318 - Addressing Caregiver Concerns About Reporting: A Real-Time, Anonymous, Bilingual Safety Observation Tool for Pediatric Inpatient Care

Publication Number: 1302.318

Naomi Bardach, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Anjana E. Sharma, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Nancy Netherland, Kids and Caregivers, Nevada City, CA, United States; Jessica M. Pequeno, UCSF Childrens Hospital, Napa, CA, United States; Deborah Franzon, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Helen Pu, University of California San Francisco, San Francisco, CA, United States; Darren Fiore, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Julia Chu, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Leslie Magana, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Urmimala Sarkar, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Addison Cuneo, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Alicia Fernandez, University of California, San Francisco, San Francisco, CA, United States; john boscardin, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Glenn Rosenbluth, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: Improving inpatient safety remains a high priority. Caregivers, often at bedside and focused on their child or loved one, can provide safety observations. We co-designed a mobile phone tool, in English and Spanish, to gather real-time safety observations from caregivers of pediatric inpatients. Our prior work found variation in safety reporting by social location (education, race, ethnicity, and language (REaL), gender), and that families are concerned about negative repercussions if they report. To address these concerns, our family advisors suggested that the tool invite both positive and constructive reports and that the tool have default anonymized reporting (with an option to share contact information).

Objective: To assess potential factors driving differential reporting engagement by REaL, exploring the use of positive and anonymous reporting.

Design/Methods: Study period: 09/2021-03/2024. Eligibility: English- or Spanish-speaking caregivers of pediatric inpatients 0-21 years, across 3 hospitals. Participants received a daily text message with a link to a safety observation reporting tool (Figure 1). We assessed associations between reporting rates (#observations/100 study-days) and patient & caregiver characteristics, using bivariate & multivariate Poisson regression. Multivariate models adjusted for clinical characteristics, social location variables, electronic health literacy, and parent-patient activation. We used chi-squared testing to assess variation in providing positive reports & providing anonymous reports.

Results: We enrolled 1886 caregivers, who submitted 1236 safety observations (3.14 observations/100 study-days). Reporting rates by REaL varied substantially, in unadjusted and fully-adjusted models (Figure 2), with Latinx Spanish-preferring and Black patient reporting rates lower than White patients' rates. About a quarter of those reporting (27%) provided both positive and constructive reports. Slightly over half (54.3%) of those providing constructive reports did so anonymously (without opting to provide contact information), with variations by REaL and other characteristics (Figure 3).

Conclusion(s): We found meaningful caregiver engagement with safety observation reporting, using a real-time, bilingual, mobile tool, but with variations in reporting by REaL. More constructive reporting occurred anonymously, suggesting the importance of this feature for all. The greater use of positive reporting and of anonymized constructive reporting in minoritized REaL groups indicates these features in safety reporting may address differential engagement and, ultimately, safety inequities.

Figure 1. Screenshots of mobile phone tool interface to gather safety reports
Notes: Family Input into Quality and Safety (FIQS) tool selected screenshots. Screenshot 1 shows the categories for event reporting. Screenshot 2 shows the main categories, and Screenshot 3 shows the subcategories related to choosing Medication. Once a participant selects one a subcategory, the screen automatically scrolls to the bottom, where the participant can fill out the free-text box eliciting narrative about the observation.

Figure 2. Safety observation reporting rates variation by race, ethnicity, and language


Figure 3. Variation in use of design features included to address concerns about negative repercussions from making a safety report