Patient- and family centered rounds have developed over a number of years. At Cincinnati Children’s, we generally follow the steps outlined below.
The patient and family decide on how rounds should be conducted. At admission, staff members explain rounds and outline options for patient and family involvement. After addressing confidentiality issues, the family’s preference is marked on a card and taped outside the patient’s door. Some of the options:
- The team rounds in the room with the patient and family.
- The family joins the team in the hallway for rounds.
- The family chooses not to be involved in rounds but prefers that the physicians and nurses meet with them after rounds.
- The family indicates if they wish to be awakened during rounds if they are sleeping.
A decision is made on who needs to be involved in rounds and if any information needs to be discussed before entering the room. This is the optimal time to discuss sensitive patient or family issues (e.g., suspected nonaccidental trauma or confidential test results) and to discuss how this information will be shared with the patient and family. The team members also decide individual roles and responsibilities. Ideally, rounds should occur with the parents present. The team also puts on any necessary personal protective equipment.
A team member enters the room and confirms that the family is ready for rounds.
- The team enters, stands in a semicircle and introduces themselves to the patient and family.
- Introductions help make the family feel they are partners in the rounding process. Families have told us they prefer to have all members of the team introduce themselves and describe their role. Parents’ preferences on how they would like to be addressed should be respected.
- A team member briefly clarifies the purpose of rounds and encourages patient and family involvement.
- A couple of phrases to use are, “I’m going to tell his or her story but if there is anything you feel is inaccurate, please speak up,” or, “We are the medical experts, but your are the experts on your child; together we will do a better job of caring for your child.”
- Common language is used to share and summarize information and to develop the care plan for the patient.
- The resident or medical student making the presentation maintains eye contact with the patient and family. The use of medical jargon is kept to a minimum, and if a technical term must be used, the term is explained to the family using common language.
Physicians, nurses other key team members and the patient and family contribute information during the rounding process.
- The patient’s clinical course over the last day is reviewed. Daily plans are made and agreed upon. Discharge goals are discussed on the first day the team rounds and are reviewed and updated on a daily basis. The date and time of discharge are also discussed each day and are updated throughout the hospital stay.
- A team member inputs orders in real time into a computerized clinical order entry system.
- While one team member issues orders, another enters them electronically. The team participates in “write down / read back” to confirm orders are accurate.
Throughout this process, the attending physician observes the interns’ understanding of the patient’s condition and the family’s and staff’s comfort levels.
- The attending physician uses verbal and nonverbal cues to better understand each family’s concerns and ability to carry out the plan. The attending physician can immediately address any issues and model methods to address families with particular fears, anger, confusion or misunderstanding.
- Senior resident and attending physicians may ask the families for permission to conduct additional teaching in the room. If allowed, this provides the senior resident or attending physician an opportunity to involve parents in teaching. Alternatively teaching can be done in the hallway or conference room in the more traditional manner. Teaching that is directly relevant to the care of the child is most likely to be valued by everyone, including the family.