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Shaik T, Aggarwal K, Singh B, Sawhney A, Naguluri R, Jain R, Jain R. A comprehensive analysis of different types of clinical rounds in hospital medicine. Proc AMIA Symp 2023; 37:135-141. [PMID: 38173995 PMCID: PMC10761014 DOI: 10.1080/08998280.2023.2261086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/15/2023] [Indexed: 01/05/2024] Open
Abstract
Table rounds and bedside rounds are two methods healthcare professionals employ during clinical rounds for patient care and medical education. Bedside rounds involve direct patient engagement and physical examination, thus significantly impacting patient outcomes, such as improving communication and patient satisfaction. Table rounds occur in a conference room without the patient present and involve discussing patient data, which is more effective in fostering structured medical education. Both bedside and table rounds have pros and cons, and healthcare professionals should consider the specific requirements of their patients and medical trainees when deciding which approach to use. This research utilized a comprehensive search to identify relevant resources, such as university website links, as well as a PubMed search using relevant keywords such as 'bedside rounding,' 'table rounding,' and 'patient satisfaction.' Relevance, publication date, and study design were the basis for inclusion criteria. This study compared the effectiveness of these two methods based on physician communication, medical education, patient care, and patient satisfaction.
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Affiliation(s)
- Tanveer Shaik
- Avalon University School of Medicine, Willemstad, Curacao
| | | | | | - Aanchal Sawhney
- Department of Internal Medicine, Crozer Chester Medical Center, Upland, Pennsylvania, USA
| | - Riya Naguluri
- Great Valley High School, Malvern, Pennsylvania, USA
| | - Rohit Jain
- Avalon University School of Medicine, Willemstad, Curacao
| | - Rahul Jain
- Avalon University School of Medicine, Willemstad, Curacao
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2
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Cabral VK, Cionek OAGD, Loureiro MM, Simbine REB, Silva DR. Audience response system smartphone application as an adjunct to tuberculosis teaching for medical students during the coronavirus disease 2019 pandemic. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 70:e20231132. [PMID: 38126453 PMCID: PMC10729663 DOI: 10.1590/1806-9282.20231132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The growing availability of devices for mobile learning has created new opportunities for teaching. With the development of smartphone apps based on audience response systems, there is a possibility to quickly assess student knowledge. The education of health professionals, including medical students, is an essential strategy for tuberculosis control. In the context of the coronavirus disease 2019 pandemic, audience response systems are very useful as online assessment tools. The aim of this study was to use the audience response systems Socrative to assess medical students during a class on tuberculosis. METHODS This is a quasi-experimental before-and-after study, with pre- and post-tests carried out through the Socrative app, respectively, before and after a lecture on tuberculosis for medical students. Also, a cross-sectional study was carried out after the course to evaluate the participant's satisfaction through an electronic, structured questionnaire with a Likert-type scale. RESULTS A total of 126 students were included in the study. The overall mean pre- and post-test scores were 5.98±1.59 and 8.37±1.36, respectively, with a statistically significant difference (p<0.0001). Almost all students were totally satisfied with the use of Socrative on pre- and post-tests. CONCLUSION This study describes how the use of Socrative in a tuberculosis class was well received by students. In addition, the baseline knowledge on tuberculosis was low in some topics, with some improvement after the lecture. These findings emphasize the need to further improve the students' knowledge on tuberculosis and help instructors customize the lecture based on the gaps identified in the Socrative assessment.
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Affiliation(s)
- Vagner Kunz Cabral
- Universidade Federal do Rio Grande do Sul, Postgraduate Program in Pneumological Sciences – Porto Alegre (RS), Brazil
| | | | | | - Rosa Elisa Bernardo Simbine
- Universidade Federal do Rio Grande do Sul, Postgraduate Program in Pneumological Sciences – Porto Alegre (RS), Brazil
- Ministry of Health – Maputo, Mozambique
| | - Denise Rossato Silva
- Universidade Federal do Rio Grande do Sul, Postgraduate Program in Pneumological Sciences – Porto Alegre (RS), Brazil
- Universidade Federal do Rio Grande do Sul, Faculty of Medicine – Porto Alegre (RS), Brazil
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3
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Backer CL, Overman DM, Dearani JA, Romano JC, Tweddell JS, Kumar SR, Marino BS, Bacha EA, Jaquiss RDB, Zaidi AN, Gurvitz M, Costello JM, Pierick TA, Ravekes WJ, Reagor JA, St Louis JD, Spaeth J, Mahle WT, Shin AY, Lopez KN, Karamlou T, Welke KF, Bryant R, Husain SA, Chen JM, Kaza A, Wells WJ, Glatz AC, Cohen MI, McElhinney DB, Parra DA, Pasquali SK. Recommendations for centers performing pediatric heart surgery in the United States. J Thorac Cardiovasc Surg 2023; 166:1782-1820. [PMID: 37777958 DOI: 10.1016/j.jtcvs.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.
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Affiliation(s)
- Carl L Backer
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - David M Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minn
| | | | - Jennifer C Romano
- Department of Cardiac Surgery, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Mich
| | - James S Tweddell
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - S Ram Kumar
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Emile A Bacha
- Department of Surgery, Columbia University/New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | | | - Ali N Zaidi
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - John M Costello
- Department of Pediatrics, Medical University of South Carolina, Shawn Jenkins Children's Hospital, Charleston, SC
| | - Trudy A Pierick
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - William J Ravekes
- Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Md
| | - James A Reagor
- Department of Cardiovascular Perfusion, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - James Spaeth
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - William T Mahle
- Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Andrew Y Shin
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, Calif
| | - Keila N Lopez
- Department of Pediatrics, Texas Children's Hospital, Houston, Tex
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Karl F Welke
- Department of Surgery, Atrium Health Levine Children's Hospital, Charlotte, NC
| | - Roosevelt Bryant
- Department of Surgery, Phoenix Children's Hospital, Phoenix, Ariz
| | - S Adil Husain
- Department of Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Jonathan M Chen
- Department of Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Aditya Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | - Winfield J Wells
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - Andrew C Glatz
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Mo
| | - Mitchell I Cohen
- Department of Pediatrics, Inova Children's Hospital, Fairfax, Va
| | - Doff B McElhinney
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, Calif
| | - David A Parra
- Department of Pediatrics, Vanderbilt Children's Hospital, Nashville, Tenn
| | - Sara K Pasquali
- Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Mich
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4
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Backer CL, Overman DM, Dearani JA, Romano JC, Tweddell JS, Kumar SR, Marino BS, Bacha EA, Jaquiss RDB, Zaidi AN, Gurvitz M, Costello JM, Pierick TA, Ravekes WJ, Reagor JA, St Louis JD, Spaeth J, Mahle WT, Shin AY, Lopez KN, Karamlou T, Welke KF, Bryant R, Husain SA, Chen JM, Kaza A, Wells WJ, Glatz AC, Cohen MI, McElhinney DB, Parra DA, Pasquali SK. Recommendations for Centers Performing Pediatric Heart Surgery in the United States. Ann Thorac Surg 2023; 116:871-907. [PMID: 37777933 DOI: 10.1016/j.athoracsur.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.
