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Kieren MQ, Kelly MM, Garcia MA, Chen T, Ngo T, Baird J, Haskell H, Luff D, Mercer A, Quiñones-Pérez B, Williams D, Khan A. Parent Experiences with the Process of Sharing Inpatient Safety Concerns for Children with Medical Complexity: A Qualitative Analysis. Acad Pediatr 2023; 23:1535-1541. [PMID: 37302701 DOI: 10.1016/j.acap.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe the process of identifying and reporting inpatient safety concerns from the perspective of parents of children with medical complexity (CMC). METHODS We conducted a secondary analysis of qualitative data from semi-structured interviews with 31 English and Spanish-speaking parents of CMC at two tertiary children's hospitals. Interviews lasted 45-60 minutes and were audio-recorded, translated, and transcribed. Three researchers inductively and deductively coded transcripts using an iteratively refined codebook with validation by a fourth researcher. Thematic analysis was used to develop a conceptual model of the process of inpatient parent safety reporting. RESULTS We identified four steps illustrating the process of inpatient parent safety concern reporting 1) parent recognizing concern, 2) parent reporting concern, 3) staff/hospital response continuum, and 4) parent feelings of validation/invalidation. Many parents endorsed that they were the first to catch a safety concern and were identified as unique reporters of safety information. Parents typically described reporting their concerns verbally and in real-time to the person they felt could quickly remedy the situation. There was a spectrum of validation. Some parents reported their concerns were not acknowledged and addressed, which led them to feel overlooked, disregarded, or judged. Others reported their concerns were acknowledged and addressed, resulting in parents feeling heard and seen and often leading to changes in clinical care. CONCLUSIONS Parents described a multi-step process of reporting safety concerns during hospitalization and a spectrum of staff response and validation. These findings can inform family-centered interventions that support safety concern reporting in the inpatient setting.
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Affiliation(s)
- Madeline Q Kieren
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics (MQ Kieren, MM Kelly, MA Garcia, and T Chen)
| | - Michelle M Kelly
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics (MQ Kieren, MM Kelly, MA Garcia, and T Chen).
| | - Miguel A Garcia
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics (MQ Kieren, MM Kelly, MA Garcia, and T Chen)
| | - Tessa Chen
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics (MQ Kieren, MM Kelly, MA Garcia, and T Chen)
| | - Tiffany Ngo
- Division of General Pediatrics, Department of Medicine (A Mercer, B Quiñones-Pérez, and A Khan), Boston Children's Hospital
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research (J Baird), Children's Hospital Los Angeles
| | - Helen Haskell
- Mothers Against Medical Error (H Haskell) South Carolina Columbia
| | - Donna Luff
- Department of Anesthesiology (D Luff), Critical Care, and Pain Medicine, Boston Children's Hospital
| | - Alexandra Mercer
- Division of General Pediatrics, Department of Medicine (A Mercer, B Quiñones-Pérez, and A Khan), Boston Children's Hospital
| | - Bianca Quiñones-Pérez
- Division of General Pediatrics, Department of Medicine (A Mercer, B Quiñones-Pérez, and A Khan), Boston Children's Hospital
| | - David Williams
- Institutional Centers for Clinical and Translational Research (D Williams), Boston Children's Hospital
| | - Alisa Khan
- Division of General Pediatrics, Department of Medicine (A Mercer, B Quiñones-Pérez, and A Khan), Boston Children's Hospital; Department of Pediatrics (A Khan), Harvard Medical School
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Khan A, Quiñones-Pérez B, Castellanos A, Garcia S, MacInnes E. Promoting true meaningful access and equity for patients and clinicians through the use of certified interpreters in hospitals. J Hosp Med 2022; 17:772-773. [PMID: 35977037 DOI: 10.1002/jhm.12943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Alisa Khan
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusettss, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Bianca Quiñones-Pérez
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusettss, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Angela Castellanos
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusettss, USA
| | - Sonia Garcia
- Department of Nursing, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Esterlina MacInnes
- Office of Experience, Boston Children's Hospital, Boston, Massachusetts, USA
