Michelle M. Kelly

Strategies for improving family engagement during family-centered rounds

BACKGROUND Family-centered rounds (FCR) are recommended as standard practice in the pediatric inpatient setting; however, limited data exist on best practices promoting family engagement during rounds. OBJECTIVE To identify strategies to enhance family engagement during FCR using a recognized systems engineering approach. METHODS In this qualitative study, stimulated recall interviews using video-recorded rounding sessions were conducted with participants representing the various stakeholders on rounds (15 parents/children and 22 healthcare team [HCT] members) from 4 inpatient services at a childrens hospital in Wisconsin. On video review, participants were asked to provide strategies that would increase family engagement on FCR. Qualitative content analysis of interview transcripts was performed in an iterative process. RESULTS We identified 21 categories of strategies corresponding to 2 themes related to the structure and process of FCR. Strategies related to the structure of FCR were associated with all five recognized work system elements: people (HCT composition), tasks (HCT roles), organization (scheduling of rounds and HCT training), environment (location of rounds and HCT positioning), and tools and technologies (computer use). Strategies related to the FCR process were associated with three rounding phases: before (HCT and family preparation), during (eg, introductions, presentation content, communication style), and after (follow-up) FCR. CONCLUSIONS We identified a range of strategies to enhance family engagement during FCR. These strategies both confirm prior work on the importance of the content and style of communication on rounds and highlight other factors within the hospital work system, like scheduling and computer use, which may affect family engagement in care.

Exceptional Charge Transport Properties of Graphene on Germanium

The excellent charge transport properties of graphene suggest a wide range of application in analog electronics. While most practical devices will require that graphene be bonded to a substrate, such bonding generally degrades these transport properties. In contrast, when graphene is transferred to Ge(001) its conductivity is extremely high and the charge carrier mobility derived from the relevant transport measurements is, under some circumstances, higher than that of freestanding, edge-supported graphene. We measure a mobility of ∼ 5 × 10(5) cm(2) V(-1) s(-1) at 20 K, and ∼ 10(3) cm(2) V(-1) s(-1) at 300 K. These values are close to the theoretical limit for doped graphene. Carrier densities in the graphene are as high as 10(14) cm(-2) at 300 K.

Thermally Processed High-Mobility MOS Thin-Film Transistors on Transferable Single-Crystal Elastically Strain-Sharing Si/SiGe/Si Nanomembranes

Demonstration of high-performance MOS thin-film transistors (TFTs) on elastically strain-sharing single-crystal Si/SiGe/Si nanomembranes (SiNMs) that are transferred to foreign substrates is reported. The transferable SiNMs are realized by first growing pseudomorphic SiGe and Si layers on silicon-on-insulator (SOI) substrates, and then, selectively removing the buried oxide (BOX) layer from the SOI. Before the release, only the SiGe layer is compressively strained. Upon release, part of the compressive strain in the SiGe layer is transferred to the thin Si layers, and the Si layers, thus, become tensile strained. Both the initial compressive strain state in the SiGe layer and the final strain sharing state between the SiGe and the Si layers are verified with X-ray diffraction measurements. The TFTs are fabricated employing the conventional high-temperature MOS process on the strain-shared SiNMs that are transferred to an oxidized Si substrate. The transferred strained-sharing SiNMs show outstanding thermal stability and can withstand the high-temperature TFT process on the new host substrate. The strained-channel TFTs fabricated on the new host substrate show high current drive capability and an average electron effective mobility of 270 cm2/V ldr s. The results suggest that transferable and thermally stable single-crystal elastically strain- sharing SiNMs can serve as excellent active material for high-speed device application with a simple and scalable transfer method. The demonstration of MOS TFTs on the transferable nanomembranes may create the opportunity for future high-speed Si CMOS heterogeneous integration on any substrate.