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Affiliation(s)
- Carl L Backer
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - David M Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minnesota
| | | | - Jennifer C Romano
- Department of Cardiac Surgery, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - James S Tweddell
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - S Ram Kumar
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, California
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Emile A Bacha
- Department of Surgery, Columbia University/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Robert D B Jaquiss
- Department of Surgery, UT-Southwestern, Children's Health, Dallas, Texas
| | - Ali N Zaidi
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - John M Costello
- Department of Pediatrics, Medical University of South Carolina, Shawn Jenkins Children's Hospital, Charleston, South Carolina
| | - Trudy A Pierick
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - William J Ravekes
- Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland
| | - James A Reagor
- Department of Cardiovascular Perfusion, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James D St Louis
- Department of Surgery, Inova Children's Hospital, Fairfax, Virginia
| | - James Spaeth
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - William T Mahle
- Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, Geogria
| | - Andrew Y Shin
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, California
| | - Keila N Lopez
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Karl F Welke
- Department of Surgery, Atrium Health Levine Children's Hospital, Charlotte, North Carolina
| | - Roosevelt Bryant
- Department of Surgery, Phoenix Children's Hospital, Phoenix, Arizona
| | - S Adil Husain
- Department of Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Jonathan M Chen
- Department of Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aditya Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Winfield J Wells
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, California
| | - Andrew C Glatz
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Missouri
| | - Mitchell I Cohen
- Department of Pediatrics, Inova Children's Hospital, Fairfax, Virginia
| | - Doff B McElhinney
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, California
| | - David A Parra
- Department of Pediatrics, Vanderbilt Children's Hospital, Nashville, Tennessee
| | - Sara K Pasquali
- Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan
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5
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Backer CL, Overman DM, Dearani JA, Romano JC, Tweddell JS, Ram Kumar S, Marino BS, Bacha EA, Jaquiss RDB, Zaidi AN, Gurvitz M, Costello JM, Pierick TA, Ravekes WJ, Reagor JA, St Louis JD, Spaeth J, Mahle WT, Shin AY, Lopez KN, Karamlou T, Welke KF, Bryant R, Adil Husain S, Chen JM, Kaza A, Wells WJ, Glatz AC, Cohen MI, McElhinney DB, Parra DA, Pasquali SK. Recommendations for Centers Performing Pediatric Heart Surgery in the United States. World J Pediatr Congenit Heart Surg 2023; 14:642-679. [PMID: 37737602 DOI: 10.1177/21501351231190353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.
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Affiliation(s)
- Carl L Backer
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David M Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, MN, USA
| | | | - Jennifer C Romano
- Department of Cardiac Surgery, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - James S Tweddell
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - S Ram Kumar
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Emile A Bacha
- Department of Surgery, Columbia University/New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Robert D B Jaquiss
- Department of Surgery, UT-Southwestern, Children's Health, Dallas, TX, USA
| | - Ali N Zaidi
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - John M Costello
- Department of Pediatrics, Medical University of South Carolina, Shawn Jenkins Children's Hospital, Charleston, SC, USA
| | - Trudy A Pierick
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - William J Ravekes
- Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - James A Reagor
- Department of Cardiovascular Perfusion, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James D St Louis
- Department of Surgery, Inova Children's Hospital, Fairfax, VA, USA
| | - James Spaeth
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William T Mahle
- Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Andrew Y Shin
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, CA, USA
| | - Keila N Lopez
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Karl F Welke
- Department of Surgery, Atrium Health Levine Children's Hospital, Charlotte, NC, USA
| | - Roosevelt Bryant
- Department of Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - S Adil Husain
- Department of Surgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Jonathan M Chen
- Department of Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aditya Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Winfield J Wells
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Andrew C Glatz
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Mitchell I Cohen
- Department of Pediatrics, Inova Children's Hospital, Fairfax, VA, USA
| | - Doff B McElhinney
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, CA, USA
| | - David A Parra
- Department of Pediatrics, Vanderbilt Children's Hospital, Vanderbilt, TN, USA
| | - Sara K Pasquali
- Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
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Rosenthal JL, Tancredi DJ, Marcin JP, Ketchersid A, Horath ET, Zerda EN, Bushong TR, Merriott DS, Romano PS, Young HM, Hoffman KR. Virtual family-centered hospital rounds in the neonatal intensive care unit: protocol for a cluster randomized controlled trial. Trials 2023; 24:331. [PMID: 37194089 DOI: 10.1186/s13063-023-07340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/29/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Family-centered rounds is recognized as a best practice for hospitalized children, but it has only been possible for children whose families can physically be at the bedside during hospital rounds. The use of telehealth to bring a family member virtually to the child's bedside during hospital rounds is a promising solution. We aim to evaluate the impact of virtual family-centered hospital rounds in the neonatal intensive care unit on parental and neonatal outcomes. METHODS This two-arm cluster randomized controlled trial will randomize families of hospitalized infants to have the option to use telehealth for virtual hospital rounds (intervention) or usual care (control). The intervention-arm families will also have the option to participate in hospital rounds in-person or to not participate in hospital rounds. All eligible infants who are admitted to this single-site neonatal intensive care unit during the study period will be included. Eligibility requires that there be an English-proficient adult parent or guardian. We will measure participant-level outcome data to test the impact on family-centered rounds attendance, parent experience, family-centered care, parent activation, parent health-related quality of life, length of stay, breastmilk feeding, and neonatal growth. Additionally, we will conduct a mixed methods implementation evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. DISCUSSION The findings from this trial will increase our understanding about virtual family-centered hospital rounds in the neonatal intensive care unit. The mixed methods implementation evaluation will enhance our understanding about the contextual factors that influence the implementation and rigorous evaluation of our intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05762835. Status: Not yet recruiting. First posted: March 10, 2023; last update posted: March 10, 2023.
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Affiliation(s)
- Jennifer L Rosenthal
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA.
- Center for Health and Technology, University of California Davis, 4610 X Street, Sacramento, CA, 95817, USA.
| | - Daniel J Tancredi
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - James P Marcin
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
- Center for Health and Technology, University of California Davis, 4610 X Street, Sacramento, CA, 95817, USA
| | - Audriana Ketchersid
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Elva T Horath
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Erika N Zerda
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Trevor R Bushong
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Daniel S Merriott
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Patrick S Romano
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
- Department of Internal Medicine and Center for Healthcare Policy and Research, University of California Davis, 4150 V St, Sacramento, CA, 95817, USA
| | - Heather M Young
- Betty Irene Moore School of Nursing, University of California Davis, 2570 48Th St, Sacramento, CA, 95817, USA
| | - Kristin R Hoffman
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
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7
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Ahmed H, King AB, Mohamed N, Mokaya E, Chapman K, Leonard R. Perception versus reality: analysis of time spent on bedside rounds in an academic ICU (Intensive Care Unit). BMC MEDICAL EDUCATION 2023; 23:274. [PMID: 37085853 PMCID: PMC10120486 DOI: 10.1186/s12909-023-04243-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/08/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Despite its importance, teaching at the bedside is declining over time. This purported decline has not been quantified. Quantifying bedside teaching is challenging, and we found only one study quantifying bedside teaching on a hospitalist service. OBJECTIVE We conducted a study to understand the prevalence of bedside teaching in our medical intensive care unit. METHODS We conducted a single-center single-unit study in the medical intensive care unit of an academic tertiary care institution. We used a survey tool to assess perceived time spent on bedside teaching, quality of teaching, and total rounding time. In parallel, independent observers objectively measured time spent on rounds and on bedside teaching. Residents were asked to complete the survey once a week. Independent observers collected data daily and weekly averages were obtained. RESULTS 43 responses were collected over a 4-month period. Most respondents (73%) reported a total rounding time of either 90-120 min or greater than 120 min. Median reported bedside teaching time was 16-20 min with 16 respondents (37%) reporting less than 15 min and 27 respondents (63%) reporting 16 min or more. The amount of time spent on bedside teaching was reported as adequate or more than adequate by 77% (33) of respondents with 58% (25) reporting that bedside teaching was very or extremely effective in helping them learn. Mean census reported by the independent observers was 12.75 patients per team. Bedside teaching represented an average of 12% of total rounding time, 16.85 min per day. While total rounding time increased with increasing census, there was no decline in bedside teaching time. CONCLUSION It is reported that bedside teaching has decreased over time. Our study has demonstrated that bedside teaching occurs in our Medical ICU, and though it represents a minority of the time spent on rounds, residents still reported teaching in the ICU to be adequate.
