Background: Interdisciplinary clinical rounds at the bedside can promote the core principles of patient- and family-centered care, including promoting respect and dignity, information sharing, and participation by the patient in the care and decision making. However, despite rounding at the bedside, the patient can still be a bystander as the team presents a care plan without the patient’s input or an understanding of the patient’s goals.
Purpose: To increase the patient- and family-centeredness of bedside rounds by eliciting and incorporating the patient’s goals.
Description: An interdisciplinary team was formed including patient and family advisors to evaluate the bedside rounding practices on a general medicine unit at an academic medical center. The team was charged with increasing the patient- and family-centeredness of bedside rounds. They identified that providers often did not elicit or incorporate the patient’s goals during bedside rounds. A Goals Card was developed with questions to elicit the patient’s goals for the day and the hospitalization and what would make it a good day for the patient. A process was developed where each morning the unit coordinator distributes a new Goals Card for each patient. During their morning assessment prior to bedside rounds, nurses engage patients in their goals and if needed assist in completing the Goals Card. At the start of bedside rounds, the patient’s nurse presents the patient’s responses so this information can be incorporated into the discussion of the care plan with the patient. This process was successfully implemented and has been in practice for greater than nine months.
The content from 335 completed Goals Cards from 132 patients during the first two months following implementation were evaluated to have a better understanding of the types of concerns and goals that were expressed by patients. For patients’ goal for the day, 38% related to symptom management, 23% an activity of daily living (ADL), 21% discharge, and 18% understanding of their diagnosis or prognosis. For patients’ goal for the hospitalization, 34% related to symptom management, 11% an ADL, 34% discharge, and 21% understanding of their diagnosis or prognosis.
Challenges and benefits associated with this process were elicited from patients and providers. Challenges identified included difficulty completing the card for patients at the beginning of the rounding order, some patients for whom goals could not be elicited, e.g. due to altered mental status, and a sense of repetition from patients with long hospitalizations. Benefits recognized included increased sense of partnership between patients and the team and improved provider satisfaction.
Conclusions: Incorporation of a Goals Card into bedside rounding can be an important tool for increasing patient engagement and participation in their care and to align patient’s and providers’ goals. The information from these cards can also help illuminate additional areas for improving patient care and satisfaction.