For more than 30 years, patient- and family-centered care has influenced change and improvement in health care, especially pediatrics.1,2 Foundational to this approach is the belief that authentic and meaningful partnerships with patients and their families are essential to quality and safety. In this issue, the study conducted by Khan and colleagues3 highlights the importance of partnering with families in family-centered rounds (FCR) or patient- and family-centered rounds (PFCR), whether in direct care, transitions in care, teaching the next generation of providers, or research.
In 2012, the American Academy of Pediatrics’ Committee on Hospital Care and the Institute for Patient- and Family-Centered Care collaborated in the development of a policy statement on patient- and family-centered care and the pediatrician’s role, which included a recommendation for implementing FCR based on studies revealing benefits for families, as well as clinicians, staff, residents, and medical students.4 In a systematic review of FCR, families reported improved communication, a better understanding of their child’s condition and care plan, increased participation in decision-making, and improved relationships between families and clinicians. Staff experienced improvements in communication, relationships with families, and understanding of families’ situations, which informed care planning.5 Residents reported enhanced learning experiences and a deeper understanding of patients and families.6 –8
In addition to partnering with families in direct care, collaborating with patients and families at the system and organizational levels has shown benefits. In a Canadian qualitative study, Anderson and colleagues found several positive results from engaging patient and family advisors in change and improvement. These included an increased capacity for hospitals, clinicians, staff, and patient and family advisors to implement engagement and improved “clinician/staff function and processes, patient experience, and patient care outcomes.”9
Although the benefits of FCR are clear, challenges have been identified, especially in implementation. A scoping review revealed that variability exists in how FCR are defined and conducted.10 To address this, other researchers reported that a more consistent structure needs to be applied to FCR practice, and more research to test this practice is needed.11,12 Additionally, little research has been done on the involvement of families in collaborating at the program level in implementing and studying FCR.
In their article, Khan and colleagues share the results of their study testing the implementation and effectiveness of the patient and family-centered Illness severity-Patient summary-Action items-Situational awareness-Synthesis by receiver (PFC I-PASS) Framework, focused on PFCR, with an innovative “Mentor-Trio” collaborative approach involving triads of physicians, nurses, and parents. These triads coached the 21 participating teaching hospitals to implement PFC I-PASS. A “Mentee-Trio” was established at each site and trained to lead the implementation. The study was partially conducted during the coronavirus disease 2019 pandemic, at which time some PFCR occurred virtually rather than in person.3
In addition to using available data to assess the association of PFC I-PASS to resident-reported patient harms, safety climate, and patient and family experience, observations and surveys were conducted as part of the study to assess adherence to this framework and relevant effects on resident physicians, nurses, and families. Importantly, study findings revealed that adherence to PFC I-PASS was associated with a reduction in resident-reported harms and an improvement in the safety climate. Nurses, who are often excluded from participating in rounds, were given the opportunity to engage in PFCR, which had a positive impact on the family experience. In larger hospitals compared with smaller hospitals, families reported that nurses made them feel engaged as team members. Although family care experience scores did not increase because many sites had high scores at baseline, it is significant that ratings did not show a decrease during the coronavirus disease 2019 pandemic.3
Through its results related to quality and safety, the Khan study reveals the importance of partnering with patients and families in care planning and decision-making. The study itself is also a model of authentic and meaningful partnership with families, at the organizational level, in the planning, implementation, and dissemination of the PFCR process:
Mentor-Trios and Mentee-Trios integrated with families as coaches, along with clinicians and nurses.
Families had opportunities to serve as coinvestigators and participate virtually, as needed.
Collaboration with families occurred at all levels, including coproduction of quality improvement efforts and publication coauthorship.3
The current study of PFC I-PASS by Khan and colleagues contributes significantly to the evidence base related to PFCR. Study findings and the innovative collaborative approach to PFCR offer promise for the future strengthening and expansion of the use of a standardized approach to PFCR and an effective process for partnering with patients and families at all levels.
Ms Dokken, Ms Abraham, and Ms Johnson drafted the commentary and reviewed it critically for intellectual content; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2023-062666.
FUNDING: No external funding.
CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest relevant to this article to disclose.
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