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Affiliation(s)
- Haroon Ahmed
- West Virginia University Health Sciences Center, Morgantown, WV, USA.
| | - Austin B King
- West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Nada Mohamed
- West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Erica Mokaya
- West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Kyle Chapman
- West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Rachel Leonard
- West Virginia University Health Sciences Center, Morgantown, WV, USA
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8
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Woldring JM, Luttik ML, Paans W, Gans ROB. The added value of family-centered rounds in the hospital setting: A systematic review of systematic reviews. PLoS One 2023; 18:e0280142. [PMID: 36662899 PMCID: PMC9858825 DOI: 10.1371/journal.pone.0280142] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Family engagement in care for adult inpatients may improve shared decision making in the hospital and the competence and preparedness of informal caregivers to take over the care at home. An important strategy to involve family members in hospital care processes is to include them in (ward) rounds, also called 'family-centered rounds'(FCRs). OBJECTIVES Summarize the evidence regarding the added value of FCRs from the perspectives of patients, family, and healthcare professionals. METHODS A review protocol was registered a priori with PROSPERO (number CRD42022320915). The electronic databases PubMed, CINAHL, and PsycInfo were searched for English-written systematic reviews with a focus on FCRs. The results and methods were presented in line with the PRISMA guidelines, and the methodological quality of the included reviews was assessed using the adapted version of the AMSTAR tool. RESULTS Of the 207 initial records, four systematic reviews were identified covering a total of 67 single studies, mainly performed in critical and pediatric care. Added values of FCR were described at review level, with references to single studies. All four systematic reviews reported an improvement in satisfaction among patients, family, and healthcare professionals, whereby satisfaction is linked to improved communication and interaction, improved situational understanding, inclusion of family in the decision-making process, and improved relationships within the care situation. CONCLUSION Although only limited research has been conducted on the value of FCRs in the adult non-critical care setting, and despite the existence of a variety of outcome measures, the results available from the pediatric and acute care setting are positive. The findings of the sole study in an adult non-critical patient population are in line with these results. Further research in adult non-critical care is required to verify its effects in this setting.
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Affiliation(s)
- Josien M. Woldring
- Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marie Louise Luttik
- Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Wolter Paans
- Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands
| | - Reinold O. B. Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Patel SJ, Khan A, Bass EJ, Graham D, Baird J, Anderson M, Calaman S, Cray S, Destino L, Fegley A, Goldstein J, Johnson T, Kocolas I, Lewis KD, Liss I, Markle P, O'Toole JK, Rosenbluth G, Srivastava R, Vara T, Landrigan CP, Spector ND, Knighton AJ. Family, nurse, and physician beliefs on family-centered rounds: A 21-site study. J Hosp Med 2022; 17:945-955. [PMID: 36131598 PMCID: PMC10087029 DOI: 10.1002/jhm.12962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Variation exists in family-centered rounds (FCR). OBJECTIVE We sought to understand patient/family and clinician FCR beliefs/attitudes and practices to support implementation efforts. DESIGNS, SETTINGS AND PARTICIPANTS Patients/families and clinicians at 21 geographically diverse US community/academic pediatric teaching hospitals participated in a prospective cohort dissemination and implementation study. INTERVENTION We inquired about rounding beliefs/attitudes, practices, and demographics using a 26-question survey coproduced with family/nurse/attending-physician collaborators, informed by prior research and the Consolidated Framework for Implementation Research. MAIN OUTCOME AND MEASURES Out of 2578 individuals, 1647 (64%) responded to the survey; of these, 1313 respondents participated in FCR and were included in analyses (616 patients/families, 243 nurses, 285 resident physicians, and 169 attending physicians). Beliefs/attitudes regarding the importance of FCR elements varied by role, with resident physicians rating the importance of several FCR elements lower than others. For example, on adjusted multivariable analysis, attending physicians (odds ratio [OR] 3.0, 95% confidence interval [95% CI] 1.2-7.8) and nurses (OR 3.1, 95% CI 1.3-7.4) were much more likely than resident physicians to report family participation on rounds as very/extremely important. Clinician support for key FCR elements was higher than self-reported practice (e.g., 88% believed family participation was important on rounds; 68% reported it often/always occurred). In practice, key elements of FCR were reported to often/always occur only 23%-70% of the time. RESULT Support for nurse and family participation in FCR is high among clinicians but varies by role. Physicians, particularly resident physicians, endorse several FCR elements as less important than nurses and patients/families. The gap between attitudes and practice and between clinician types suggests that attitudinal, structural, and cultural barriers impede FCR.
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Affiliation(s)
- Shilpa J Patel
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
- Division of Pediatric Hospital Medicine, Kapiolani Medical Center for Women & Children, Hawaii Pacific Health, Honolulu, Hawaii, USA
| | - Alisa Khan
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of General Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Ellen J Bass
- Department of Information Science in the College of Computing and Informatics, Department of Health Systems and Sciences Research in the College of Nursing & Health Professions, School of Biomedical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Dionne Graham
- Department of General Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Michele Anderson
- Family-Centered Care Department, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Sharon Calaman
- Division of Pediatric Critical Care, Department of Pediatrics, NYU Grossman School of Medicine, NYU Langone Health/Hassenfeld Children's Hospital, New York City, New York, USA
| | - Sharon Cray
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
- Patient and Family-Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts, USA
| | - Lauren Destino
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford/Stanford School of Medicine, Palo Alto, California, USA
| | - April Fegley
- Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Jenna Goldstein
- Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Tyler Johnson
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Irene Kocolas
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, University of Utah, Utah, USA
| | - Kheyandra D Lewis
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Isabella Liss
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Peggy Markle
- Patient and Family-Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts, USA
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jennifer K O'Toole
- Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Glenn Rosenbluth
- Department of Pediatrics, San Francisco School of Medicine, University of California, San Francisco, California, USA
- Department of Pediatrics, Benioff Children's Hospital, San Francisco, California, USA
| | - Raj Srivastava
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, University of Utah, Utah, USA
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, USA
| | - Tiffany Vara
- Division of Pediatric Hospital Medicine, Kapiolani Medical Center for Women & Children, Hawaii Pacific Health, Honolulu, Hawaii, USA
- Patient and Family-Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts, USA
| | - Christopher P Landrigan
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of General Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nancy D Spector
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- The Hedwig van Amerigen Executive Leadership in Academic Medicine (ELAM) Program, Philadelphia, Pennsylvania, USA
| | - Andrew J Knighton
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, USA
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Parente VM, Reid HW, Robles J, Johnson KS, Svetkey LP, Sanders LL, Olsen MK, Pollak KI. Racial and Ethnic Differences in Communication Quality During Family-Centered Rounds. Pediatrics 2022; 150:e2021055227. [PMID: 36345704 PMCID: PMC9724176 DOI: 10.1542/peds.2021-055227] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To evaluate racial and ethnic differences in communication quality during family centered rounds. METHODS We conducted an observational study of family-centered rounds on hospital day 1. All enrolled caregivers completed a survey following rounds and a subset consented to audio record their encounter with the medical team. We applied a priori defined codes to transcriptions of the audio-recorded encounters to assess objective communication quality, including medical team behaviors, caregiver participatory behaviors, and global communication scores. The surveys were designed to measure subjective communication quality. Incident Rate Ratios (IRR) were calculated with regression models to compare the relative mean number of behaviors per encounter time minute by race and ethnicity. RESULTS Overall, 202 of 341 eligible caregivers completed the survey, and 59 had accompanying audio- recorded rounds. We found racial and ethnic differences in participatory behaviors: English-speaking Latinx (IRR 0.5; 95% confidence interval [CI] 0.3-0.8) Black (IRR 0.6; 95% CI 0.4-0.8), and Spanish-speaking Latinx caregivers (IRR 0.3; 95% CI 0.2-0.5) participated less than white caregivers. Coder-rated global ratings of medical team respect and partnership were lower for Black and Spanish-speaking Latinx caregivers than white caregivers (respect 3.1 and 2.9 vs 3.6, P values .03 and .04, respectively: partnership 2.4 and 2.3 vs 3.1, P values .03 and .04 respectively). In surveys, Spanish-speaking caregivers reported lower subjective communication quality in several domains. CONCLUSIONS In this study, Black and Latinx caregivers were treated with less partnership and respect than white caregivers.
