Family Input for Quality and Safety (FIQS): Using mobile technology for in-hospital reporting from families and patients

Abstract

Objective: Despite three decades of effort, ensuring inpatient safety remains elusive. Patients and family members are a potential source of safety observations, but systems gathering these are limited. Our goal was to test a system to gather safety observations from hospitalized patients and their family members via a real-time mobile health tool.

Methods: We developed a mobile-responsive website for reporting safety observations. We piloted the tool during June 2017-April 2018 on the medical-surgical unit of a children's hospital. Participants were English-speaking family members and patients ≥13 years. We sent a daily text with a website link. We assessed: (1) face validity by comparing observations to incident reporting (IR) criteria and to hospital IRs and (2) associations between the number of safety observations/100 patient-days and participant characteristics using Poisson regression.

Results: We enrolled 235 patients (43.8% of 537 reviewed for eligibility), resulting in 8.15 safety reports/100 patient-days, most frequently regarding medications (29% of reports) and communication (20% of reports). Fifty-one (40% of 125) met IR criteria; only one (1.1%) had been reported via the IR system. Latinx participants submitted fewer observations than White participants (3.9 vs. 10.1, p = .002); participants with more prior hospitalizations submitted more observations (p < .001). In adjusted analyses, including measures of preference in decision making, and patient activation, the difference between Latinx and White participants diminished substantially (6.4 vs. 11.3, p = .16).

Conclusions: We demonstrated the feasibility of real-time patient and family-member technology-enabled safety observation reporting and elicited reports not otherwise identified. Variation in reporting may potentially exacerbate disparities in safety if not addressed.

Figure 1.

Family Input into Quality and Safety (FIQS) Tool Selected Screenshots. Screenshot 1 shows the categories for event reporting. Screenshots 2a and 2b show the screens subsequent to choosing either the Medication (2a) or Communication (2b) headings. Once a participant selects one of the sub-categories, the screen automatically scrolls to the bottom, where the participant can fill out the free text box depicted in screenshot 3. For complete screenshots of the FIQS mobile-responsive website interface, see Appendix 2.

Figure 2.

Percent of Reports by Category Made at the Point of Care by Hospitalized Patients and Family Members (N=89 non-duplicate reports, not including “What Went Well”). Categories: Medication (e.g., timing, dose); Communication (e.g., poor patient-provider communication, team miscommunication); Equipment (e.g., equipment was broken); Unexpected event (e.g., test done incorrectly). Missed care was not included as a separate category, but could have been reported as an “Other”.