Family-Centered Rounds

Basics of Family-Centered Rounds

"Family-Centered Care and the Pediatrician's Role"

Conducting physician rounds (i.e., patient presentations and rounds discussions) in patients' rooms with the family present should be standard practice."

Pediatrics, September 2003

Staff at Cincinnati Children's Hospital Medical Center have found that there are four basic steps that can be utilized to make each encounter during family-centered rounds most effective:

1. Family Choice

All families need to understand what rounds are, be given options about how they can participate in rounds, and be given the opportunity to choose their role in rounds. Before beginning rounds, staff should address privacy issues and fears the parent(s) might have. Have parents complete a Preference Card detailing what they want their involvement to be in rounds. Keep the card posted, and respect the parents' wishes.

2. Roles and Responsibilities

Before beginning rounds, make sure key people are present.  Agree on roles and responsibilities of everyone involved ahead of time.

3. Setting the Scene

Before entering a patient room, decide if some discussion needs to occur separate from family (e.g., a sensitive topic). Agree why, and conduct this discussion in a way that respects the family's privacy. From there follow these basic guidelines:

  • Key doctor leads and confirms that it's okay to start rounds
  • Make introductions – use the family's name as they prefer
  • Use appropriate "ice breaker" to help establish rapport between family and team, such as:
    • "Great socks!"
    • "I'll bet it was a short night. You must be tired"
    • "What a beautiful baby. Congratulations."
    • "Can I tell the rest of the team what you told me about your soccer team?"
    • "Good morning. We're sorry to wake you."
  • Position key participants in a circle that includes the family
  • Ask if it is okay to turn off the television
  • Consider having key physician sit down if the family is seated

4. Leveling the Playing Field

It's important for the parent(s) to feel like an integral part of the care team. This can be done by leveling the playing field by using some key phrases, such as:

  • "I'm going to review the story so our entire group understands what brought you to the hospital. Please feel free to add or correct anything as I go along."
  • "I'm going to review for the team what happened in the last 24 hours. Your input will be very important."
  • "The most important thing we do on rounds is make the plan for the day. While we're the experts on medicine, you're the expert on your child and family. Together we'll make better decisions."'
  • "Rounds is not us talking at you or in front of you. It is us talking together. Please join in at any time."
  • For Night Float Patients: "Good news. You don't have to tell your story all over again. The doctors who cared for you explained the story and wrote it out. I do want to go over key parts to make sure we have it right before we discuss plans. Is that okay?"
  • If concerned family needs more time: "This discussion usually lasts about 10 to 15 minutes. If we need more time, one or two of us will return after we finish seeing the other patients. Dr. Senior Resident keeps our team organized. She'll / he'll let us know if we need to finish later."
  • To introduce Discharge Goals: "The patient is not ready to go home, but for everyone's sake let's talk about what will need to happen here in the hospital for him / her to be ready to go home.

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