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Affiliation(s)
| | - Hadley W. Reid
- Duke University School of Medicine, Durham, North Carolina
| | - Joanna Robles
- Hematology/Oncology, Department of Pediatrics
- Cancer Prevention and Control, Duke Cancer Institute, Durham, North Carolina
| | - Kimberly S. Johnson
- Division of Geriatrics, Department of Medicine
- Center for Aging and Human Development
- Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | | | | | - Maren K. Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Departments of Biostatistics and Bioinformatics
| | - Kathryn I. Pollak
- Population Health Sciences, Duke University, Durham, North Carolina
- Cancer Prevention and Control, Duke Cancer Institute, Durham, North Carolina
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11
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Khalaf Z, Khan S. Education During Ward Rounds: Systematic Review. Interact J Med Res 2022; 11:e40580. [PMID: 36285742 PMCID: PMC9685505 DOI: 10.2196/40580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/10/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Background Enhancing the educational experience provided by ward rounds requires an understanding of current perceptions of the educational value of rounds. Objective This systematic review examines perceptions of education in ward rounds, educational activities in ward rounds, barriers to learning, and perceptions of simulation-based ward rounds. Methods The 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. MEDLINE (EBSCO), Cochrane, and Scopus were searched on May 29, 2022, for studies assessing learning during ward rounds. The search terms included “ward rounds,” “education,” and “trainees.” Then, the selected articles were reference searched. In total, 354 articles were retrieved. The articles were assessed for eligibility by 2 independent reviewers who screened titles, abstracts, and full-length texts. Articles addressing trainees’ education in all ward rounds were included. Articles were excluded if they were specific to certain disciplines, were reviews, were not published in scholarly journals, were published before 2015, were published in languages other than English, or did not concern human participants. Following the removal of 63 duplicates, a total of 268 articles were excluded. The risk of bias within the selected articles was also assessed via the Critical Appraisal Skills Programme checklist for qualitative research. Qualitative data were used to describe results in a narrative synthesis and in tables. Results A total of 23 articles were included. Perceptions of teaching in rounds were addressed by 6 studies, of which 3 showed negative perceptions among participants, 2 reported ambivalent perceptions, and 1 showed positive perceptions. Perceived barriers to teaching during rounds were assessed by 7 studies. The reported barriers included time constraints, workloads, schedules, interruptions, the service-oriented nature of rounds, the lack of feedback, hierarchies, the lack of opportunities to ask questions and be engaged in patient management, and divergent learner needs. Further, 8 studies identified types of educational activities, including observation, patient-specific teaching, and discussion. Perceptions of learning through simulated ward rounds were assessed by 8 studies, and a consensus of satisfaction was noted among learners. The interventions that were explored to improve education included using teaching frameworks, involving clinical librarians, and changing the setting of ward rounds. Conclusions The main limitations of this review are the predominant use of qualitative data in the included articles and the lack of standardization for the educational compositions of ward rounds among articles, which made the articles hard to compare. In conclusion, learning opportunities in ward rounds are often missed, and trainees perceive rounds to have low educational value. It is important to recognize the barriers to education during ward rounds and address them to maximize the benefits of ward rounds. Finally, there is a need to develop plans that incorporate teaching regularly during ward rounds in the inpatient setting. Trial Registration PROSPERO CRD42022337736; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=337736
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Affiliation(s)
- Zahra Khalaf
- Department of Postgraduate Surgical Studies, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Shaheer Khan
- Department of Postgraduate Surgical Studies, Royal College of Surgeons in Ireland, Dublin, Ireland
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12
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Ratelle JT, Gallagher CN, Sawatsky AP, Kashiwagi DT, Schouten WM, Gonzalo JD, Beckman TJ, West CP. The Effect of Bedside Rounds on Learning Outcomes in Medical Education: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:923-930. [PMID: 35020612 PMCID: PMC9126262 DOI: 10.1097/acm.0000000000004586] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE To determine if bedside rounds, compared with other forms of hospital ward rounds, improve learning outcomes in medical education. METHOD For this systematic review, the authors searched Ovid MEDLINE, Embase, and Scopus from inception through February 20, 2020. Experimental studies were included if they (1) compared bedside rounds to any other form of rounds in a hospital-based setting, and (2) reported a quantitative comparison of a learning outcome (e.g., learner reaction, knowledge, skills, behavior, health care delivery) among physicians-in-training (medical students, residents, fellows). Extraction elements were summarized using descriptive statistics and a narrative synthesis of design, implementation, and outcomes. RESULTS Twenty studies met inclusion criteria, including 7 randomized trials. All studies involved resident physicians, and 11 also involved medical students. The design and implementation of bedside rounds varied widely, with most studies (n = 13) involving cointerventions (e.g., staff education, real-time order entry).Of the 15 studies that reported learner satisfaction, 7 favored bedside rounds, 4 favored the control, and 4 were equivocal. Of the 4 studies reporting an outcome of learners' knowledge and skills, 2 favored bedside rounds and 2 were equivocal. Of the 8 studies that reported on learner behavior (e.g., bedside communication with patients), 5 favored bedside rounds, 1 favored the control, and 2 were equivocal. Finally, of the 14 studies that reported a health care delivery outcome (e.g., teamwork, rounding time), 8 favored bedside rounds and 6 were equivocal. Due to the high risk of bias and unexplained heterogeneity across studies, the overall strength of evidence was low. CONCLUSIONS In hospital-based settings, learners' satisfaction with bedside rounds is mixed. However, bedside rounds appear to have a positive effect on learner behavior and health care delivery. Given their potential value, additional research is needed to identify barriers to and facilitators of educationally successful bedside rounds.
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Affiliation(s)
- John T. Ratelle
- J.T. Ratelle is assistant professor of medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0001-8061-283X
| | - Caitlyn N. Gallagher
- C.N. Gallagher is a second-year resident, Department of Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-4906-4019
| | - Adam P. Sawatsky
- A.P. Sawatsky is associate professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-4050-7984
| | - Deanne T. Kashiwagi
- D.T. Kashiwagi is associate professor of medicine, Division of Hospital Internal Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Will M. Schouten
- W.M. Schouten is assistant professor of medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-0448-3615
| | - Jed D. Gonzalo
- J.D. Gonzalo is professor of medicine, Division of General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0001-8061-283X
| | - Thomas J. Beckman
- T.J. Beckman is professor of medicine and medical education, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-4343-3936
| | - Colin P. West
- C.P. West is professor of medicine, medical education, and biostatistics, Divisions of General Internal Medicine, and Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1628-5023
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13
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Carey MO, O'Riordan N, Carty M, Ivers M, Taylor LK, Higgins MF. Validation of a questionnaire exploring patient attitudes towards bedside teaching. BMC MEDICAL EDUCATION 2022; 22:152. [PMID: 35255874 PMCID: PMC8900100 DOI: 10.1186/s12909-022-03192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Bedside teaching (BST) facilitates medical education and has reduced in practice, often due to patient-related concerns. This study aimed to validate a questionnaire exploring patients attitudes towards BST. METHODS International guidelines for questionnaire development were followed. Seven steps were included: literature review, patient interviews, development of clear and understandable items, expert validation, cognitive interviewing and pilot testing. Statistical analyses included exploratory factor analysis, internal consistency, investigation of demographic influences and discriminant validity across subscales. RESULTS Following the literature review, 32 interviews were conducted. Potential items were developed, reviewed and adapted. Experts in medical education and statistics reviewed the draft questionnaire. Fifteen patients consented to cognitive testing and 401 consenting patients completed the final version. The median age of participants was 35 years of age (range: 18 to 70 years). Participants included women attending for antenatal (40%), postnatal (32%) and gynaecology issues (28%). Just under one third (29%) had taken part in medical student teaching previously. Statistical analyses found a two-factor solution, consisting of Educate medical professionals and Conditions for participation subscales with good internal consistency; responses did not vary by age or education. Participants who had opted-in for teaching in the ward and bedside endorsed higher levels of Educate medical professionals, suggesting discriminant validity. A majority of patients (> 92%) reported that they were happy to be involved in BST. Patients believed that they should not be asked to participate in BST should they feel stressed or unwell (68.2%). CONCLUSION This study shows extensive patient support for BST, independent of age or education. The desire to educate is a strong motivating factor. This strong support by patients for BST is an area that medical schools and universities can potentially develop. Future versions of this questionnaire may include virtual bedside teaching, in the context of social distancing.
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Affiliation(s)
- M O Carey
- Obstetrics and Gynaecology, National Maternity Hospital Dublin, Dublin, Ireland
| | - N O'Riordan
- Obstetrics and Gynaecology, National Maternity Hospital Dublin, Dublin, Ireland
| | - M Carty
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | - M Ivers
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | - L K Taylor
- UCD School of Psychology, University College Dublin, Dublin, Ireland
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - M F Higgins
- Obstetrics and Gynaecology, National Maternity Hospital Dublin, Dublin, Ireland.
- Obstetrics and Gynaecology, UCD Perinatal Research Centre, National Maternity Hospital Dublin, 65-66 Lower Mount Street, D02YH21, Dublin, Republic of Ireland.
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Thomas C, Plumblee L, Dieffenbaugher S, Talley C. Teaching on Rounds and in Small Groups. Surg Clin North Am 2021; 101:555-563. [PMID: 34242599 DOI: 10.1016/j.suc.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bedside teaching plays a vital role the training future physicians, allowing for instruction in history taking, physical examination skills, differential diagnosis development, professionalism, teamwork integration, effective communication, and discussions of medical ethics. Due to changes in the health care system, accreditation bodies, and shortened admittance of patients, rates of bedside teaching have declined. Attending surgeons feel increased external pressures to meet performance metrics while resident physicians adhere to duty hour restrictions. This article highlights popular methods, including bedside rounds, near-peer teaching, and resident versus attending preceptors, and discusses how teaching on rounds has an impact on patients.
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Affiliation(s)
- Christopher Thomas
- Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Leah Plumblee
- Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Sean Dieffenbaugher
- Carolinas Medical Center, Atrium Health, Department of Surgery, 1000 Blythe Boulevard, MEB Office 601, Charlotte, NC 28203, USA
| | - Cynthia Talley
- Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
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Fernandes AK, Wilson S, Nalin AP, Philip A, Gruber L, Kwizera E, Sydelko BS, Forbis SG, Lauden S. Pediatric Family-Centered Rounds and Humanism: A Systematic Review and Qualitative Meta-analysis. Hosp Pediatr 2021; 11:636-649. [PMID: 34021029 DOI: 10.1542/hpeds.2020-000240] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Pediatric family-centered rounds (FCRs) have been shown to have benefits in staff satisfaction, teaching, and rounding efficiency, but no systematic review has been conducted to explicitly examine the humanistic impact of FCRs. OBJECTIVE The objective with this review is to determine if FCRs promote the core values of humanism in medicine by answering the question, "Do FCRs promote humanistic pediatric care?" DATA SOURCES Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and Dissertation Abstracts for peer-reviewed pediatric studies through January 1, 2020. We used search terms including FCRs, communication, humanism, and the specific descriptors in the Gold Foundation's definition of humanism. STUDY SELECTION Abstracts (n = 1003) were assessed for 5 primary outcomes: empathy, enhanced communication, partnership, respect, and satisfaction and service. We evaluated 158 full-text articles for inclusion, reconciling discrepancies through an iterative process. DATA EXTRACTION Data abstraction, thematic analysis, and conceptual synthesis were conducted on 29 studies. RESULTS Pediatric family-centered rounds (FCRs) improved humanistic outcomes within all 5 identified themes. Not all studies revealed improvement within every category. The humanistic benefits of FCRs are enhanced through interventions targeted toward provider-family barriers, such as health literacy. Patients with limited English proficiency or disabilities or who were receiving intensive care gained additional benefits. CONCLUSIONS Pediatric FCRs promote humanistic outcomes including increased empathy, partnership, respect, service, and communication. Limitations included difficulty in defining humanism, variable implementation, and inconsistent reporting of humanistic outcomes. Future efforts should include highlighting FCR's humanistic benefits, universal implementation, and adapting FCRs to pandemics such as coronavirus disease 2019.
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Affiliation(s)
- Ashley K Fernandes
- Department of Pediatrics, College of Medicine, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio; .,Center for Bioethics
| | - Sheria Wilson
- Department of Pediatrics, College of Medicine, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | | | - Andrew Philip
- Department of Psychiatry, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | | | - Elise Kwizera
- Department of Internal Medicine, The Cleveland Clinic, Cleveland, Ohio
| | - Bette S Sydelko
- School of Medicine/Medical Library, Wright State University, Dayton, Ohio; and
| | | | - Stephanie Lauden
- Department of Pediatrics, College of Medicine, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
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Rosenthal JL, Sauers-Ford HS, Williams J, Ranu J, Tancredi DJ, Hoffman KR. Virtual Family-Centered Rounds in the Neonatal Intensive Care Unit: A Randomized Controlled Pilot Trial. Acad Pediatr 2021; 21:1244-1252. [PMID: 33746043 PMCID: PMC8429071 DOI: 10.1016/j.acap.2021.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To measure the feasibility, reach, and potential impact of a virtual family-centered rounds (FCR) intervention in the neonatal intensive care unit. METHODS We conducted a randomized controlled pilot trial with a 2:1 intervention-to-control arm allocation ratio. Caregivers of intervention arm neonates were invited to participate in virtual FCR plus standard of care. We specified 5 feasibility objectives. We profiled intervention usage by neonatal and maternal characteristics. Exploratory outcomes included FCR caregiver attendance, length of stay, breast milk feeding at discharge, caregiver experience, and medical errors. We performed descriptive analyses to calculate proportions, means, and rates with 95% confidence intervals (CI). RESULTS We included 74 intervention and 36 control subjects. Three of the five feasibility objectives were met based on the point estimates. The recruitment and intervention uptake objectives were not achieved. Among intervention arm subjects, recruitment of a caregiver occurred for 47 (63.5%, 95% CI 51.5%-74.4%) neonates. Caregiver use of the intervention occurred for 36 (48.6%, 95% CI 36.8%-60.6%) neonates in the intervention arm. Feasibility objectives assessing technical issues, burden, and data collection were achieved. Among the attempted virtual encounters, 95.0% (95% CI 91.5%-97.3%) had no technical issues. The survey response rate was 87.5% (95% CI 78.2%-93.8%). Intervention arm neonates had 3.36 (95% CI 2.66%-4.23) times the FCR caregiver attendance rate of subjects in the control arm. CONCLUSIONS A randomized trial to compare virtual FCR to standard of care in neonatal subjects is feasible and has potential to improve patient and caregiver outcomes.
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Affiliation(s)
- Jennifer L. Rosenthal
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Hadley S. Sauers-Ford
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Jacob Williams
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Jaskiran Ranu
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Kristin R. Hoffman
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
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Ramackers W, Stupak JV, Marcheel IL, Tuffs A, Schrem H, Fischer V, Beneke J. Regression analyses of questionnaires in bedside teaching. BMC MEDICAL EDUCATION 2020; 20:371. [PMID: 33081766 PMCID: PMC7574454 DOI: 10.1186/s12909-020-02295-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/09/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND Students' ratings of bedside teaching courses are difficult to evaluate and to comprehend. Validated systematic analyses of influences on students' perception and valuation of bedside teaching can serve as the basis for targeted improvements. METHODS Six hundred seventy-two observations were conducted in different surgical departments. Survey items covered the categories teacher's performance, student's self-perception and organizational structures. Relevant factors for the student overall rating were identified by multivariable linear regression after exclusion of variable correlations > 0.500. The main target for intervention was identified by the 15% worst overall ratings via multivariable logistic regression. RESULTS According to the students the success of bedside teaching depended on their active participation and the teacher's explanations of pathophysiology. Further items are both relevant to the overall rating and a possible negative perception of the session. In comparison, negative perception of courses (worst 15%) is influenced by fewer variables than overall rating. Variables that appear in both calculations show slight differences in their weighing for their respective endpoints. CONCLUSION Relevant factors for overall rating and negative perception in bedside teaching can be identified by regression analyses of survey data. Analyses provide the basis for targeted improvement.
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Affiliation(s)
- Wolf Ramackers
- General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | | | | | - Annette Tuffs
- Transplantation Centre, Management-Team, Hannover Medical School, Hannover, Germany
| | - Harald Schrem
- Department of General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Volkhard Fischer
- Office of the Dean of Studies, Hannover Medical School, Hannover, Germany
| | - Jan Beneke
- Transplantation Centre, Management-Team, Hannover Medical School, Hannover, Germany
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18
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Organizational Characteristics Associated With ICU Liberation (ABCDEF) Bundle Implementation by Adult ICUs in Michigan. Crit Care Explor 2020; 2:e0169. [PMID: 32885171 DOI: 10.1097/cce.0000000000000169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The ICU Liberation (ABCDEF) Bundle can help to improve care and outcomes for ICU patients, but bundle implementation is far from universal. Understanding how ICU organizational characteristics influence bundle implementation could inform quality improvement efforts. We surveyed all hospitals in Michigan with adult ICUs to determine whether organizational characteristics were associated with bundle implementation and to determine the level of agreement between ICU physician and nurse leaders around ICU organizational characteristics and bundle implementation. Design We surveyed ICU physician and nurse leaders, assessing their safety culture, ICU team collaboration, and work environment. Using logistic and linear regression models, we compared these organizational characteristics to bundle element implementation, and also compared physician and nurse leaders' perceptions about organizational characteristics and bundle implementation. Setting All (n = 72) acute care hospitals with adult ICUs in Michigan. Subjects ICU physician and nurse leader pairs from each hospital's main ICU. Interventions We developed, pilot-tested, and deployed an electronic survey to all subjects over a 3 month period in 2016. Results Results from 73 surveys (28 physicians, 45 nurses, 60% hospital response rate) demonstrated significant variation in hospital and ICU size and type, organizational characteristics, and physician/nurse perceptions of ICU organization and bundle implementation. We found that a robust safety culture and collaborative work environment that uses checklists to facilitate team communication are strongly associated with bundle implementation. There is also a significant dose-response effect between safety culture, a collaborative work environment, and overall bundle implementation. Conclusions We identified several specific ICU practices that can facilitate ABCDEF Bundle implementation. Our results can be used to develop effective bundle implementation strategies that leverage safety culture, interprofessional collaboration, and routine checklist use in ICUs to improve bundle implementation and performance.
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Ricotta DN, Freed JA, Hale AJ. Things We Do for No Reason™: Card Flipping Rounds. J Hosp Med 2020; 15:498-501. [PMID: 32118567 DOI: 10.12788/jhm.3374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/17/2019] [Indexed: 11/20/2022]
Abstract
Inspired by the ABIM Foundation's Choosing Wisely® campaign, the "Things We Do for No Reason™" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.
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Affiliation(s)
- Daniel N Ricotta
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts
| | - Jason A Freed
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Andrew J Hale
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
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Stollings JL, Devlin JW, Lin JC, Pun BT, Byrum D, Barr J. Best Practices for Conducting Interprofessional Team Rounds to Facilitate Performance of the ICU Liberation (ABCDEF) Bundle. Crit Care Med 2020; 48:562-570. [PMID: 32205603 DOI: 10.1097/ccm.0000000000004197] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Daily ICU interprofessional team rounds, which incorporate the ICU Liberation ("A" for Assessment, Prevention, and Manage Pain; "B" for Both Spontaneous Awakening Trials and Spontaneous Breathing Trials; "C" for Choice of Analgesia and Sedation; "D" for Delirium Assess, Prevent, and Manage; "E" for Early Mobility and Exercise; "F" for Family Engagement and Empowerment [ABCDEF]) Bundle, support both the care coordination and regular provider communication necessary for Bundle execution. This article describes evidence-based practices for conducting effective interprofessional team rounds in the ICU to improve Bundle performance. DESIGN Best practice synthesis. METHODS The authors, each extensively involved in the Society of Critical Care Medicine's ICU Liberation Campaign, reviewed the pertinent literature to identify how ICU interprofessional team rounds can be optimized to increase ICU Liberation adherence. RESULTS Daily ICU interprofessional team rounds that foster ICU Liberation Bundle use support both care coordination and regular provider communication within and between teams. Evidence-based best practices for conducting effective interprofessional team rounds in the ICU include the optimal structure for ICU interprofessional team rounds; the importance of conducting rounds at patients' bedside; essential participants in rounds; the inclusion of ICU patients and their families in rounds-based discussions; and incorporation of the Bundle into the Electronic Health Record. Interprofessional team rounds in the ICU ideally employ communication strategies to foster inclusive and supportive behaviors consistent with interprofessional collaboration in the ICU. Patient care discussions during interprofessional team rounds benefit from being patient-centered and goal-oriented. Documentation of ICU Liberation Bundle elements in the Electronic Health Record may help facilitate team communication and decision-making. CONCLUSIONS Conducting high-quality interprofessional team rounds in the ICU is a key strategy to support ICU Liberation Bundle use.
