Patient- and family-centered rounds (PFCR) have been supported by the American Academy of Pediatrics as the preferred way of rounding on hospitalized children. Best practices for PFCR include elements of shared decision-making with families while limiting the use of medical jargon; however, the way these rounds are implemented can be varied. While there are many benefits to PFCR, there are ongoing concerns from learners, including a loss of autonomy and increased discomfort. Additionally, not all families benefit equally from PFCR. In light of these concerns, a study in Hospital Pediatrics by Osborn et al. looked at family perceptions of a hybrid model of rounding (10.1542/hpeds.2024-007998).
This hybrid model included a pre-rounds huddle with a short, traditional SOAP (Subjective, Objective, Assessment, Plan) presentation by learners outside of the room. The pre-rounds huddle also focused on areas of uncertainty and communication strategies for shared decision-making when inside the room. Following the huddle, the PFCR presentation inside the patient’s room included an opening statement inviting parents to participate. Rather than go through the whole SOAP format, the PFCR presentation focused on pertinent information and a set of refined differential diagnoses.
In their quasi-experimental design, the authors were able to compare family perceptions to existing data from traditional PCFR encounters several years prior. Checklists were used to guide rounds during both the PCFR and hybrid rounding time periods. The authors also collected data on the amount of time spent rounding during pre- and post-intervention periods. They found that when compared to traditional PFCR, the hybrid model showed improvements in families’ reporting that their doctors used language they could understand, and that the team addressed their questions and concerns. Rounding time was significantly longer with the hybrid model (18 minutes versus 14 minutes), although it should be noted that time in the pre-intervention period only measured the time inside the room and did not account for any teaching or discussion that occurred outside the room.
There were a few notable limitations to the study. It was unclear if rounds adhered to the standardized rounding checklist as rounds were not directly observed. The study did not include families with primary languages other than English, an important demographic when looking at family perceptions of PFCR. Finally, the authors note that it is unclear how family access to chart and lab data impacted rounds as families may have already had access to much of the information discussed on rounds. The authors emphasize that family input needs to be solicited and diagnostic uncertainty must be discussed, otherwise this model loses key benefits of PFCR. The authors note that further studies could examine other key stakeholder perceptions of the hybrid model, such as learners and nursing staff.
As efforts are made to optimize the rounding experience for hospitalized children and their families, this study illustrates that a hybrid model of rounding may be more beneficial to families when compared to traditional PFCR.
