PROJECT SUMMARY/ABSTRACT Hospitalized children experience alarming rates of harm due to medical errors and rely on their clinicians and parents to exchange important information about their care and work together to identify and intercept errors. While recent mandates require clinicians to share their clinical notes with parents, which detail a child’s diagnosis, progress and treatment plans, fewer than 10% of parents read these notes during their child’s hospital stay. To address this gap, we developed Bedside Notes – a health IT intervention that provides parents with real-time access to their child’s clinical notes through an inpatient portal on a bedside tablet during their child’s hospitalization. Our single-center pilot study showed a 14-fold increase in parent access to notes after implementation. Additionally, one in five parents who accessed notes identified a potential safety concern, 60% of which were confirmed. The long-term goal of this research is to improve access to trusted health information for parents of hospitalized children to enhance the safety of pediatric inpatient care. The objective of this proposed study is to evaluate the impact of the Bedside Notes intervention on note access and parent- reported outcomes for hospitalized children. Our objective will be accomplished with these aims: 1) Assess the impact of the Bedside Notes intervention on parent access to inpatient notes, 2) Evaluate the effectiveness of note access on improving parent safety perceptions and experiences, and 3) Identify contextual factors contributing to parent use of and hospital staff receptivity to the intervention. Guided by the Systems Engineering Initiative for Patient Safety 2.0 framework, our approach will be to conduct a hybrid type 1 randomized controlled trial (RCT) with English and Spanish-speaking parents of 558 children admitted to a pediatric service at 3 sites. Parents will be randomized to one of two arms: (1) usual care (notes through an outpatient portal on a personal device) or (2) the Bedside Notes intervention (notes through an inpatient portal on a hospital-owned bedside tablet + orientation video). Mixed methods (EHR audit reports, surveys, interviews) will assess note access and parent safety perceptions and experiences. Deliverables include data on the efficacy of the Bedside Notes intervention and contextual factors informing future implementation and dissemination. Our team’s expertise in pediatric health services research and consumer-facing informatics, and experience successfully collaborating to design and pilot test the Bedside Notes intervention, form a strong foundation for this research. This proposal is innovative because it will be the first RCT evaluating an intervention to improve note access and impact on parent-reported outcomes. Utilizing a multisite RCT design, multiple electronic health record vendors, and national advisory group feedback, this study is poised to make a sustained positive impact on the del...