Family-Centered Pediatric Rounds Boost Satisfaction

Want to markedly boost family satisfaction with inpatient pediatric care, foster a closer physician-family bond, impress families that you and your health care team operate at a high level of skill and intergroup communication, and – while you’re at it – score major points with hospital administrators?

Adopt family-centered rounds as your hospital’s standard in conducting inpatient pediatric rounds.

That’s what the American Academy of Pediatrics urged some 8 years ago in a policy statement. The academy declared that standard practice should be to conduct rounds in patients’ rooms with both the health care team (attending physician, residents, medical students, and charge nurse) and the families present, instead of in the conventional fashion, with the team meeting out in the hallway or in a conference room separated from patient and family.

The AAP statement elaborated that family-centered rounds are "interdisciplinary work rounds at the bedside in which the patient and family share in the control of the management plan as well as in the evaluation of the process itself" (Pediatrics 2003;112:691-97).

A growing number of hospitals have heeded this AAP recommendation. Indeed, a recent survey of pediatric hospitalists concluded that family-centered rounds have become the standard method of rounding in 48% of academic and 31% of nonacademic hospitals (Pediatrics 2010;126:37-43). Yet few studies have actually examined the impact of family-centered rounds on family satisfaction with inpatient care.

Dr. Alan R. Schroeder and his colleagues at Santa Clara Valley Medical Center in San Jose, Calif., have recently done so. And the results are unabashedly positive, he reported at the annual meeting of the Pediatric Academic Societies in Denver.

The hospital’s general pediatric inpatient unit switched to family-centered rounds in September 2008. The resultant highly positive changes in families’ satisfaction with physicians, nurses, and quality of care for their child were documented through standardized anonymous surveys that were routinely administered on a quarterly basis by Professional Resource Consultants Inc. to 50 randomly selected families with recently discharged pediatric inpatients.

Here’s what the survey showed in a comparison of the proportion of "excellent" scores provided by 600 families during 2006-2008, prior to implementation of family-centered rounds, and by 457 families who were surveyed in 2009-2011:

• Overall quality of care was rated as excellent by 46.7% of families prior to introduction of family-centered rounds, compared with 60% afterwards.

• Overall quality of the physician’s care improved from a 54.5% excellent rating in 2006-2008 to 65.7% in 2009-2011.

• Nurses’ instructions and explanations of tests were rated excellent by 41.4% of families in 2006-2008 and by 53.7% of families after introduction of family-centered rounds.

• Physicians’ instructions about treatments and tests were rated excellent by 50.9% of families during 2006-2008 and by 60.3% in 2009-2011.

• Adoption of family-centered rounds appeared to have an impact extending beyond the physician-family relationship. Notably, 46.8% of families rated overall teamwork between physicians, nurses, and staff as excellent in 2006-2008, compared with 58.9% afterwards.

Because the hospital is dedicated to continuous quality improvement, Dr. Schroeder and coinvestigators sought to learn whether the increase in family satisfaction resulting from introduction of family-centered rounds could be differentiated from the impact of other constructive hospital changes that were made during the study period.

This appeared to be the case. The mean absolute 11.4% increase in family satisfaction scores on survey items that were deemed likely to be affected by family-centered rounds was greater than the 8.1% rise in items that were "possibly" related to family-centered rounding, such as satisfaction with the discharge process, and the 7.1% increase in satisfaction with survey items that were unlikely to be linked to family-centered rounds, such as hospital food quality, cleanliness, and nurses’ promptness in responding to phone calls.

Dr. Schroeder declared having no relevant financial disclosures.

Want to markedly boost family satisfaction with inpatient pediatric care, foster a closer physician-family bond, impress families that you and your health care team operate at a high level of skill and intergroup communication, and – while you’re at it – score major points with hospital administrators?

Adopt family-centered rounds as your hospital’s standard in conducting inpatient pediatric rounds.

That’s what the American Academy of Pediatrics urged some 8 years ago in a policy statement. The academy declared that standard practice should be to conduct rounds in patients’ rooms with both the health care team (attending physician, residents, medical students, and charge nurse) and the families present, instead of in the conventional fashion, with the team meeting out in the hallway or in a conference room separated from patient and family.

The AAP statement elaborated that family-centered rounds are "interdisciplinary work rounds at the bedside in which the patient and family share in the control of the management plan as well as in the evaluation of the process itself" (Pediatrics 2003;112:691-97).

A growing number of hospitals have heeded this AAP recommendation. Indeed, a recent survey of pediatric hospitalists concluded that family-centered rounds have become the standard method of rounding in 48% of academic and 31% of nonacademic hospitals (Pediatrics 2010;126:37-43). Yet few studies have actually examined the impact of family-centered rounds on family satisfaction with inpatient care.

Dr. Alan R. Schroeder and his colleagues at Santa Clara Valley Medical Center in San Jose, Calif., have recently done so. And the results are unabashedly positive, he reported at the annual meeting of the Pediatric Academic Societies in Denver.

The hospital’s general pediatric inpatient unit switched to family-centered rounds in September 2008. The resultant highly positive changes in families’ satisfaction with physicians, nurses, and quality of care for their child were documented through standardized anonymous surveys that were routinely administered on a quarterly basis by Professional Resource Consultants Inc. to 50 randomly selected families with recently discharged pediatric inpatients.

