title: Communication and Shared Understanding Between Parents and Resident-Physicians at Night.
abstract: OBJECTIVE
  Communication breakdowns between members of the health care team compromise patient safety and experience. Communication breakdowns with parents, an important but often overlooked part of the health care team, are understudied. Parents may play a particularly important role in nighttime care given decreased staffing and inadequate transitions of care at night. We studied communication breakdowns evidenced by lack of shared understanding between parents and night-team residents about the reason for admission and care plan.
  
  
  METHODS
  We conducted a prospective cohort study of parents (n = 286) and night-team senior residents (n = 34) from May 1, 2013 to October 31, 2013. Parents and residents rated communication and described patients' reason for admission, overall plan, and overnight plan. Two physician investigators independently reviewed (κ = 0.63) resident-parent dyads, assigned subsequently dichotomized 4-point overall agreement scores, and rated plan complexity. Using clustered logistic regression, we evaluated relationships among demographics, plan complexity, and shared understanding. We also examined resident and parent perceptions of shared understanding.
  
  
  RESULTS
  We analyzed data from 257 parent-resident dyads. Among these, 45.1% were rated as lacking shared understanding (agreement score = 1 or 2). In multivariate analysis, higher plan complexity (P < .001) and length of stay (P = .002) were associated with lack of shared understanding; lower parental education was a borderline predictor (P = .05). When surveyed, parents and residents reported that they shared an understanding with one another about care plans in 86.0% and 73.1% of cases, respectively.
  
  
  CONCLUSIONS
  Parents and night-team residents frequently lack shared understanding. Family-centered care initiatives to improve parent-provider communication and shared understanding may help empower parents as partners in safe and high-quality nighttime care.
authors.affiliation: Division of General Pediatrics, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and alisa.khan@childrens.harvard.edu.
authors.forename: Alisa
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Nursing, Boston Children's Hospital, Boston, Massachusetts;
authors.forename: Jayne E
authors.initials: JE
authors.lastname: Rogers
authors.affiliation: Division of General Pediatrics, and.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Forster
authors.affiliation: Division of General Pediatrics, and.
authors.forename: Stephannie L
authors.initials: SL
authors.lastname: Furtak
authors.affiliation: Division of General Pediatrics, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
authors.affiliation: Division of General Pediatrics, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Landrigan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D003695:Delivery of Health Care / Q000379:methods; D034462:Dissent and Disputes; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007396:Internship and Residency; D007902:Length of Stay; D008297:Male; D010290:Parents; D010358:Patient Participation; D061214:Patient Safety; D010817:Physician-Patient Relations; D011203:Poverty; D011368:Professional-Family Relations; D011446:Prospective Studies; D011787:Quality of Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires