Overview
Definition:
Family-centered rounds (FCR) are a structured, interdisciplinary team meeting held at the patient's bedside, where the healthcare team discusses the patient's care plan with the patient and/or their family actively involved
It emphasizes collaboration, communication, and shared decision-making, recognizing the family as an integral component of the child's care team
This model shifts from a physician-centric approach to a partnership model.
Epidemiology:
FCR implementation varies across pediatric units globally, but its adoption is increasing due to evidence supporting improved patient outcomes, family satisfaction, and resident education
Specific epidemiological data on FCR prevalence is limited but growing, with most academic pediatric centers actively exploring or implementing such models.
Clinical Significance:
FCR are crucial in pediatrics as children are often dependent on their families for understanding and advocating for their care
This approach fosters trust, improves adherence to treatment plans, enhances patient safety by allowing families to voice concerns and observations, and provides a richer learning environment for medical residents by exposing them to family dynamics and communication strategies
It aligns with modern healthcare philosophies of patient empowerment and partnership.
Structure Of Fcr
Timing And Frequency:
Rounds are typically conducted daily, usually in the morning, after initial nursing assessments and vital sign checks
The timing can be adjusted based on unit workflow and patient needs
A consistent schedule is important for family and team expectations.
Location:
The rounds occur at the patient's bedside, promoting privacy and comfort for the family while allowing the team to directly observe the patient and their environment
Designated quiet zones or spaces near the room may be used for brief team huddles before entering the room, especially for sensitive discussions.
Participants:
Key participants include the primary pediatric resident, attending physician, nurses, social workers, child life specialists, pharmacists, dietitians, and other allied health professionals involved in the patient's care
Family members (parents, guardians, and sometimes other significant caregivers or even the child, depending on age and condition) are central participants.
Pre Round Preparation:
Before rounds, the primary resident and nursing staff typically review the patient's chart, recent vital signs, laboratory results, and overnight events
A brief interdisciplinary huddle may occur to discuss key issues, formulate a preliminary plan, and identify questions or concerns to be addressed during rounds
The team should agree on the goals and agenda for the round.
During Round Process:
The attending physician or senior resident usually leads the round, starting with introductions and setting the agenda
The team systematically discusses each problem, progress, and plan
Open-ended questions are used to encourage family participation
Information is presented clearly, avoiding excessive medical jargon
The team collaboratively develops a shared plan with clear goals and follow-up actions, ensuring family understanding and agreement.
Post Round Documentation:
Following rounds, the team thoroughly documents the discussion, the plan, and any decisions made in the patient's electronic health record
This ensures continuity of care and provides a clear record of the family's involvement and agreement.
Roles In Fcr
Attending Physician:
Provides senior leadership, oversees the team, ensures patient safety, facilitates complex decision-making, and models effective communication and FCR principles
They are the ultimate decision-maker but guide the team and family toward a consensus.
Pediatric Resident:
Acts as the primary coordinator of care, often leading the daily rounds under attending supervision
They present the patient's case, gather information, and work with the team and family to develop and execute the care plan
They are responsible for educating the family and ensuring their understanding.
Nursing Staff:
Provides direct patient care, monitors vital signs and patient status, administers medications, educates the family on daily care, and offers crucial insights into the child's condition and family's needs
They are often the first to identify subtle changes and are a constant presence for the family.
Social Worker:
Addresses psychosocial needs of the family, provides emotional support, facilitates communication, connects families with resources (financial, logistical, emotional), and advocates for family needs within the healthcare system
They are critical in managing family stress and ensuring access to support services.
Child Life Specialist:
Focuses on the child's developmental and emotional needs, helping them cope with hospitalization through play, education, and distraction
They prepare children for procedures and provide a link between the child's experience and the medical team, ensuring the child's voice is heard.
Other Allied Health Professionals:
Specialists like pharmacists (medication reconciliation, education), dietitians (nutritional support, education), physical/occupational therapists (rehabilitation), and respiratory therapists contribute their expertise to the interdisciplinary plan, ensuring holistic care
They provide specific guidance relevant to their discipline.
Benefits Of Fcr
Improved Patient Outcomes:
Enhanced adherence to treatment plans due to family understanding and involvement
Reduced medical errors through better communication and family vigilance
More comprehensive care addressing the child's holistic needs.
Increased Family Satisfaction:
Families feel respected, heard, and empowered in their child's care
Reduced anxiety and improved trust in the healthcare team
Greater sense of control and partnership in decision-making.
Enhanced Resident Education:
Develops crucial communication skills, teamwork, and understanding of family dynamics
Exposure to diverse perspectives in patient care
Improves problem-solving and clinical reasoning through collaborative discussion.
Better Team Collaboration:
Fosters mutual respect and understanding among interdisciplinary team members
Streamlines communication and care planning, leading to more efficient and coordinated care
Reduces interdisciplinary conflicts by addressing issues openly.
Challenges And Solutions
Time Constraints:
Rounds can be lengthy
Solution: Efficient pre-round preparation, clear agenda setting, and defined roles to keep discussions focused
Utilize brief team huddles for complex issues.
Privacy Concerns:
Discussing sensitive information at the bedside
Solution: Develop protocols for sensitive topics, using private spaces or focusing discussions on broader care goals at the bedside, with detailed discussions in private rooms when necessary
Ensure curtains are drawn.
Communication Barriers:
Medical jargon, cultural differences, family stress
Solution: Train teams in plain language communication, cultural humility, and active listening
Utilize interpreters when needed
Social work and child life support are vital.
Resistance To Change:
From staff or families accustomed to traditional models
Solution: Phased implementation, clear articulation of benefits, ongoing education, and feedback mechanisms
Involve champions within the team to promote adoption.
Inconsistent Attendance:
Difficulty ensuring all key personnel and family members are present
Solution: Establish a consistent schedule and communicate it clearly
Leverage technology for remote participation if feasible
Prioritize core team members.
Key Points
Exam Focus:
Understand the core principles of FCR: partnership, communication, shared decision-making
Be able to identify the roles of each team member and how they contribute to the patient's care
Recognize the benefits for patients, families, and trainees.
Clinical Pearls:
Always introduce yourself and your role
Ask families what they want to discuss at the start of rounds
Use teach-back methods to ensure understanding
Be mindful of non-verbal cues from both the child and family
Empower families to be active participants, not just observers.
Common Mistakes:
Using excessive medical jargon
Not allowing sufficient time for family questions
Presenting information without seeking family input
Failing to assign clear action items
Not documenting family input or decisions
Overlooking the child's perspective in discussions.