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Family-centered rounds: Partnering, learning from parents and patients

04/01/2012

A five-year-old boy who arrived at Floating Hospital with acute pain in his right hip stares out from his bed at a group of residents, interns, medical students, a dietitian, a nurse and attending physician Melissa Mauro-Small, MD, a pediatric hospitalist who works at Signature Healthcare Brockton Hospital and Floating Hospital for Children through Floating’s pediatric hospitalist program. The boy’s mom stands side by side with the team of caregivers, discussing his condition and treatment – and how he had fun on a trip to the Playroom the day before, but overdid it and experienced more pain afterwards.

“Since he feels better, he thinks everything is fine,” she reports to the group. The boy’s mother talks with the team about keeping up round-the-clock ibuprofen for her son after his discharge, and when to send him back to school. She asks when she should set up a follow-up appointment with his pediatrician.

“I’ll call your pediatrician today and let him know this guy is coming home tomorrow,” Mauro-Small says, looking from the mom to the patient. “I spoke to your doctor yesterday and I’ll speak to him tomorrow after you go home.”

The mom asks a few more questions about pain relief for her son, and then the team heads to the next patient.

At one time, morning rounds might have occurred off the unit in a conference room, and may have included only med students, resident physicians and the attending. But family-centered rounds – part of Floating Hospital for Children’s broader family-centered care model – puts the discussion, planning and learning at the bedside with parents front and center as members of the caregiving team. That team often involves nurses, pharmacists, social workers and dieticians involved in children’s care, in addition to doctors, residents and med students.

“We’ve always talked to families about care plans, but this is a new way our team is involving the family,” says Dan Hale, MD, a hospitalist who spends his time at Floating Hospital and Lawrence General Hospital.

“Family centered rounding is about partnering and making sure every decision you make is with a family, not for a family,” explains Julia Aquino, MD, who has been a leader in establishing family-centered rounds at Floating Hospital and throughout Floating’s network of affiliates, where pediatric hospitalists provide 24-7 coverage. Floating hospitalists work and conduct family-centered rounds at Lawrence General Hospital, Lowell General Hospital, MetroWest Medical Center and Signature Healthcare Brockton Hospital.

Rounding has always served a number of purposes: teaching medical students how to present a patient; fostering an increased understanding of the patient’s medical history and the current state of their illness or injury; discussing information about a patient so that a plan for the day and an overall care plan can be established; and training students and residents to spot changes in a patient’s condition and how to appropriately respond.

Family-centered rounds serve to accomplish those goals and expand them. Floating hospitalists say that rounds help them get to know patients and their families better, and allow caregivers to better understand what families will be able to handle, as part of an ongoing treatment or management plan for when the child returns home.  Family-centered rounds also improve patient safety by ensuring the whole caregiving team has an opportunity to get on the same page at the same time. The rounds improve teaching, because students and residents get the chance to watch attending physicians interact with families and patients – and receive feedback on their own communication styles.

“It adds another layer of patient safety to have the entire team of caregivers standing together with the family and talking about everything all at once,” Aquino says. “When everyone’s on the same page, all the members of the caregiving team can listen to and understand and address the family’s concerns at the same time.”

Hospitalists say they believe that family-centered rounds also help make parents better partners with their child’s pediatrician post-discharge, by fostering a better understanding of what took place during the child’s hospitalization.

Karen Fauman, MD, a critical care pediatrician who has led the development of family-centered rounds in Floating’s Pediatric Intensive Care Unit, said the rounds can be particularly important to families whose children are chronically ill and experiencing an acute episode.

“If a family doesn’t understand the reasoning behind a care plan and don’t understand how important it is, why would they feel tied to a plan they had no part in designing?” she says. “We’re all partners with different expertise. The parents are the expert in their child, and we are the experts in the child’s illness and physiology.”

In community hospitals, the team involved in family-centered rounds may be smaller, but almost always involves the hospitalist, one or more nurses and, of course, parents and patients.

Hale says the nursing team at Lawrence General Hospital enthusiastically embraced family-centered rounds when they were introduced a little over a year ago.

“It was such a radically good change – it was extremely helpful for patient care,” he says. “With family-centered rounding, efficiency is much improved. When the team is finished rounding on each patient, everyone - the caregiving team, the parents and the patient - is on the same page with the care plan.”

“Our group of hospitalists has really made consistent family-centered rounding a top priority both at the Floating and throughout our community hospital network,” Aquino says.