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Khan A, Baird J, Kelly MM, Blaine K, Chieco D, Haskell H, Lopez K, Ngo T, Mercer A, Quiñones-Pérez B, Schuster MA, Singer SJ, Viswanath K, Landrigan CP, Williams D, Luff D. Family Safety Reporting in Medically Complex Children: Parent, Staff, and Leader Perspectives. Pediatrics 2022; 149:188129. [PMID: 35615941 DOI: 10.1542/peds.2021-053913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite compelling evidence that patients and families report valid and unique safety information, particularly for children with medical complexity (CMC), hospitals typically do not proactively solicit patient or family concerns about patient safety. We sought to understand parent, staff, and hospital leader perspectives about family safety reporting in CMC to inform future interventions. METHODS This qualitative study was conducted at 2 tertiary care children's hospitals with dedicated inpatient complex care services. A research team conducted approximately 60-minute semistructured, individual interviews with English and Spanish-speaking parents of CMC, physicians, nurses, and hospital leaders. Audio-recorded interviews were translated, transcribed, and verified. Two researchers coded data inductively and deductively developed and iteratively refined the codebook with validation by a third researcher. Thematic analysis allowed for identification of emerging themes. RESULTS We interviewed 80 participants (34 parents, 19 nurses and allied health professionals, 11 physicians, and 16 hospital leaders). Four themes related to family safety reporting were identified: (1) unclear, nontransparent, and variable existing processes, (2) a continuum of staff and leadership buy-in, (3) a family decision-making calculus about whether to report, and (4) misaligned staff and parent priorities and expectations. We also identified potential strategies for engaging families and staff in family reporting. CONCLUSIONS Although parents were deemed experts about their children, buy-in about the value of family safety reporting among staff and leaders varied, staff and parent priorities and expectations were misaligned, and family decision-making around reporting was complex. Strategies to address these areas can inform design of family safety reporting interventions attuned to all stakeholder groups.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Departments of Pediatrics
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kevin Blaine
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Deanna Chieco
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Mount Sinai School of Medicine, New York, New York
| | - Helen Haskell
- Mothers Against Medical Error, Columbia, South Carolina
| | - Kelleen Lopez
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Tiffany Ngo
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Alexandra Mercer
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Bianca Quiñones-Pérez
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Departments of Pediatrics
| | - Mark A Schuster
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Sara J Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Organizational Behavior, Stanford Graduate School of Business, Stanford, California
| | - K Viswanath
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,McGraw-Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Christopher P Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Departments of Pediatrics.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - David Williams
- Orthopedic Surgery.,Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Donna Luff
- Anesthesia, Harvard Medical School, Boston, Massachusetts
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Quiñones-Pérez B, VanNoy GE, Towne MC, Shen Y, Singh MN, Agrawal PB, Smith SE. Three-generation family with novel contiguous gene deletion on chromosome 2p22 associated with thoracic aortic aneurysm syndrome. Am J Med Genet A 2018; 176:560-569. [DOI: 10.1002/ajmg.a.38590] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 11/23/2017] [Accepted: 12/01/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Bianca Quiñones-Pérez
- Division of Genetics and Genomics; Boston Children's Hospital; Boston Massachusetts
- Division of General Pediatrics; Boston Children's Hospital; Boston Massachusetts
| | - Grace E. VanNoy
- Division of Genetics and Genomics; Boston Children's Hospital; Boston Massachusetts
- The Manton Center for Orphan Disease Research; Boston Children's Hospital; Boston Massachusetts
| | - Meghan C. Towne
- Division of Genetics and Genomics; Boston Children's Hospital; Boston Massachusetts
- The Manton Center for Orphan Disease Research; Boston Children's Hospital; Boston Massachusetts
| | - Yiping Shen
- Division of Genetics and Genomics; Boston Children's Hospital; Boston Massachusetts
| | - Michael N. Singh
- Department of Cardiology; Boston Children's Hospital; Boston Massachusetts
| | - Pankaj B. Agrawal
- Division of Genetics and Genomics; Boston Children's Hospital; Boston Massachusetts
- The Manton Center for Orphan Disease Research; Boston Children's Hospital; Boston Massachusetts
- Division of Newborn Medicine; Boston Children's Hospital; Boston Massachusetts
| | - Sharon E. Smith
- Division of Genetics and Genomics; Boston Children's Hospital; Boston Massachusetts
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