The Impact of "Family-First Rounds" on Timely Discharge
Family-centered care is a key to quality. Parents have insights about their child and their hospital experience that are invaluable. At Cincinnati Children's, we're learning how to collaborate with families to improve our ability to deliver quality care.
A good example are the processes we call Discharge When and Family-First Rounds. Discharge When is based on our goal to get patients discharged and home without needless delay.
| | October 2007 |
Percentage of Patients Who Go Home Without Delay (in the following units: B5E, A6S, A6N, A7, A5N, B5W, A3N, A6C, A5S, A3S, RCNIC): What percentage of patients are discharged within 4 hours of meeting goals?
(Percent of inpatients who are discharged within 4 hours of meeting goals)
View our performance over time. (.pdf, 26k) | 66% |
Discharge When
A key element of our rounding process is called "Discharge When." Soon after the child is admitted, the care team, including the parents, develops specific discharge criteria. The goals are entered into the electronic record and posted in the patient's room for the family.
Progress is discussed daily, during Family-First Rounds. Patients are ready to go home when they meet their discharge goals and their parents are confident they understand and can perform any continuing treatment the child may need at home.
One satisfied parent commented: "Rounds happened about 9:30 am in Troy's room. They asked us what we needed. We were part of the team. We knew the plan. Nothing happened that we didn't know about. The best part is we went home as soon as he reached his goals!"
Discharge When was introduced in October 2004 on one general pediatric unit. It greatly increased the percent of patients discharged without needless delay. Based on success in the pilot unit, Discharge When was rolled out to additional units. Outcomes for these units have varied, affected by such factors as the unit's culture, patient population, level of acceptance among attending physicians and nurses and staff skill in implementing the new procedures.
We are continuing to learn how to spread this improvement from a test site to widespread use within the hospital.
The Impact of "Family-First Rounds"
In most academic hospitals, doctors meet in a conference room to discuss the patient and then come to the patient's room to tell the family what they've decided. Our approach is to have all the individuals responsible for the care — parents, residents, attending physicians, nurses and others — meet at the bedside to discuss the child's progress and the course of treatment.
Rounding at the bedside improves communication among members of the team and improves the coordination and timeliness of care. Parents are more informed about their child's hospitalization, participate in daily care plans and are more satisfied with the hospital experience.
Comparing procedures at Cincinnati Children's with those he's experienced at other hospitals, one family medicine resident described rounding at Cincinnati Children's as "awesome." Our approach "takes steps out of the process and assures that everyone hears the same information at the same time."
Family-First Rounds started as a small test of change, piloted by one physician on one unit. Today it is an essential part of how we care for patients and families. Over time, the process has become well defined and standardized. Staff members with experience in Family-First Rounds serve as coaches, teaching the process to others.
Spreading the Word
To help spread family-centered rounds, Cincinnati Children's has produced a series of videos to share what we've learned and help people implement our findings at their own institutions. The videos have been used as a teaching tool at national conferences and in workshops at Cincinnati Children's. They are now posted on our web site as part of a facilitator guide that provides a wealth of information about how hospitals can implement family-centered rounds.
Last updated November 2007
