well they deliver patient and family centered care? • Yes • No

13. There is a clear recognition in my ED that family involvement on quality improvement teams is critical to achieving improvement goals. • Strongly agree • Agree somewhat • Disagree somewhat • Strongly disagree

14. Which of the following statements best describes how your ED uses patient satisfaction data? • We don’t measure patient satisfaction on an ongoing basis. • Patient satisfaction results are shared with leadership and staff, but there is no formal process in place to respond to results • We have an improvement team that meets regularly to review data, develop and test improvement interventions.

15. 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: • Patient flow and ED processes that do not limit the child’s access to family members or separate the child from the family • Allowing family presence during procedures • Coordination with the patient’s medical home • Routine measurement and continual assessment of pain, anxiety and comfort • Modeling patient and family centered care in the ED for trainees • Patient and family input in ED policies and procedures

16. 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)

17. Moving from Patient- to Family- Centered Care • Families play key role in the in the health & well-being of their children (Eichner, 2003) • Most patients have a connection to or dependence on family or other support networks and these connections should be encouraged (Institute for Family Centered Care, 2010) • Involving parents in health care decisions for their children is important, especially for children with special healthcare needs (Institute of Medicine, 2007)

18. Respect for patients’ values, preferences and expressed needs Access to interpreter services Patient and family satisfaction with care Coordination and integration of care Coordination with medical home Information and, communication and education Customized discharge planning instructions Physical Comfort Routine measurement of pain Physical space that will accommodate families Principles of Patient-Centered Care Sources: The Picker Institute (2010), O’Malley et al (2008)

19. Emotional Support and alleviation of fear and anxiety Routine assessment of anxiety Involvement of family and friends Family presence during invasive procedures Patient flow that does not limit family access to child Family input on policies and procedures Continuity and transition Coordination with medical home Access to care ED Overcrowding Principles of Patient-Centered Care Source: The Picker Institute (2010), O’Malley et al (2008)

20. Challenges to Delivering Patient- and Family-Centered Care in PEM • Overcrowding and acuity can disrupt care • Previous relationships between healthcare providers and families are lacking • Acute nature of the visit limits ability to create effective partnerships • Children can arrive without family • Child and parents can disagree on plan of treatment • Critical events or death Source: American Academy of Pediatrics (2006), O’Malley et al (2008)

21. Creative Exercise • Objective • To develop testable ideas for improving patient- and family-centered care in pediatric emergency medicine • Ground Rules* • Criticism is ruled out • Encourage wild ideas • Go for quantity • Build on the ideas of others • One conversation at a time *Source: Maher et al (2007)

22. References American Academy of Pediatrics. (2006). Patient- and family-centered care and the role of the emergency physician providing care to a child in the emergency department. Pediatrics, 118(5), 2242-2244. Eichner, J., Neff, J., Hardy, D., Klein, M., Percelay, M., Sigrest, T., et al. (2003). Family-centered care and the pediatrician's role. Pediatrics, 112(3 Pt 1), 691-697. Institute of Medicine. (2007). Emergency care for children : Growing pains. Washington, D.C.: National Academies Press. Institute for Family-Centered Care (2010). Retrieved March 2010 from http://familycenteredcare.org Maher L, Plsek P, Garrett S, Bevan H, Thinking Differently, NHS Institute for Innovation and Improvement, 2007. O'Malley, P. J., Brown, K., & Krug, S. E. (2008). Patient- and family-centered care of children in the emergency department. Pediatrics, 122(2), e511-521 Picker Institute. (2010). Retrieved March 2010 from http://www.pickerinstitute.org/about/about.html