Family-centered rounds benefit residents, get parents involved

By Jan Jarvis

Andrew Yu, a fourth-year medical student, saw firsthand the benefits of family-centered rounds while at Children’s Medical Center Dallas.

“Parents love it,” he said after visiting with a young patient.

The UT Southwestern/Children’s Medical Center care team for 9-year-old asthma patient Mario Buffin Jr., along with his grandmother, Linda Buffin, receive a report on his progress in family-centered rounds, a growing practice involving full-team discussion of pediatric patient cases with families.
The UT Southwestern/Children’s Medical Center care team for 9-year-old asthma patient Mario Buffin Jr., along with his grandmother, Linda Buffin, receive a report on his progress in family-centered rounds, a growing practice involving full-team discussion of pediatric patient cases with families.

Just as important, he found the rounds, which allow medical teams to partner with parents of pediatric patients in making decisions, helped him understand what patients go through when hospitalized and how to better communicate with them.

During traditional rounds, the medical team discusses pediatric patients’ cases among themselves. Family-centered rounds are conducted in patients’ rooms, with parents involved in the discussion. Since 2003, the American Academy of Pediatrics has recommended family-centered rounds.

“It’s helped me think about how I talk to patients,” Mr. Yu said. “It’s changed how I approach them.”

A study recently published in the Journal of Graduate Medical Education bears this out. Family-centered rounds allow residents to interact with patients and provide valuable experience, according to Dr. Vineeta Mittal, Associate Professor of Pediatrics at UT Southwestern Medical Center and a pediatric hospitalist at Children’s Medical Center, where the practice has been in place since 2007.

“We already know there are a lot of benefits for the patients and hospitals,” Dr. Mittal said. “But we didn’t know whether residents found them to be beneficial.”

Although the practice has been widely adopted, little was known about its educational impact on pediatric residents. The study led by Dr. Mittal was conducted at two sites: Children’s Medical Center and Children’s National Medical Center in Washington, D.C. Dr. Benjamin Lee and Dr. Timothy McCavit, both Assistant Professors of Pediatrics, co-authored the study and Dr. Glenn Flores, Professor of Pediatrics and Clinical Sciences, was the senior author.

The study, which ran from November 2008 to February 2010, was based on feedback from 34 interns and residents at the two pediatric hospitals.

The researchers found that the rounds enhanced the educational experience and gave residents the chance to directly observe and learn about communication, compassion, respect, accountability, and sensitivity with diverse populations.

“Residents learned to use lay language when talking to families during rounds,” Dr. Mittal said.

As a trainee was quoted in the study, “We all need to learn to eliminate that medical vocabulary when we are talking to the families, and I think if it is done well, you can be just as efficient in your rounds.”

 In her study, Dr. Mittal found that residents retained more information about the patients they saw. One trainee quoted in the study said, “I can get information about a disease process and retain it because I have a face, family, and situation.” The rounds also exposed residents to more patient encounters without increasing their workload, as they saw multiple patients during family-centered rounds and not just their own. Role modeling by attending physicians during rounds was found to be valuable to improve resident communication and physical examination skills.

The bedside interactions that are a part of family-centered rounds also improve communication, boost family satisfaction, and cut down on how long patients stay in the hospital, Dr. Mittal found.

Parents like the approach because they can communicate with the whole medical team at once.

“When everyone goes in together, parents don’t have to repeat things to 20 people going in at different times,” Dr. Mittal said. “With one visit, everyone rounds together, and it puts everyone on the same page.”

When Linda Buffin’s 9-year-old grandson, Mario Buffin Jr., was hospitalized at Children’s Medical Center, she found the family-centered rounds reduced the stress of hospitalization.

“They informed me about everything that had taken place and was going to take place,” said Mrs. Buffin, who brought Mario to the hospital when he suffered a severe asthma attack. “It really was enlightening and put my mind at ease.”

Dr. Flores holds the Judith and Charles Ginsburg Chair in Pediatrics.

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