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As we have completed workshops and presentations on patient- and family-centered rounds, physicians express five common concerns:
Concern No. 1: Conducting rounds at the bedside will make pediatric patients and their families uncomfortable
Research has shown that patients and families like bedside rounds. Data were collected to measure patients’ and families’ responses to being included in rounds using satisfaction surveys, anxiety scales, clinical indicators, structured interviews and focus groups. With each research method, the result has been the same: parents want to know what is going on and have a voice in their child’s or family member’s care.
John Romano’s observations in Patients’ Attitudes and Behavior in Ward Teaching Rounds, published in 1941, are still relevant:
Although patients and their families generally like to be included on rounds, there are things that can be done to improve their experience, such as:
Concern No. 2: Conducting rounds at the bedside will make learners (medical students and residents) uncomfortable
For physicians conducting rounds at teaching hospitals, there is often the concern that learners will be uneasy about participating in patient- and family-centered rounds. It is true that medical students, residents and other learners are uncomfortable about presenting at the bedside at first. However, with experience comes increased comfort. Learners who present frequently are more likely to prefer to do it in the future.
Concern No. 3: Conducting rounds at the bedside will push attending physicians outside of their “teaching comfort zone”
Conducting rounds at the bedside brings with it a certain amount of vulnerability for the attending physician. Learners and families might present issues or ask questions to which she or he doesn’t know the answer. Conducting rounds outside of a classroom environment means a loss of control for the attending physician. Studies have found that physicians who have been in the role of an attending physician for less than 10 years prefer the conference room (57 percent) over people who have been an attending physician for more than 10 years (18 percent). This illustrates that with time comes increased comfort and confidence in conducting rounds in front of families.
Concern No. 4: Conducting rounds at the bedside will take longer and is not an effective use of time
Rounds play an important role in patient care at hospitals. It is a time for information to change hands between caregivers and an opportunity for experienced physicians to teach students and residents. If rounds are done with patients and families present, it’s also a time to answer their questions.
In 1997, Lisa S. Lehmann, MD, published The Effect of Bedside Case Presentations on Patients’ Perceptions of Their Medical Care, in which she examined the length of rounds at the bedside versus in a conference room. She found that conducting rounds at the bedside did increase time spent with the patient from six minutes to 10. Multiplied by the number of patients seen during rounds each morning, this can add up. So why do it?
Our experience here at Cincinnati Children’s has been that although more time is spent during rounds, there is much less time spent following up, carrying out orders and delivering information to families and staff. Because everyone hears the information at the same time, the plan of care can be executed much more quickly and efficiently. By investing time during rounds, time is saved later.
Concern No. 5: Conducting rounds at the bedside will negatively impact the quality of teaching
There has not been much research done on the effect of bedside rounds on teaching. Early studies indicate that moving rounds into the patient room shifts the focus from direct teaching to addressing things like the physical diagnosis and bedside manner.
Ultimately, patient- and family-centered rounds challenge us to move beyond our comfort zone and approach uncertainty at the bedside. Patients like bedside rounds but want doctors to use understandable language and allow them to participate. Learners don’t like bedside presentations, but they become comfortable with experience and practice.
The information in this literature review on family-centered rounds referenced data from the following sources:
Brinkman WB, Simmons J, Vossmeyer M, Muething S. Family-Centered Rounds: Overcoming Barriers To Get Back to the Bedside. Educational Workshop at Pediatric Academic Societies Annual Meeting. San Francisco, CA, May, 2006.
Using Patient-Centered Care Principles to Improve Discharge Timeliness. Pediatric Academic Societies’ Meeting Platform Presentation, San Francisco, CA., May 1-4, 2004. Pediatric Research 55:4; 2004.
Anderson RJ, Cyran E, Schilling L, Lin C-T, Albertson G, Ware L, Steiner JF. Outpatient case presentations in the conference room versus examination room: Results from two randomized controlled trials. Am J Med. 2002; 113:657-662.
Nair BR, Coughlan JL, Hensley MJ. Student and patient perspectives on bedside teaching. Medical Education 1997; 31:341-346.
Lehmann LS, Brancati GL, Chen MC, Roter D, Dobs AS. The effect of bedside case presentation on patients’ perceptions of their medical care. N Engl J Med. 1997; 336:1150-1155.
Miller M, Johnson B, Greene HL, Baier M, Nowlin S. An observational study of attending rounds. J Gen Intern Med. 1992; 7:646-648.
Kroenke K, Simmons JO, Copley JB, Smith C. Attending rounds: a survey of physician attitudes. J Gen Intern Med. 1990; 5: 229-233.
Wang-Cheng RM, Barnas GP, Sigmann P, Riendl PA, Young JM. Bedside case presentation: why patients like them but learners don’t. J Gen Intern Med. 1989; 321:1273-1275.
Linfors EW, Neelon FA. The case for bedside rounds. N Engl J Med. 1980; 21:1230-1233.
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