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Affiliation(s)
- Joanna L Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
| | - John W Devlin
- School of Pharmacy, Northeastern University, Boston, MA
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA
| | - John C Lin
- Division of Pediatrics and Critical Care Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Brenda T Pun
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN
| | - Diane Byrum
- Innovative Solutions for Healthcare Education, LLC, Charlotte, NC
| | - Juliana Barr
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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Zurca AD, Wang J, Cheng YI, Dizon ZB, October TW. Racial Minority Families' Preferences for Communication in Pediatric Intensive Care Often Overlooked. J Natl Med Assoc 2019; 112:74-81. [PMID: 31653328 DOI: 10.1016/j.jnma.2019.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/05/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the communication experiences and preferences of racial/ethnic minority and non-Hispanic white (NHW) families in the pediatric intensive care unit (PICU), including their interactions with bedside nurses. METHODS Retrospective cohort study performed at a quaternary university-affiliated children's hospital with 70 pediatric intensive care beds. From October 2013 to December 2014, English-speaking family members of children admitted to the PICU were asked about their experiences communicating with PICU caregivers using a survey tool. RESULTS 107 participants were included for analysis, of which 60 self-identified as a racial minority and 47 as NHW. Overall, 11% of families chose family meetings as their preferred setting for receiving information, as compared to family-centered rounds or unplanned bedside meetings. Only 50% of those with a family meeting felt they learned new information during the meeting. Chi-square statistics or Fisher's exact tests showed that minority families were less likely to report their bedside nurses spent enough time speaking with them (minority 67%, NHW 85%; p = 0.03) and less likely to receive communication from the medical team in their preferred setting (minority 63%, NHW 85%; p = 0.01). Logistic regression, controlling for covariates including education, insurance, and risk of mortality, showed that the relationship between minority status and concordance of preferred setting persisted (OR = 0.32, 95% C·I.: 0.11, 0.91). CONCLUSION In general, families of PICU patients prefer meeting with the medical team during rounds or unplanned bedside meetings as opposed to formal family meetings. Despite this preference, minority families are less likely to receive communication from the medical team in their preferred settings. Meeting all families' communication setting needs may improve their communication experiences in the PICU.
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Affiliation(s)
- Adrian D Zurca
- Penn State Hershey Children's Hospital, Hershey, PA, USA.
| | - Jichuan Wang
- Children's National Health System, Washington, DC, USA; The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Yao I Cheng
- Children's National Health System, Washington, DC, USA
| | | | - Tessie W October
- Children's National Health System, Washington, DC, USA; The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Pingree EW, Freed JA, Riviello ED, Bilello LA, Hayne CC, Hibbert KA, Huang GC. A Tale of Two Rounds: Managing Conflict During the Worst of Times in Family-Centered Rounds. Hosp Pediatr 2019; 9:563-565. [PMID: 31217238 DOI: 10.1542/hpeds.2019-0047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Elizabeth W Pingree
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts;
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Jason A Freed
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Departments of Medicine
| | - Elisabeth D Riviello
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Departments of Medicine
| | - Leslie A Bilello
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Emergency Medicine, and
| | - Cynthia C Hayne
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Pathology and
| | - Kathryn A Hibbert
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Grace C Huang
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Departments of Medicine
- Carl J. Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
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Keeping Time: Implementing Appointment-based Family-centered Rounds. Pediatr Qual Saf 2019; 4:e182. [PMID: 31572884 PMCID: PMC6708638 DOI: 10.1097/pq9.0000000000000182] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 05/08/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Family-centered rounds (FCRs) provide many benefits over traditional rounds, including higher patient satisfaction, and shared mental models among staff. These benefits can only be achieved when key members of the care team are present and engaged. We aimed to improve patient engagement and satisfaction with our existing bedside rounds by designing a new FCR process. Methods: We conducted a needs assessment and formed a multidisciplinary FCR committee that identified appointment-based family-centered rounds (aFCRs) as a primary intervention. We designed, implemented, and iteratively refined an aFCR process. We tracked process metrics (rounds attendance by key participants), a balancing metric (time per patient), and outcome metrics (patient satisfaction domains) during the intervention and follow-up periods. Results: After implementing aFCR, 65% of patients reported positive experience with rounds and communication. Rounds duration per patient was similar (9 versus 9.4 min). Nurse, subspecialist, and interpreter attendance on rounds was 72%, 60%, and 90%, respectively. We employed a Rounding Coordinator to complete the scheduling and communication required for successful aFCR. Discussion: We successfully improved our rounding processes through the introduction of aFCR with the addition of a rounding coordinator. Our experience demonstrates one method to increase multidisciplinary team member attendance on rounds and patient satisfaction with physician communication in the inpatient setting.
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Impacting Satisfaction, Learning, and Efficiency Through Structured Interdisciplinary Rounding in a Pediatric Intensive Care Unit: A Quality Improvement Project. Pediatr Qual Saf 2019; 4:e176. [PMID: 31579875 PMCID: PMC6594789 DOI: 10.1097/pq9.0000000000000176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/12/2019] [Indexed: 11/27/2022] Open
Abstract
Background Daily rounds in many pediatric intensive care units (PICUs) vary in quality, duration, and participation. We hypothesized that implementing structured interdisciplinary bedside rounds (SIBR®) would improve our rounding process. Methods This was a quality improvement initiative in a 25-bed multidisciplinary PICU in a tertiary children's hospital. Baseline data included rounding duration; participation of nurses, respiratory care practitioners (RCP), parents; and physician order read-back practices. Interventions were implementing pre-rounding huddles, changing the start of the rounding week, and instituting a SIBR model. All staff, consecutive patients and parents participated over 18 months. We used Mann-Whitney, z-test, and t-tests for statistical analysis with a significance level of 0.05. We tracked data with a statistical process control chart. Results Rounds participation increased for nurses (88% to 100%), RCPs (13% to 61%), and families (24% to 49%) (all p <0.001). Physician order read-back increased (41% to 79%) (p<0.001). The median length of stay (LOS) decreased from 2.1 to 1.9 days (p=0.004) with no changes in mortality or readmissions. The proportion of top responses from family surveys increased from 0.69 to 0.76 (p<0.001). PICU rounding duration (minutes/patient) decreased from 17.1 to 11.3. Most resident physicians felt SIBR positively impacted their education (70%), was more effective than rounds without structure (97%), and that family presence positively impacted learning (70%). Conclusions Implementing a SIBR process in our PICU resulted in greater family and staff satisfaction, improved workflow and decreased rounding time by 34% without compromising education. LOS decreased significantly with no increases in mortality or readmissions.
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Gamp M, Becker C, Tondorf T, Hochstrasser S, Metzger K, Meinlschmidt G, Langewitz W, Schäfert R, Bassetti S, Hunziker S. Effect of Bedside vs. Non-bedside Patient Case Presentation During Ward Rounds: a Systematic Review and Meta-analysis. J Gen Intern Med 2019; 34:447-457. [PMID: 30604116 PMCID: PMC6420670 DOI: 10.1007/s11606-018-4714-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/21/2018] [Accepted: 10/15/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ward rounds are important for communicating with patients, but it is unclear whether bedside or non-bedside case presentation is the better approach. METHODS We conducted a comprehensive search up to July 2018 to identify randomized controlled trials (RCTs) comparing bedside and non-bedside case presentations. Data was abstracted independently by two researchers and study quality was assessed using the Cochrane Risk of Bias Tool. Our primary outcome was patient's satisfaction with ward rounds. Our main secondary outcome was patient's understanding of disease and the management plan. RESULTS Among 1647 identified articles, we included five RCTs involving 655 participants with overall moderate trial quality. We found no difference in having low patient's satisfaction between bedside and non-bedside case presentations (risk ratio [RR], 0.85; 95% CI, 0.66 to 1.09). We also found no impact on patient's understanding of their disease and management plan (RR, 0.92; 95% CI, 0.67 to 1.28). Trial sequential analysis (TSA) indicated low power of our main analysis. DISCUSSION We found no differences in patient-relevant outcomes between bedside and non-bedside case presentations with a lack of statistical power among current trials. There is a need for larger studies to find the optimal approach to patient case presentation during ward rounds.
