Skip to Main Content
Skip Nav Destination

Being a Fly on the Wall During Family-Centered Rounds: What Do We Learn?

November 11, 2022

When a child is hospitalized, most communication between the family and the health care team takes place during rounds. More and more pediatric teams conduct family-centered rounds, which has been associated with improved family engagement and satisfaction. The tenets of family-centered rounds include:

  • Ensure the nurse is present.
  • Check family preference for rounds: Do they want to participate? Is this a good time?
  • Ask if the family knows everyone on the team.
  • Discuss with the family the patient assessment and plan for the day.
  • Review and update goals for discharge.
  • Ask the family and the team for questions.
  • Read back orders.

Ideally, family-centered rounds are effective, regardless of the family’s background. But is this true? What could one learn by being a fly on the wall during family-centered rounds? This week, Pediatrics is early releasing an interesting article and an accompanying Video Abstract, entitled “Racial and Ethnic Differences in Communication Quality During Family-Centered Rounds,” by Dr. Victoria Parente and colleagues at Duke University (10.1542/peds.2021-055227).

The authors audio-recorded and coded the first family-centered rounds for children who had been hospitalized to the hospital’s general pediatrics service, and then surveyed the parents. They chose the first rounds because it was likely to be more standardized in format, include more decision-making, and parents were likely to have more questions than on subsequent days.

How did the teams do? With regards to asking questions and making empathic statements, the teams performed similarly for all families when the length of the encounter was accounted for, but English- and Spanish-speaking Latinx families were less likely to demonstrate participatory behaviors (e.g., ask questions), and the team was less likely to ask open-ended questions of Spanish-speaking Latinx families. Teams were also rated lower for respect and partnership when the families were Black or Spanish-speaking Latinx.

Why would this be? In an invited commentary, Drs. Jennifer Gutierrez-Wu, Jennifer Fuchs, and Kori Flower from the University of North Carolina-Chapel Hill note that there are many potential reasons for this (10.1542/peds.2022-058962). These families may feel less empowered, or they may not fully understand what is being said and may be embarrassed to ask. In some cultures, families may also feel less comfortable with questioning the doctor’s authority.

I encourage you to read the article so that you can begin to consider how to better engage families in family-centered rounds. When families truly understand what is going on with their child, they are better able to participate in shared decision-making and to better care for their child after discharge.

Close Modal

or Create an Account

Close Modal
Close Modal