Keeping Time: Implementing Appointment-based Family-centered Rounds

Abstract

Background: Family-centered rounds (FCRs) provide many benefits over traditional rounds, including higher patient satisfaction, and shared mental models among staff. These benefits can only be achieved when key members of the care team are present and engaged. We aimed to improve patient engagement and satisfaction with our existing bedside rounds by designing a new FCR process. Methods: We conducted a needs assessment and formed a multidisciplinary FCR committee that identified appointment-based family-centered rounds (aFCRs) as a primary intervention. We designed, implemented, and iteratively refined an aFCR process. We tracked process metrics (rounds attendance by key participants), a balancing metric (time per patient), and outcome metrics (patient satisfaction domains) during the intervention and follow-up periods. Results: After implementing aFCR, 65% of patients reported positive experience with rounds and communication. Rounds duration per patient was similar (9 versus 9.4 min). Nurse, subspecialist, and interpreter attendance on rounds was 72%, 60%, and 90%, respectively. We employed a Rounding Coordinator to complete the scheduling and communication required for successful aFCR. Discussion: We successfully improved our rounding processes through the introduction of aFCR with the addition of a rounding coordinator. Our experience demonstrates one method to increase multidisciplinary team member attendance on rounds and patient satisfaction with physician communication in the inpatient setting.

A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals

“…Monash et al (2017) found that despite their model shortening rounds on average by 8 minutes overall, trainees were less satisfied and perceived them to last longer than the previous rounding model. Bekmezian et al (2019) described adding 5-to 10-minute- 69 (87.3%) 5 (6.3%) 5 (6.3%)…”

Implementing Family-Centered Rounds in Hospital Pediatric Settings: A Scoping Review

“…Scheduled rounds are associated with increased participation by the clinical care team and families and should be considered. 61,67 Telehealth use can enable nurse and family participation and access to interpreters. 48,66,81 This has been particularly helpful, given the restrictions necessary in response to the novel coronavirus disease 2019 pandemic.…”

“…The use of FCRs has been associated with a statistically significant increase in the duration of rounding, by an average of 1.0-1.5 minutes, 39,67 which in aggregate may meaningfully impact daily routines for clinicians and nurses, although study results vary. 1,52,61 However, at least 1 research team suggested that a well-executed FCR that produces a clear understanding of the daily care plan may reduce communications later in the day. 67 The duration of FCRs remains difficult to compare across studies, given the variation in the FCR interventions deployed.…”

“…Nurses 3,7,23,24,26,27,36,37,39,44,47,48,51,54-56,60,63,68 19 (49) Trainees (physicians and/or students) 3,7,23,25,27,36,39,40,44-46,48,50,51,53,55,57-59,62 20 (51) Intervention Variability of rounds approach (eg, timing, roles, and/or content) 3,7,23,[25][26][27]29,36,40,43,[45][46][47][48]53,[55][56][57][58][59][60][61][62]64 24 (62) Duration and efficiency of rounds 3,7,23-25,27,29,36,37,39,40,45,46,49,53,55-62,64,65 25 (64) Sensitivity to the patient situation 3,7,23-25,27,37,39,40,43-46,49,50,58,62 17 (44) Family concerns about speaking and/or participating in rounds (eg, need for interpreter services or team size) 2,3,7,24,26,27,29,33,37,40,41,[43][44][45]48,49,53,…”

“…a Family preferences integrated into care plan1,2,23,24,26,[29][30][31]33,34,[38][39][40]43,[51][52][53]55,56,58,59,61,65,67,69 (69)Opportunities for the nurse to participate during rounds 1,26,28-31,33-35,38-40,51-57,59,61,65,67-69,71 (72) Bedside teaching of trainees occurs during rounds 1,2,24,25,29-31,33,35,39,40,43,51,52,55-59,61,65,67 (63*) Daily care plans developed and presented during rounds (eg, daily goals, discharge plans, or orders placed) 1-3,23-26,28-35,38-41,43,51-59,61,65,67-71 (100) Rounding process: after rounds Postrounding activities (eg, follow-up with family during the day or midshift huddles) 1,26,35,55,67,69 (17) Delivery methods Use of plain language explicitly by the care team emphasized 1,2,26,29-31,35,40,43,55,58,61,69,70(39)Teach-back to residents and/or family used for understanding explicitly referenced1,26,31,69 (11)Process artifacts Written version of daily care plan and/or goals made available to family (eg, paper or whiteboard)1,28,30,31,33,38,41,51,55,56,68,70 …”