Background: Family Centered Rounds (FCR) is recommended by the American Academy of Pediatrics as a process for improving communication between the health care team and families, increasing efficiency of rounds, providing a positive learning environment for residents and students, and ensuring that families have the opportunity to participate in medical decision making. The purpose of this study was to evaluate the current state of FCR in an academic tertiary medical center.
Methods: Inclusion criteria were all inpatient general pediatric and sub-specialty medical rounding teams; surgery teams were excluded. A standardized checklist was created based on published guidelines, rounds were observed and timed by a study team member, and observational data was recorded. Prior to observing rounds, each study team member watched a FCR video and completed the checklist; these responses were discussed. The initial 41 observations were performed by more than one study member to validate the checklist; these results were discarded. Descriptive statistics were performed.
Results: Two hundred eighty FCR experiences were observed on 4 units, representing 12 pediatric medical subspecialties, and 239 were included in the analysis. Forty one observations were excluded in order to validate the checklist. The average rounding time per patient was 21 minutes, 58 seconds. Sixty seven percent (162/239) of medical teams entered the patient room for rounds, and on average 9 medical providers were present. The team was observed to form a circle around the patient during 62% of encounters (148/239) and the presenter was observed making eye contact with the family member in 57% of encounters (136/239). Electronic order entry was completed in 54% (129/239), prescription writing in 54% (129/239), discharge summaries were updated in 35% (83/239), and home health care plans were discussed in 28% (66/239). Teaching occurred in the room 25% percent of the time, and of those instances families were asked permission before teaching 10% of the time. Upon exiting the room, teaching physicians were observed using the FCR experience for further discussion in 22% of the FCR experiences observed. One hundred seventeen families were asked to participate in developing a plan for the day (47%) and 81 families were asked to participate in developing discharge goals (34%).
Conclusions: In this study, FCR did not consistently follow published guidelines, however, it is unclear how this is affecting the quality of the patient rounding experience or the educational goals of trainees. Future studies are warranted to elicit information from parents and learners about their perception of the current FCR model.