Background: Family members often play a significant role in the care of geriatric patients during and after hospitalization. Both patients and families have expectations for communication with the provider team in the acute setting, but navigating the flow of medical information across the family unit is challenging with current care models. Pediatric medicine recognizes that family involvement in communication is critical to effective care. Experience from pediatric hospitals may suggest methods for optimizing communication with a patient’s social support network relevant for inpatient geriatric care. This study used a positive deviance approach to identify and define communication structures and processes utilized in pediatric hospitals to communicate with family.
Methods: We used an internally validated, semi-structured interview tool with open-ended questions surrounding communication processes, routes, timing, behaviors and measurement, and team structure. Eleven top-performing pediatric institutions as reported by U.S. News and World Reports were contacted and asked to identify an individual who could speak to communication structures and processes used on best performing pediatric teams. The semi-structured interviews were completed, transcribed via phone, and analyzed qualitatively.
Results: Eight of eleven institutions elected to participate in this work. Interviews were conducted with hospitalists on general pediatric academic units and lasted 38 minutes on average. Qualitative analysis focused on identifying common themes across institutions, areas identified for improvement, and communication innovations. Common themes included 1) deliberate use and labeling of family-centered rounds; 2) identification of patient and family preferences for communication; 3) use of care conferences to communicate complex information; and 4) focus on discharge goals and criteria at time of admission. Areas for improvement were 1) setting expectations for communication; 2) identifying caregivers and sharing contact information and preferences across providers; 3) written communication via whiteboards; 4) discharge communication; and 5) behaviors surrounding communication. Key innovations focused on information sharing, rounding, care conferences, discharge, and feedback and evaluation.
Conclusions: For many elderly patients, family members are relied upon to provide support with decision-making and caregiving. Our positive deviance research highlights that deliberate communication practices, such as family-centered rounds and exploring patient and family preferences, are key to involving family in the care plan. Adaptation of some of the structures, processes and behaviors from pediatric hospitaists identified through our work can inform next steps to enhance communication with families in the inpatient geriatric setting.