Patrick Brady, MD, MSc is a pediatrician in hospital medicine whose overarching career goal is to partner with patients and families to predict and prevent the clinical deterioration of hospitalized children at its earliest stage, leading to early interventions and improved outcomes. In the research he proposes here, he seeks to understand how families of hospitalized, medically complex children identify and communicate changes in their children's status and then co-design communication tools to improve shared understanding and reduce medical errors. This group of children is ideal as they have many co-morbid diagnoses and medications and often require medical technology. They are at increased risk for harm in the hospital, and their families have a unique expertise that is inconsistently leveraged in hospital care. Candidate: Dr. Brady is an Assistant Professor of Pediatrics in the Division of Hospital Medicine and James M. Anderson Center for Health Systems Excellence at Cincinnati Children's Hospital Medical Center (CCHMC). He obtained a Master of Science degree in Clinical Research at the University of Cincinnati and advanced improvement training during his fellowship through the Quality Scholars Program in Transforming Healthcare at CCHMC. Through that initial training and his first three years as junior faculty, he has conducted multiple studies on clinical team situation awareness in the inpatient context. Situation awareness informs how individuals and teams perceive, comprehend, and make short-term predictions on data. Poor situation awareness is associated with error and accident in complex and dynamic environments like healthcare. The proposed K08 career development plan will build upon his early work to focus on three areas where he requires additional development to enhance his trajectory toward becoming an independent investigator: 1) patient-centered participatory research and design thinking, 2) mixed methods research, and 3) development and testing of complex interventions. The proposed training activities include coursework, seminars, and experiential learning that will give Dr. Brady the necessary expertise for development and comparative effectiveness research of family-designed communication tools in the inpatient setting. Mentors/Environment: Dr. Brady and his primary mentor, Carole Lannon, MD, MPH, have assembled an excellent team of co-mentors and advisors to assist Dr. Brady through the proposed research plan and training activities. The career development plan utilizes the broad intellectual resources available through CCHMC and the University of Cincinnati, including both the medical and design schools, as well as focused national seminars. Cincinnati Children's Hospital is committed to supporting junior faculty members through structured opportunities for education and networking, administrative support, and internal grant funding. Dr. Brady's mentorship team and advisory committee contain national leaders in hospital medicine, safety science, and health services research. The research plan uses a large patient population cared for by the Division of Hospital Medicine's complex care service and leverages data and a data infrastructure from the PCORI-funded Bringing I-PASS to the Bedside study which will use an intensive and validated medical error data collection process at CCHMC during this award with cooperation from Chris Landrigan, MD, MPH, the PCORI study PI, and a member of the advisory committee for Dr. Brady's award. Research: Patient- and family-centered care and engagement are goals of the American Academy of Pediatrics and the Institute of Medicine. However, there are few strategies to promote engagement in safety and quality in the hospital setting, and they are of modest effectiveness and rarely designed with input from patients and families. In order to best design tools and interventions to leverage families' unique expertise, families must be involved at each stage. This proposal will begin to fill that gap and will provide a co-designed communication tool and evidence of its efficacy.
Aim 1 will use interviews, journaling, and direct observation to understand how families identify their child's worsening illness as well as modifiable factors which influence their communication with the clinical team.
Aim 2 will bring together families of medically complex children and clinicians to co-design and test the feasibility, usability, and preliminary efficacy of these tools in clinical practice.
Aim will evaluate the association between shared situation awareness and communication on the safety outcomes of medical error. This research will produce a family and clinician co-designed tool that is tested in the real-world setting of clinical care, as well as evidence of this tool's impac on communication, shared situation awareness, and medical error. Summary: The proposed innovative collaboration between clinician-scientists, health service researchers, designers, patients, and families will allow for a comprehensive understanding of how families identify and communicate their child's illness in the hospital setting and produce a family and clinician co-designed tool which will be evaluated in the context of clinical care. Dr. Brady's research and clinical training, prior work in patient safety, and experienced, dedicated mentorship team make him ideally suited to pursue this research and development plan. This career development award will enable Dr. Brady's continued development into a national leader and independent investigator conducting research that partners patients, families, and clinicians to improve the safety of hospital care for children.

Public Health Relevance

Family-engagement in the safety of care for hospitalized children is endorsed by the American Academy of Pediatrics and the Institute of Medicine, but evidence-based strategies to utilize families' expertise of their child are limited. This proposal aims to understand how families of hospitalized children identify a worsening condition or illness and communicate their concerns to the healthcare team, and then to partner with families and clinicians to co-design and test communication tools to improve shared understanding and reduce medical errors. While this research is aimed at the families of medically complex children in the hospital, the findings of this study and the communication tool it produces, as well as the career development activities of the investigator, will be applicable across a broad number of conditions and contexts of care.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Clinical Investigator Award (CIA) (K08)
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HSR Health Care Research Training SS (HCRT)
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Willis, Tamara
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Cincinnati Children's Hospital Medical Center
United States
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Schondelmeyer, Amanda C; Brady, Patrick W; Goel, Veena V et al. (2018) Physiologic Monitor Alarm Rates at 5 Children's Hospitals. J Hosp Med 13:396-398
Daymont, Carrie; Balamuth, Fran; Scott, Halden F et al. (2018) Elevated Heart Rate and Risk of Revisit With Admission in Pediatric Emergency Patients. Pediatr Emerg Care :
Unaka, Ndidi I; Statile, Angela; Haney, Julianne et al. (2017) Assessment of readability, understandability, and completeness of pediatric hospital medicine discharge instructions. J Hosp Med 12:98-101
Hoefgen, Eric; Tchou, Michael; Brady, Patrick (2017) Continued Learning in Supporting Value-Based Decision Making. J Hosp Med 12:683-684
Parker, Michelle W; Carroll, Matthew; Bolser, Benjamin et al. (2017) Implementation of a Communication Bundle for High-Risk Patients. Hosp Pediatr 7:523-529
Wellner, Ben; Grand, Joan; Canzone, Elizabeth et al. (2017) Predicting Unplanned Transfers to the Intensive Care Unit: A Machine Learning Approach Leveraging Diverse Clinical Elements. JMIR Med Inform 5:e45
Bonafide, Christopher P; Brady, Patrick W; Daymont, Carrie (2016) Physiologic monitor alarms for children: Pushing the limits. J Hosp Med 11:886-887
Bonafide, Christopher P; Roland, Damian; Brady, Patrick W (2016) Rapid Response Systems 20 Years Later: New Approaches, Old Challenges. JAMA Pediatr 170:729-30
Schondelmeyer, Amanda C; Brady, Patrick W; Landrigan, Christopher P (2016) Alarm fatigue: Clearing the air. J Hosp Med 11:153-4
Forster, Catherine S; Jerardi, Karen E; Herbst, Lori et al. (2016) Right Test, Wrong Patient: Biomarkers and Value. Hosp Pediatr 6:315-7

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