Background: Family Centered Rounds (FCR) allow the medical team to partner with patients and families in medical decision-making, improve patient communication, and enhance safety. Our children's hospital recently increased FCR utilization by implementing geographic-based teams. A balancing measure demonstrated that while the majority of respondents agreed that FCR provided the best patient care, only 20% felt FCR provided the best educational experience as compared to table rounds.
Objective: Increase the percentage of residents with a positive perception of the educational experience on FCR from 20% to 80% in 6 months.
Methods: The Model for Improvement and sequential PDSA cycles were utilized. A needs assessment identified top educational activities negatively impacted by FCR and top barriers to education during FCR (figure 1). In response, the FCR process was standardized and included formal presentations with medical terminology outside patient rooms in order to focus on assessments, differential diagnoses, and anticipatory guidance. Rounding duration and the percentage of patients receiving FCR were measured daily, while monthly surveys tracked resident perception of the educational experience. Family satisfaction and comprehension surveys were collected quarterly.
Results: Residents who perceive FCR as the best format for their educational experience improved from a baseline of 20% to 77% (N=8, 24) (figure 2). Patients receiving FCR remained above 80% (N=267, 299). Importantly, 100% (N=14) of families understood their care plans and remained satisfied with the amount of information presented post-intervention. Twenty-one percent of families (N=3) were understandably concerned about the number of people rounding during the COVID-19 pandemic. Unfortunately, rounds continued to frequently exceed the allotted time, increasing from 37% to 65% (N=7, 13).
Conclusions: Hybridization of FCR to include formal presentations resulted in an average of 55% more residents agreeing that FCR provided the best educational experience, while preserving family satisfaction and comprehension. Results may be generalizable to similarly sized residency programs. Future interventions will target barriers and negatively impacted educational activities identified upon re-evaluation of the new FCR structure. Additionally, in response to the COVID-19 pandemic, capabilities for virtual rounding have helped to preserve the educational experience for learners and ensure the ability to social distance inside patient rooms.