Using an inpatient portal to engage families in pediatric hospital care

Objective: Assess parent use and perceptions of an inpatient portal application on a tablet computer that provides information about a child’s hospital stay. Methods: This cross-sectional study was conducted with parents of children hospitalized on a medical/surgical unit at a tertiary children’s hospital. From December 2014 to June 2015, parents were provisioned a tablet portal application to use throughout the hospitalization. The portal includes real-time hospital vitals, medications, schedules, lab results, education, health care team pictures/roles, and request and messaging functionalities. Portal use information was gathered from tablet metadata. Parents completed discharge surveys on portal satisfaction, use, and impact on their information needs, engagement, communication, error detection, and care safety and quality. Data were analyzed using descriptive statistics and qualitative content analysis. Results: Over 6 months, 296 parents used the portal, sending 176 requests and 36 messages. No tablets were lost or damaged. The most used and liked features included vitals, medication list, health care team information, and schedules. Overall, parent survey respondents (90) were satisfied with the portal (90%), reporting that it was easy to use (98%), improved care (94%), and gave them access to information that helped them monitor, understand, make decisions, and care for their child. Many parents reported that portal use improved health care team communication (60%). Most perceived that portal use reduced errors in care (89%), with 8% finding errors in their child’s medication list. Conclusions: Overall, parents were satisfied with the inpatient portal. Portals may engage parents in hospital care, facilitate parent recognition of medication errors, and improve perceptions of safety and quality.

Medical Student Self-Efficacy with Family-Centered Care during Bedside Rounds

Purpose Factors that support self-efficacy in family-centered care (FCC) must be understood in order to foster FCC in trainees. Using social cognitive theory, the authors examined (1) how three supportive experiences (observing role models, practicing for mastery, and receiving feedback) influence self-efficacy with FCC during rounds and (2) whether the influence of these supportive experiences was mediated by self-efficacy with three key FCC tasks (relationship building, information exchange, and decision making). Method Researchers surveyed third-year students during pediatric clerkship rotations during the 2008–2011 academic years. Surveys assessed supportive experiences and students’ self-efficacy both with FCC during rounds and with key FCC tasks. Researchers constructed measurement models via exploratory and confirmatory factor analyses. Composite indicator structural equation models evaluated whether supportive experiences influenced self-efficacy with FCC during rounds and whether self-efficacy with key FCC tasks mediated any such influences. Results Of 184 eligible students, 172 (93%) completed preclerkship surveys. Observing role models and practicing for mastery supported self-efficacy with FCC during rounds (each P < .01), whereas receiving feedback did not. Self-efficacy with two specific FCC tasks—relationship building and decision making (each P < .05)—mediated the effects of these two supportive experiences on self-efficacy with FCC during rounds. Conclusions Both observing role models and practicing for mastery foster students’ self-efficacy with FCC during rounds, operating through self-efficacy with key FCC tasks. Results suggest the importance both of helping students gain self-efficacy in key FCC tasks before rounds and of helping educators implement supportive experiences during rounds.

Treatment Trends and Outcomes in US Hospital Stays of Children With Empyema

Background: Recently published practice guidelines continue to reflect uncertainty about the comparative effectiveness of various treatments for empyema in children. We describe treatment trends and outcomes in pediatric empyema using the most current nationally representative data. Methods: Using survey methods and Kids’ Inpatient Databases from 1997 to 2009, we evaluated hospital stays in children 0–18 years of age. We used 2009 data to compare transfer-out rates and lengths of stay across various types of treatment, after adjusting for patient and hospital factors. Results: From 1997 to 2009, empyema discharges steadily increased from 3.1 to 6.0 per 100,000 children (P < 0.001 for trend) and also were increasingly likely (P < 0.01) to be coded for: (1) at least 1 pleural drainage procedure (76.4–83.2%), (2) multiple drainage procedures (36.0–41.6%) and (3) home health care (8.7–15.0%). By 2009, video-assisted thoracoscopic surgery was more commonly coded than chest tube drainage and was associated with a lower transfer-out rate (0.6% vs. 10.1%, adjusted P < 0.001) but no reduction in mean length of stay [11.2 vs. 13.4 days, adjusted incidence rate ratio 0.95 (95% confidence interval: 0.88–1.04)] for children neither admitted nor discharged by transfer. Conclusions: US hospital stays for empyema in children not only continued to increase through 2009 but were also characterized by more intense procedural management. Outcomes results in this population-based study are consistent with practice guidelines and recommendations that recently endorsed chest tube drainage as an acceptable first treatment option for most children with empyema.

