Editor's Note: In March 2017, Ms. Coleman’s daughter Justice Hope, who was medically complex and had multiple disabilities, died at age 11. She was the sunshine in the lives of many and communicated using a thousand smiles.
If you have had a child who has been hospitalized, then you may know of “family-centered rounds” (FCR). While many of us may not be able to define it, we can describe it: the medical team talking about each child’s care at the bedside. Model rounds include plain language discussions with families, as well as shared decision-making to create a plan with the family. During the eleven years of my daughter’s life, I experienced many approaches to family-centered rounds in different settings at a number of hospitals. I spent many mornings waiting for rounds—not leaving the bedside for fear I might miss it. Sometimes I was invited to join, but other times I was told to wait in the room. I watched and studied: who was there, what was said, what was the plan, and how could I work as part of the care team.
Two articles in this month’s Pediatrics, “Implementing a Family-Centered Rounds Intervention Using Novel Mentor-Trios” by Kahn et al. (10.1542/peds.2023-062666) and a companion commentary, “Patient- and Family-Centered Rounds: Partnering to Improve Care” (10.1542/peds.2023-063619), share a new approach to FCR that improves safety and partnership with families. Recognizing FCR as a best practice, both articles identify common challenges with implementing FCR, and point to novel mentor-trios, or parent-nurse-physician collaboration teams, as a key to strengthen and expand the family partnership in rounds and do so using a quality improvement (QI) focus.
What was this study about?
The authors of this study previously worked with families in 7 hospitals to create the communication tool “Patient and Family Centered I-PASS” (PFC I-PASS). The tool addresses the following components:
- Illness severity
- Patient summary
- Action items
- Situational awareness
- Synthesis by receiver
The tool improved FCR by focusing on family/nurse engagement, health literacy, and written/verbal communication. Harmful medical errors decreased by 38% and hospital experience improved when using this tool.
In this study, the authors expanded use of the tool and also tested the role of coaching at 21 hospitals. Mentor-trios of families, nurses, and physicians guided and coached mentee-trios at each hospital on using the PFC I-PASS tool during rounds.
What were some of the results of the study?
Authors gathered data a number of ways, such as observing rounds and conducting surveys. Here are a few of the results:
- When all 5 pieces of PFC I-PASS were used, harms from medical errors decreased and safety climate improved.
- Nurses, often left out of rounds, had increased participation in rounds in this study.
- In larger hospitals, nurse participation in rounds made families feel engaged as team members.
- The use of a written summary of rounds increased.
- Use of plain language, both oral and written, to discuss care increased.
The family-nurse-physician mentor/mentee trios played a significant role in the findings. Authors noted that using families as coaches, co-investigators, QI team members, and co-authors led to improvements in rounds. They also point to this trio model as key to making FCR stronger, standardized, and sustained across more centers.
What can you do with these articles?
- Read them—don’t let the acronym of PFC I-PASS scare you! Watch the video abstract that clearly lists the benefits of the study and includes testimonials from parents involved. As you read and watch, think back to rounds you have been a part of. How could this tool and coaching model have helped improve communication or safety?
- If you are involved with your children’s hospital advisory committee or work as part of a QI team, share these articles with the group. Start a discussion about how family-nurse-physician collaboration like I-PASS and the mentor trio can improve FCR and other QI work in your community.