Family-Centered Care

Introduction

Welcome to the APSA Quality and Safety Committee Family-Centered Care toolkit. This toolkit is intended to help anyone who is interested in quality improvement projects to improve family-centered care.

Available toolkit projects are listed below. Many of the approaches described are evidence based - some are not. These approaches have not been approved by APSA.

Family Boarding Pass

Here are the steps to creating a family/patient boarding pass experience.

Step 1: Define purpose / give context.

Tell the family how they are moving from point A to point B. Define B as a clear finish/end to this activity. Discharge can be Point B. But the family’s journey continues, so define who will get them from point B to point C if your work is done.

Make completion of checklist a gate to the next step.

Example: From consult to treatment/surgery start. From surgery/admission to discharge. From postoperative to follow-up appointment. Each checklist is a progression towards an end point. A family must complete a checklist to proceed to the next gate. Bonus: What gets “unlocked” for the family upon completion of the checklist?

Bonus: What is the consequence if the parents don’t complete the checklist?

Step 2: Provide a trigger / due date.

This could be “complete one day before your appointment” or “complete two days before surgery” or “complete before you can be discharged home.”

Step 3: Identify tasks families must complete.

Begin each task with a verb.Identify tasks that are within the control of the parent to complete.

Review clinical workflow to identify tasks can be handed off to the family to complete.

Where would they like to have choice? e.g. medical device company, pharmacy, physical therapy provider

Content: give sufficient instruction and tools to complete the task.

For example, list medical device options, refer them to call their insurance to determine coverage. Ask them to select a community provider from a list of recommendations you provide.

Step 4: Provide a point of contact for questions.

Step 5: Identify who will introduce the boarding pass to parents and when.

Step 6: Identify who will review/check for completion of the boarding pass.

Examples: Before clinic, the provider or nurse can review. Before surgery, the preregistration team can review. Before discharge, the care coordinator or bedside nurse can review.

Quiz: How effective is your checklist? Is each task a critical/mandatory task (versus a nice to have task)? Specifically, if the family doesn’t do it, will it hold up work or cause rework for clinical team, or the family risks needing to come back for a second visit/waiting for processing time/showing up in the emergency department.

Does each task have a clear purpose to the parents/family?

Examples: Get supplies, apply for financial aid, fill out application to determine benefits, get school forms completed, register for clinic, get insurance coverage, etc.

Is each task stated as a clear action, in the form of "Verb + Noun"? Tip: Create action oriented tasks that go beyond "complete education." Break education tasks into smaller components with an outcome (e.g. learn to identify common complications, make an emergency plan, memorize signs of an emergency. Review “how to’s” every 3 months. Practice XYZ. Set reminders on your phone. Get supplies. Make appointment. Complete a form/log. Sign a consent/release of information. Provide guardianship documentation. Complete diagnostic test.

Minimize the number of general education tasks in the checklist such as "learn about the benefits of xyz". These do not feel actionable to families and may be perceived as rote, uninteresting, lower value activities. It is better to embed this as part of an activity: e.g. sign consent. Does the checklist have ten tasks or less? Tip: Create more than one checklist if there are pauses/gaps in time between tasks. The clearer the end goal, the more likely the family will complete the entire series.

Boarding pass template

electronic ERAS boarding pass
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