Parent perceptions of children's hospital safety climate

Background Because patients are at the frontline of care where safety climate is closely tied to safety events, understanding patient perceptions of safety climate is crucial. We sought to develop and evaluate a parent-reported version of the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture and to relate parent-reported responses to parental need to watch over their childs care to ensure mistakes are not made. Methods Parents (n=172) were surveyed about perceptions of hospital safety climate (14 items representing four domains—overall perceptions of safety, openness of staff and parent communication, and handoffs and transitions) and perceived need to watch over their childs care. Confirmatory factor analysis (CFA) was used to validate safety climate domain measures. Logistic regression was used to relate need to watch over care to safety climate domains. Results CFA indices suggested good model fit for safety climate domains. Thirty-nine per cent of parents agreed or strongly agreed they needed to watch over care. In adjusted models, need to watch over care was significantly related to overall perceptions of safety (OR 0.20, 95% CI 0.11 to 0.37) and to handoffs and transitions (0.25, 0.14 to 0.46), but not to openness of staff (0.67, 0.40 to 1.12) or parent (0.83, 0.48 to 1.45) communication. Conclusions Findings suggest parents can provide valuable data on specific safety climate domains. Opportunities exist to improve our safety climates impact on parent burden to watch over their childs care, such as targeting overall perceptions of safety as well as handoffs and transitions.

Multi-stakeholder collaboration in the redesign of family-centered rounds process

A human factors approach to healthcare system redesign emphasizes the involvement of multiple healthcare stakeholders (e.g., patients and families, healthcare providers) in the redesign process. This study explores the experience of multiple stakeholders with collaboration in a healthcare system redesign project. Interviews were conducted with ten stakeholder representatives who participated in the redesign of the family-centered rounds process in a pediatric hospital. Qualitative interview data were analyzed using a phenomenological approach. A model of collaborative healthcare system redesign was developed, which defined four phases (i.e., setup of the redesign team, preparation for meetings, collaboration in meetings, follow-up after meetings) and two outcomes (i.e., team outcomes, redesign outcomes) of the collaborative process. Challenges to multi-stakeholder collaboration in healthcare system redesign, such as need to represent all relevant stakeholders, scheduling of meetings and managing different perspectives, were identified.

Application of participatory ergonomics to the redesign of the family-centred rounds process

Participatory ergonomics (PE) can promote the application of human factors and ergonomics (HFE) principles to healthcare system redesign. This study applied a PE approach to redesigning the family-centred rounds (FCR) process to improve family engagement. Various FCR stakeholders (e.g. patients and families, physicians, nurses, hospital management) were involved in different stages of the PE process. HFE principles were integrated in both the content (e.g. shared mental model, usability, workload consideration, systems approach) and process (e.g. top management commitment, stakeholder participation, communication and feedback, learning and training, project management) of FCR redesign. We describe activities of the PE process (e.g. formation and meetings of the redesign team, data collection activities, intervention development, intervention implementation) and present data on PE process evaluation. To demonstrate the value of PE-based FCR redesign, future research should document its impact on FCR process measures (e.g. family engagement, round efficiency) and patient outcome measures (e.g. patient satisfaction). Practitioner Summary: The application of participatory ergonomics (PE) to healthcare system redesign is limited. This study broadens PE application from designing individual tasks in specific jobs to address physical ergonomic issues to designing complex healthcare processes to address cognitive and organisational ergonomic issues.

Stimulated recall methodology for assessing work system barriers and facilitators in family-centered rounds in a pediatric hospital

Human factors and ergonomics methods are needed to redesign healthcare processes and support patient-centered care, in particular for vulnerable patients such as hospitalized children. We implemented and evaluated a stimulated recall methodology for collective confrontation in the context of family-centered rounds. Five parents and five healthcare team members reviewed video records of their bedside rounds, and were then interviewed using the stimulated recall methodology to identify work system barriers and facilitators in family-centered rounds. The evaluation of the methodology was based on a survey of the participants, and a qualitative analysis of interview data in light of the work system model of Smith and Carayon (1989, 2001). Positive survey feedback from the participants was received. The stimulated recall methodology identified barriers and facilitators in all work system elements. Participatory ergonomics methods such as the stimulated recall methodology allow a range of participants, including parents and children, to participate in healthcare process improvement.