Patient Safety Learning Laboratory Looks to Enhance Clinical Communication

A newly funded pediatric Patient Safety Learning Laboratory will study clinician-to-clinician communication to enhance pediatric patient safety.

By Barbara Drosey

Beep. Ding. Chime. The advent of HIPAA-compliant text platforms has not only created a mechanism for safe and private communication for clinicians, but also a constant stream of notifications during their shifts. A newly funded pediatric Patient Safety Learning Laboratory (PSLL) will study what is working and what is challenging for clinicians as communication technologies evolve.

As principal investigator of the new PSLL, Children's Hospital of Philadelphia nurse researcher Halley Ruppel, PhD, RN, aims to reengineer clinician-to-clinician communication and enhance pediatric patient safety. She leads a multidisciplinary team from CHOP and the University of Pennsylvania that will use the Safety-II framework of resilient healthcare. This approach recognizes the capacity of the healthcare system and staff to adapt to challenges while maintaining high-quality care for patients, and factors human behavior into analysis and implementation of solutions.

"Technology changes quickly, and we need to have a plan for what is to come," said Dr. Ruppel, who also is a core faculty member of Clinical Futures, a CHOP Research Institute Center of Emphasis. For example, a multigenerational workforce can have varied views on how to convey information via a phone call versus a text. "We hypothesize that improving team communication could have a positive effect on other patient outcomes."

Analyzing Problems, Testing Interventions, and Gauging Real-World Usage

PSLLs, supported through the Agency for Healthcare Research and Quality (AHRQ) patient safety program, enable researchers and practitioners to evaluate clinical processes and enhance the flow of work and information to improve patient safety using a cross-disciplinary systems engineering approach.

First, Dr. Ruppel and her team will conduct a problem analysis of the work system that drives interprofessional communication, including the people, technology, tasks, environment, and organizational factors. They will explore and diagram communication system components, processes, workflows, and adaptations.

The next step will be to design, develop, and test interventions that support a safe, effective, and resilient clinician-to-clinician communication system. Then they will implement and evaluate interventions in the clinical setting, including effects on patients and families. They will analyze efficiency metrics, such as how quickly a message receives a response compared to before implementation and reducing the clinician's workload associated with responding to various forms of communication.

Although the work will be completed at CHOP, Dr. Ruppel hopes the team's processes and findings will benefit other organizations that undertake a clinician-to-clinician communications analysis to enhance patient care and safety.

"The pace and cadence of operational work doesn't always allow the time or resources to do this sort of deep dive," Dr. Ruppel said. "This PSLL enables rigorous research and the resources to simultaneously provide operational feedback so that findings can move quickly into practice."

Encouraging Cross-disciplinary Collaboration

Dr. Ruppel will build on the successful collaborations and strategies that Co-investigator Christopher Bonafide, MD, MSCE, established in CHOP's first AHRQ-funded PSLL, which focused on reducing nonactionable alarms and accelerating clinician responses to critical alarms. His previous work demonstrated the value of collaboration between clinician researchers and CHOP's robust human factors team. Human factors engineering focuses on the interaction of people, tools, technology, work environments, and team dynamics to ensure safety and effectiveness.

In her previous work with Dr. Bonafide, Dr. Ruppel saw how a diverse group of researchers, clinicians, and operational stakeholders helps close the gap between research and implementation. Dr. Ruppel's co-investigators include CHOP colleagues Christopher Bonafide, MD, MSCE; James Won, PhD, director of Human Factors; Brooke Luo, MD, director of Health IT Safety; and Marion Leary, PhD, MPH, RN, director of Innovation at Penn Nursing.