Here’s what the survey showed in a comparison of the proportion of "excellent" scores provided by 600 families during 2006-2008, prior to implementation of family-centered rounds, and by 457 families who were surveyed in 2009-2011:

• Overall quality of care was rated as excellent by 46.7% of families prior to introduction of family-centered rounds, compared with 60% afterwards.

• Overall quality of the physician’s care improved from a 54.5% excellent rating in 2006-2008 to 65.7% in 2009-2011.

• Nurses’ instructions and explanations of tests were rated excellent by 41.4% of families in 2006-2008 and by 53.7% of families after introduction of family-centered rounds.

• Physicians’ instructions about treatments and tests were rated excellent by 50.9% of families during 2006-2008 and by 60.3% in 2009-2011.

• Adoption of family-centered rounds appeared to have an impact extending beyond the physician-family relationship. Notably, 46.8% of families rated overall teamwork between physicians, nurses, and staff as excellent in 2006-2008, compared with 58.9% afterwards.

Because the hospital is dedicated to continuous quality improvement, Dr. Schroeder and coinvestigators sought to learn whether the increase in family satisfaction resulting from introduction of family-centered rounds could be differentiated from the impact of other constructive hospital changes that were made during the study period.

This appeared to be the case. The mean absolute 11.4% increase in family satisfaction scores on survey items that were deemed likely to be affected by family-centered rounds was greater than the 8.1% rise in items that were "possibly" related to family-centered rounding, such as satisfaction with the discharge process, and the 7.1% increase in satisfaction with survey items that were unlikely to be linked to family-centered rounds, such as hospital food quality, cleanliness, and nurses’ promptness in responding to phone calls.

Dr. Schroeder declared having no relevant financial disclosures.

Want to markedly boost family satisfaction with inpatient pediatric care, foster a closer physician-family bond, impress families that you and your health care team operate at a high level of skill and intergroup communication, and – while you’re at it – score major points with hospital administrators?

Adopt family-centered rounds as your hospital’s standard in conducting inpatient pediatric rounds.

That’s what the American Academy of Pediatrics urged some 8 years ago in a policy statement. The academy declared that standard practice should be to conduct rounds in patients’ rooms with both the health care team (attending physician, residents, medical students, and charge nurse) and the families present, instead of in the conventional fashion, with the team meeting out in the hallway or in a conference room separated from patient and family.

The AAP statement elaborated that family-centered rounds are "interdisciplinary work rounds at the bedside in which the patient and family share in the control of the management plan as well as in the evaluation of the process itself" (Pediatrics 2003;112:691-97).

A growing number of hospitals have heeded this AAP recommendation. Indeed, a recent survey of pediatric hospitalists concluded that family-centered rounds have become the standard method of rounding in 48% of academic and 31% of nonacademic hospitals (Pediatrics 2010;126:37-43). Yet few studies have actually examined the impact of family-centered rounds on family satisfaction with inpatient care.

Dr. Alan R. Schroeder and his colleagues at Santa Clara Valley Medical Center in San Jose, Calif., have recently done so. And the results are unabashedly positive, he reported at the annual meeting of the Pediatric Academic Societies in Denver.

The hospital’s general pediatric inpatient unit switched to family-centered rounds in September 2008. The resultant highly positive changes in families’ satisfaction with physicians, nurses, and quality of care for their child were documented through standardized anonymous surveys that were routinely administered on a quarterly basis by Professional Resource Consultants Inc. to 50 randomly selected families with recently discharged pediatric inpatients.

Here’s what the survey showed in a comparison of the proportion of "excellent" scores provided by 600 families during 2006-2008, prior to implementation of family-centered rounds, and by 457 families who were surveyed in 2009-2011:

• Overall quality of care was rated as excellent by 46.7% of families prior to introduction of family-centered rounds, compared with 60% afterwards.

• Overall quality of the physician’s care improved from a 54.5% excellent rating in 2006-2008 to 65.7% in 2009-2011.

• Nurses’ instructions and explanations of tests were rated excellent by 41.4% of families in 2006-2008 and by 53.7% of families after introduction of family-centered rounds.

• Physicians’ instructions about treatments and tests were rated excellent by 50.9% of families during 2006-2008 and by 60.3% in 2009-2011.

• Adoption of family-centered rounds appeared to have an impact extending beyond the physician-family relationship. Notably, 46.8% of families rated overall teamwork between physicians, nurses, and staff as excellent in 2006-2008, compared with 58.9% afterwards.

Because the hospital is dedicated to continuous quality improvement, Dr. Schroeder and coinvestigators sought to learn whether the increase in family satisfaction resulting from introduction of family-centered rounds could be differentiated from the impact of other constructive hospital changes that were made during the study period.

This appeared to be the case. The mean absolute 11.4% increase in family satisfaction scores on survey items that were deemed likely to be affected by family-centered rounds was greater than the 8.1% rise in items that were "possibly" related to family-centered rounding, such as satisfaction with the discharge process, and the 7.1% increase in satisfaction with survey items that were unlikely to be linked to family-centered rounds, such as hospital food quality, cleanliness, and nurses’ promptness in responding to phone calls.

Dr. Schroeder declared having no relevant financial disclosures.