Feedback from Physicians
Find out from physicians about family-centered rounds that they have participated in at Cincinnati Children's Hospital Medical Center:
Feedback from Jeffrey M. Simmons, MD, Instructor of Pediatrics in the Division of General and Community Pediatrics at Cincinnati Children's
If you see family-centered rounds and then try them, the face validity overwhelms most of the concerns. In other words, immediately families will tell you they are getting better care.
Family-centered rounds are a tremendously efficient teaching mode. After rounding for one or two days, I have an excellent idea which learners need the most help with communication / bedside manner, and gain a lot of "material" to give learners concrete examples of what didn't go so well. Finally, during rounds I have a "stage" on which to model other ways of talking to families and recognizing non-verbal cues, not to mention physical exam. These things can happen during the more traditional methods of rounding, but usually only haphazardly and with extra effort. With family-centered rounds it is daily, efficient and residents quickly come to appreciate the pattern of immediate feedback / adjustment. Senior residents, in particular, relish feedback on "how to deal with families" based on concrete examples.
A lot of people think that conducting family-centered rounds means you will be rounding until 2 pm. Family-centered rounds take, on average, 2 to 4 minutes longer per patient, but if you pick the right measure, how many minutes per patient do the resident and attending spend on patient care for the whole day, family-centered rounds are far, far more efficient. (I would estimate time savings of close to an hour.) The litmus test for this is the nurses. What they tell us in focus groups is that if family-centered rounds have occurred on their patients they are able to give much better sign-out to the evening shift, and need to page the interns during the day a lot less.
From an attending's point of view, in order to be a more effective teacher on rounds, I pre-round by looking through vital signs, labs, radiology on the computer. This takes me about 25 to 30 minutes for a census of 10 to 15 patients (our average per attending). I see the majority of my patients in the afternoon as well. (Our hospitalist group commits to seeing each of our patients twice a day.) I do any physical exam on rounds that is key for decision-making (and teach senior residents the need to do the same), but save the complete exam needed for documentation / billing for after rounds. The exception is the 20 to 30% of patients we discharge on rounds; if such a patient is a new admission (i.e. a <24 hour stay), I will do a more thorough physical on rounds - usually as the team is moving on to the next patient unless there are exam findings worth sharing.
A point worth emphasizing is that getting families, nurses and residents to participate in the design, implementation and feedback process of family-centered rounds is the key to success.
Feedback from Javier A. Gonzalez del Rey, MD, Associate Director of Emergency Medicine and Director of the Pediatric Residency Programs at Cincinnati Children's
Family-centered rounds are the best way to teach and care for patients. It's as close as it gets to "real life." We go to patient rooms, discuss plans and bring in all members of the care team. When we conduct family-centered rounds, we can make sure the families get a consistent message.
To perfect family-centered rounds, it needs practice from all parties:
- Attendings need to be successful facilitators of discussion and know when to teach and what to teach
- Residents need to practice communication skills and senior leadership skills
- Nurses to perfect sharing their insights about the patient with the group during rounds
When we initially started family-centered rounds, we had some resistance from residents. After the residents saw the rounds in practice, they became out biggest advocates.
