Reports From the Field

How to Manage Family-Centered Rounds


 

References

From the Department of Pediatrics, George Washington University and Children’s National Medical Center, Washington, DC (Dr. Kern), the Department of Pediatrics, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, CA (Dr. Gay), and the Department of Pediatrics, University of Texas Southwestern Medical Center and Children’s Health System, Dallas, TX (Dr. Mittal).

Abstract

  • Objective: To present a model for operationalizing successful family-centered rounds (FCRs).
  • Methods: Literature review and experience with leading FCR workshops at national meetings.
  • Results: FCRs are multidisciplinary rounds that involve patients and families in decision-making. The model has gained substantial momentum nationally and is widely practiced in US pediatric hospitals. Many quality improvement–related FCR benefits have been identified, including improved parental satisfaction, communication, team-based practice, incorporation of practice guidelines, prevention of medication errors, and improved trainee and staff education and satisfaction. Physical and time constraints, variability in attending FCR style and teaching style, lack of FCR structure and process, specific and sensitive patient conditions, and language barriers are key challenges to implementing FCRs. Operationalizing a successful FCR program requires key stakeholders developing and defining a FCR process and structure, including developing a strong faculty development program.
  • Conclusion: FCR benefits for a health care system are many. Key stakeholders involvement, developing FCR "ground rules," troubleshooting FCR barriers, and developing a strong faculty development program are key to managing successful FCRs.

The practice of medicine is a team sport and no team is complete without the patient and family being an integral part of it. Over the past 15 years, health care and the practice of medicine has slowly moved away from physician-centered care to patient- and family-centered care (FCC). This change has been a gradual shift in our culture and FCC has become a widely adopted philosophy within the US health care system [1]. FCC has been recognized and embraced by numerous medical and professional societies, including the Institute of Medicine (IOM), the American Academy of Pediatrics (AAP), and family advocacy organizations such as Family Voices and the Institute for Patient- and Family-Centered Care [1,2]. At its most basic, “family-centered care” occurs when patients/families and medical providers partner together to formulate medical plans that are built upon the sharing of open and unbiased information and that account for the diversity and individual strengths and needs of each patient and family unit [3]. FCC in the inpatient setting for hospitalized patients is most exemplified by the practice of family-centered (bedside) rounds, or FCRs [1].

Interestingly, FCC as a philosophy of care developed during a time when bedside rounds, and by extension clinical teaching, moved away from the bedside. Rounds are an integral part of how work is done in the inpatient setting. They come in many different flavors, from “pre-rounds” to “card-flip rounds” to “attending rounds,” “table/conference room rounds,” “hallway rounds,” “bedside rounds,” and the aforementioned family-centered rounds. In the first half of the 20th century,the majority of teaching rounds took place at the patient’s bedside, in the model advocated by Sir William Osler [4]. Indeed, as Dr. Osler wrote in 1903, “there should be no teaching without a patient for a text, and the best teaching is that taught by the patient himself” [5]. By the late 1970s through the mid-1990s, however, the proportion of clinical teaching occurring at the bedside had decreased to as low as 16% [6–8]. Many reasons behind the change have been speculated, including faculty comfort with lecture-based teaching and desire to control the content of teaching discussions, as well as technological advancement necessitating access to computers during case review.

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