June 28, 2010 / 4:46 PM / 8 years ago

Family-centered rounds more common, obstacles remain

NEW YORK (Reuters Health) - Many hospital pediatric wards have moved from conducting traditional “rounds” to a newer, family-oriented form of the practice — but obstacles still remain, a new study finds.

Traditionally, hospital rounds have been “provider-oriented,” with doctors, doctors-in-training (residents and medical students), and other members of the medical team discussing patients’ cases among themselves.

However, since 2003 the American Academy of Pediatrics has recommended that teams in pediatric wards conduct rounds in patients’ rooms, with parents present and involved in the discussion. The guideline is part of the AAP’s recommendation that hospitals move toward an overall approach of “family-centered care” designed to get parents more involved in decisions about their children’s care.

Studies have found that family-centered care may improve the quality of children’s care and their families’ satisfaction with it.

However, little has been known about how hospitals are putting family-centered rounds, in particular, into practice — or the factors that may be supporting or standing in the way of hospitals’ willingness to adopt the practice.

For the new study, reported in the journal Pediatrics, researchers surveyed 265 pediatric-ward “hospitalists” (mainly attending physicians) at hospitals throughout the U.S. and Canada.

Overall, the study found, 44 percent said they conducted family-centered rounds, while the rest conducted more-traditional rounds, away from patients and families. University-affiliated medical centers were more likely to have family-centered rounds than community hospitals — 48 percent, versus 31 percent.

Not surprisingly, hospitals where staff believed that the benefits of family-centered rounds outweighed the potential downsides were more likely to conduct them.

Some of the most commonly cited benefits included greater family involvement in children’s care, and an improved learning experience for doctors-in-training, who benefit from seeing senior physicians interact with families.

Some of the barriers to implementing family-centered rounds were logistical — such as small patient rooms making it difficult for the whole medical team and family to gather bedside. Other obstacles included worry about patient confidentiality, since discussions would take place in patient rooms instead of a closed meeting area; and concerns from doctors-in-training that they would look bad in front of families if they seemed to lack knowledge about the case.

The good news, lead researcher Dr. Vineeta S. Mittal told Reuters Health, is that a significant percentage of pediatric wards were conducting family-centered rounds.

“There are still barriers, but I think we are identifying them and finding ways to address them,” said Mittal, of the University of Texas Southwestern Medical Center at Dallas.

One way, she and her colleagues say, is for hospitals to address common misperceptions about family-centered rounds — such as staff members’ belief that the rounds are too time-consuming.

In this study, one-third of survey respondents said their staff worried that parents’ questions would add too much time onto their rounds.

However, respondents whose wards did conduct family-centered rounds reported no substantial increase in rounding time overall. That, Mittal said, suggests that concerns about time constraints should not keep centers from implementing the practice.

SOURCE: here Pediatrics, July 2010.

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