Evidence map›Paper›PMID 40986500›Full record

ArticleJournal of patient safety2025

Clinician Communication and Patient Safety in Pediatrics: A Practical Application of Human-Centered Design for Problem Identification and Analysis.

Halley Ruppel, Brooke Luo, James Won, Christopher P Bonafide, Kimberly Albanowski, Austin DeChalus, Brianna Reed, Amina N Khan, Alexis Z Tomlinson, Andi Fu and 2 more

Abstract read
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Article in Journal of patient safety, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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2citing papers in PubMed
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1 · What the graph read from it

What it found

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2 · The registry

The trial behind it

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3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

12 authors.

Halley RuppelDepartment of Family and Community Health, University of Pennsylvania School of Nursing.
Brooke LuoClinical Futures, a Center of Emphasis in the CHOP Research Institute.
James WonDepartment of Pediatrics, Perelman School of Medicine at the University of Pennsylvania.
Christopher P BonafideClinical Futures, a Center of Emphasis in the CHOP Research Institute.
Kimberly AlbanowskiSection of Pediatric Hospital Medicine, Children's Hospital of Philadelphia.
Austin DeChalusClinical Futures, a Center of Emphasis in the CHOP Research Institute.
Brianna ReedDepartments of Nursing and Clinical Care Services.
Amina N KhanBiomedical and Health Informatics.
Alexis Z TomlinsonBiomedical and Health Informatics.
Andi FuChild and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA.
Jess EttoreDepartments of Nursing and Clinical Care Services.
Marion LearyUniversity of Pennsylvania School of Nursing, Philadelphia, PA.

Funding

AHRQ HHS R18 HS029473
6 · The paper itself

Abstract

backgroundWe established a Patient Safety Learning Lab (AHRQ R18HS029473) to examine the sociotechnical system that drives interprofessional communication in pediatric inpatient settings in the context of evolving communication technologies, and to co-create and evaluate solutions with clinician end users. Here, we describe the use of human-centered design and system engineering processes for the Problem Analysis phase of this project.

methodsWe applied the "Empathize" and "Define" steps of the design thinking process to our Problem Analysis. The goal of the Empathize step is to generate a comprehensive understanding of a problem(s) as experienced by the end user. We conducted interviews and observations with interprofessional clinicians from pediatric inpatient units in a single children's hospital. We used other operational and clinical data to triangulate findings (clinician secure messaging metadata, survey data, and policies/procedures). In the "Define" step, we iteratively developed user-centered problem statements.

resultsData synthesized for the problem analysis included: interviews with 28 clinicians, 32 hours of unit observations; metadata for 433,432 secure messages; 155 free-text clinician survey responses; and 40 communication-related policies/procedures. The Problem Analysis revealed communication challenges in the following domains for clinicians providing frontline care (i.e., bedside nurses, residents, frontline fellows): (1) efficiently locating and contacting other members of the care team; (2) communicating urgency level of information; and (3) managing high volume of minimally informative messages.

conclusionsPractical application of human-centered design and systems thinking contributed to a more holistic understanding of communication challenges, and their patient safety implications, from the perspective of multiple end-user groups.

Indexed as

CommunicationInterprofessional RelationsPatient SafetyPediatricsUser-Centered DesignHospitals, PediatricHumanscommunicationhealth care teamhospitalhuman centered designpatient safetypediatrics

Identifiers

PMID40986500
PMCPMC12453098

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.