At our hospital, we use Patient/Family-Centered Rounds (PFCR), in which the medical care team rounds on each patient in the patient room, so that the patient and family can actively participate in creating the patient care plan and can ask questions. Even though PFCR is considered best practice by the AAP, it is not the norm in many hospitals.
Dr. Alisa Khan at Boston Children’s and colleagues at 15 US institutions tested an intervention to implement PFCR, using mentor trios of a parent, nurse, and physician. Their article and accompanying video abstract, entitled “Implementing a Family-Centered Rounds Intervention Using Novel Mentor-Trios,” is being early released in Pediatrics this week (10.1542/peds.2023-062666).
The authors structured their intervention around the I-PASS framework, which is used to communicate among medical team members and has been shown to decrease harmful medical errors and improve the patient’s hospital experience, without increasing the duration of rounds or decreasing the quality of teaching. The I-PASS framework has 5 components that should be included in medical team communication:
- Illness severity: How sick is the patient? Are they stable or unstable?
- Patient summary: Why was the patient hospitalized? What has happened during the hospitalization? What is the assessment and plan?
- Action items: What needs to be done and when? Who will be responsible for doing these action items?
- Situational awareness: What could happen, and what should be done if this happens?
- Synthesis by receiver: Person who will be responsible for the patient’s care summarizes what was heard, asks clarifying questions, and restates the key action items.
The authors then created multidisciplinary teams, consisting of a parent, nurse, and physician, to coach inpatient teams to implement PFCR, organized around the I-PASS framework. They then observed more than 4500 rounds, including those with families with limited English proficiency (13.8%) and with limited health literacy (25%), and surveyed patients/parents, nurses, residents, and attendings about the experience.
The authors found that there was:
- More rounding at the patient’s bedside
- Improved adherence to all the I-PASS components
- Increased nurse and family engagement
- More use of plain language
- No increases in harms; in larger hospitals, there was an overall decrease in harms
- No decreases in patient/family ratings of their experience in the hospital
- No decreases in trainees’ satisfaction with the quality of teaching during PFCR
In an invited commentary entitled, “Patient- and Family-Centered Rounds: Partnering to Improve Care,” Deborah Dokken, Marie Abraham, and Beverley Johnson at the Institute for Patient- and Family-Centered Care note that Khan’s study demonstrates “authentic and meaningful partnership with families” not only with regard to the rounds themselves, but also in the coaching of medical teams and even in the authorship of the paper (10.1542/peds.2023-063619).
If you are not currently using PFCR in your practice, or if you’re interested in learning how to improve how you use PFCR, take a look at this article. Improving communication and partnership with families is critical to everything that we do, and this article may spur ideas for improvement.