How to Manage Family-Centered Rounds

Definition of Family-Centered Rounds

While no consensus definition of FCR exists, the most frequently cited description comes from Sisterhen et al who describe FCR as “interdisciplinary work rounds at the bedside in which the patient and family share in the control of the management plan as well as in the evaluation of the process itself” [11]. Three key features should be noted in this definition. First, FCR requires the active participation of family members, not merely their presence. In this way, patient and family voices are heard and their preferences solicited with respect to clinical decision-making. Second, FCR take place at the bedside, in alignment with the 2003 AAP policy statement that standard practice should be to conduct attending rounds with full case presentations in patient rooms in the presence of family. Third, FCR are typically interdisciplinary, involving patients and their families, physicians and trainees, nurses, and other ancillary staff (such as interpreters, case managers, and pharmacists) [1,10,11,12].

Since the IOM report, FCRs have gained substantial national momentum. A PRIS (Pediatric Research in Inpatient Setting) network study in 2010 published the first survey of pediatric hospitalist rounding practices in the US and Canada [12]. The study reported that 44% of pediatric hospitalists conducted FCRs, and about a quarter conducted rounds as hallway rounds or sit down rounds. Academic hospitalists were significantly more likely to conduct FCRs compared with non-academic (48% vs. 31%; P < 0.05) hospitalists. In accordance with Muething et al’s experience with FCRs in the Cincinnati model, the survey respondents did not associate FCR with prolonged rounding duration [10,12]. FCRs were also associated with greater bedside nurse participation [12]. Given the momentum behind FCC and the oft-cited benefits of FCR, it can only be presumed that the number of pediatric hospitals conducting FCR has significantly increased since the PRIS study was published in 2010.

FCRs Can Improve Quality of Care for Hospitalized Children

FCRs bring together multiple stakeholders involved in the patient’s care in the same place at the same time everyday. This allows for shared-decision making, identification of medical teams by families, and allows for direct and open communication between parents and medical teams [1,10–12]. The key stakeholders on a FCR team include the patient and family members and the medical team. The medical team includes attending physician, fellow, resident, and students, bedside nurse, care coordinator/case manager and other ancillary services. Although not enough data is available on who should attend rounds, case mangers and bedside nurse along with medical team and patients and families were found to be crucial in the general inpatient setting [12].

Integrating FCRs into the daily workflow in the inpatient setting provides several benefits for patients and families and the medical team, including trainees. Improvements in family-centered care principles, parental satisfaction, interdisciplinary team communication, efficiency, patient safety, and resident and medical student education have been reported consistently [9–23].

FCR Benefits for Patients and Families    

Muething et al described increased patient-family satis-faction with higher levels of family participation in rounds and earlier discharge times [10]. On FCRs, families report having the opportunity to communicate directly with the entire care team, clarify misinformation and better understand care plans including discharge goals, leading to higher levels family satisfaction [10,14,24]. Both English and limited-English-proficient families report positive experiences with FCRs [21–23]. Families express appreciation with learning opportunities on FCRs, as well as the opportunity to serve as teachers to the medical team [14,16,21]. Families reported comfort with trainees being on rounds and appreciated seeing the medical personnel working as team [21]. They also report trust, comfort, and accountability towards the system and providers as they saw them working together as teams. They felt respected and involved as the medical teams involved them during rounds. Parents also report comfort with diversity of providers and feel that having multidisciplinary and diverse teams help with cultural competencies. Parents appreciated trainees being led by attending physician and felt that attending FCRs made them understand the medical process and the steps involved in caring for their child. They also reported that attending FCRs helps trainees learn about answering the kind of questions that parents usually ask. Contrary to the popular belief, parental participation has not increased the duration of FCRs and parental presence during rounds decreases time spent discussing each patient [14,25].

FCRs and Staff Satisfaction

Staff satisfaction with FCRs has been consistently high [13,14,18–23]. Nursing and medical staffs report valuing FCRs as they foster a sense of teamwork, improve understanding of the patient’s care plan and enhance communication between the care team and families [14]. FCRs significantly increase bedside nurse participation during rounds [12]. Presence of nursing and ancillary staff on FCRs improves efficiency by providing valuable information and helping address discharge goal [10]. Anecdotal data suggests that FCRs reduces number of pages trainees receive from nurses.

FCRs and Outcomes

FCRs have been perceived to improve in patient safety including errors in history taking and miscommunication, and incorrect information; and promote medication reconciliation, safety and adherence [17,20,21]. FCRs have shown to improve patient satisfaction, communication, and coordination of care and trainee education [10,14,21].

Educational Benefits of FCRs