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Affiliation(s)
- Martina Gamp
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, and University of Basel, Klingelbergstrasse 23, 4056, Basel, Switzerland
| | - Christoph Becker
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, and University of Basel, Klingelbergstrasse 23, 4056, Basel, Switzerland
| | - Theresa Tondorf
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, and University of Basel, Klingelbergstrasse 23, 4056, Basel, Switzerland
| | - Seraina Hochstrasser
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, and University of Basel, Klingelbergstrasse 23, 4056, Basel, Switzerland
| | - Kerstin Metzger
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, and University of Basel, Klingelbergstrasse 23, 4056, Basel, Switzerland
| | - Gunther Meinlschmidt
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Wolf Langewitz
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, and University of Basel, Klingelbergstrasse 23, 4056, Basel, Switzerland
| | - Rainer Schäfert
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, and University of Basel, Klingelbergstrasse 23, 4056, Basel, Switzerland.
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Caldwell C, MacBean V, Hunt K, Greenough A. Parental views on attending neonatal intensive care ward rounds. BMJ Paediatr Open 2019; 3:e000449. [PMID: 31206082 PMCID: PMC6542448 DOI: 10.1136/bmjpo-2019-000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/13/2019] [Accepted: 03/20/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To ascertain parental views regarding taking part in neonatal unit ward rounds. DESIGN A service evaluation project. SETTING Tertiary neonatal intensive care unit. PATIENTS Parent(s) of infants receiving care on the neonatal unit. INTERVENTIONS Structured interviews conducted at the cot side. MAIN OUTCOME MEASURES Parents were asked if they knew when ward rounds occurred, whether they had attended ward rounds and if they had not what were the factors inhibiting them from doing so, their experience of attending ward rounds and whether they were concerned about issues of confidentiality. RESULTS 23 of 24 consecutive parents agreed to be interviewed. The median age of their infants was 14 (range 3 - 123) days when they were interviewed. Eighty-five per cent were able to identify when a nursing handover or doctor's ward round occurred. Seventy-five per cent of parents had attended at least one ward round and the median score in terms of usefulness was 5 out of 5. Reasons for not attending included time and cost to travel to the unit, their partners were working and having other children. Parents volunteered that the nurses proactively updated them as soon as they arrived, hence making regular attendance less important. Regarding confidentiality, 85% were not concerned if other people overheard information about their baby, unless the news was bad. CONCLUSIONS Parents recognised the value of attending ward rounds and generally found it a positive experience, but emphasised limitations on their ability to attend.
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Affiliation(s)
- Claire Caldwell
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Katie Hunt
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.,MRC Centre for Allergic Mechanisms of Asthma, King's College London, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.,MRC Centre for Allergic Mechanisms of Asthma, King's College London, London, UK
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Ratelle JT, Sawatsky AP, Kashiwagi DT, Schouten WM, Erwin PJ, Gonzalo JD, Beckman TJ, West CP. Implementing bedside rounds to improve patient-centred outcomes: a systematic review. BMJ Qual Saf 2018; 28:317-326. [PMID: 30224407 DOI: 10.1136/bmjqs-2017-007778] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 07/23/2018] [Accepted: 08/16/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Bedside rounds (BR) have been proposed as an ideal method to promote patient-centred hospital care, but there is substantial variation in their implementation and effects. Our objectives were to describe the implementation of BR in hospital settings and determine their effect on patient-centred outcomes. METHODS Data sources included Ovid MEDLINE, Ovid Embase, Scopus and Ovid Cochrane Central Registry of Clinical Trials from database inception through 28 July 2017. We included experimental studies comparing BR to another form of rounds in a hospital-based setting (ie, medical/surgical unit, intensive care unit (ICU)) and reporting a quantitative patient-reported or objectively measured clinical outcome. We used random effects models to calculate pooled Cohen's d effect size estimates for the patient knowledge and patient experience outcome domains. RESULTS Twenty-nine studies met inclusion criteria, including 20 from adult care (17 non-ICU, 3 ICU), and nine from paediatrics (5 non-ICU, 4 ICU), the majority of which (n=23) were conducted in the USA. Thirteen studies implemented BR with cointerventions as part of a 'bundle'. Studies most commonly reported outcomes in the domains of patient experience (n=24) and patient knowledge (n=10). We found a small, statistically significant improvement in patient experience with BR (summary Cohen's d=0.09, 95% CI 0.04 to 0.14, p<0.001, I2=56%), but no significant association between BR and patient knowledge (Cohen's d=0.21, 95% CI -0.004 to -0.43, p=0.054, I2=92%). Risk of bias was moderate to high, with methodological limitations most often relating to selective reporting, low adherence rates and missing data. CONCLUSIONS BR have been implemented in a variety of hospital settings, often 'bundled' with cointerventions. However, BR have demonstrated limited effect on patient-centred outcomes.
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Affiliation(s)
- John T Ratelle
- Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam P Sawatsky
- General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Will M Schouten
- Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jed D Gonzalo
- General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Thomas J Beckman
- General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Colin P West
- General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
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Ludmir J, Liu X, Gupta A, Ramani GV, Liu SS, Zakaria S, Verceles AC, Shah NG, McCurdy MT, Dammeyer JA, Netzer G. Cardiologist perceptions of family-centred rounds in cardiovascular clinical care. Open Heart 2018; 5:e000834. [PMID: 30228906 PMCID: PMC6135426 DOI: 10.1136/openhrt-2018-000834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/10/2018] [Accepted: 07/24/2018] [Indexed: 11/04/2022] Open
Abstract
Objective Few data exist regarding physician attitudes and implementation of family-centred rounds (FCR) in cardiovascular care. This study aimed to assess knowledge and attitudes among cardiologists and cardiology fellows regarding barriers and benefits of FCRs. Methods An electronic, web-based questionnaire was nationally distributed to cardiology fellows and attending cardiologists. Results In total, 118 subjects were surveyed, comprising cardiologists (n=64, 54%) and cardiology fellows (n=54, 46%). Overall, 61% of providers reported participating in FCRs and 64% felt family participation on rounds benefits the patient. Both fellows and cardiologists agreed that family rounds eased family anxiety (fellows, 63%; cardiologists, 56%; p=0.53), improved communication between the medical team and the patient and family (fellows, 78%; cardiologists, 61%; p=0.18) and improved patient safety (fellows, 59%; cardiologists, 47%; p=0.43). Attitudes regarding enhancement of trainee education were similar (fellows, 69%; cardiologists, 55%; p=0.19). Fellows and cardiologists felt that family increased the duration of rounds (fellows, 78%; cardiologists, 80%; p=0.18) and led to less efficient rounds (fellows, 54%; cardiologists, 58%; p=0.27). Conclusion The majority of cardiologists and fellows believed that FCRs benefited families, communication and patient safety, but led to reduced efficiency and longer duration of rounds.
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Affiliation(s)
- Jonathan Ludmir
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Xinggang Liu
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anuj Gupta
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gautam V Ramani
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stanley S Liu
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sammy Zakaria
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Avelino C Verceles
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nirav G Shah
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Dammeyer
- Critical Care Medicine Unit, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Giora Netzer
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Clinical rounds with parental involvement in a neonatal unit. Early Hum Dev 2018; 120:21-25. [PMID: 29604487 DOI: 10.1016/j.earlhumdev.2018.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 03/20/2018] [Indexed: 11/22/2022]
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Measuring and improving comprehensive pediatric cardiac care: Learning from continuous quality improvement methods and tools. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rea KE, Rao P, Hill E, Saylor KM, Cousino MK. Families' Experiences With Pediatric Family-Centered Rounds: A Systematic Review. Pediatrics 2018; 141:peds.2017-1883. [PMID: 29437931 DOI: 10.1542/peds.2017-1883] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Family-centered rounding (FCR) is of increasing importance in pediatric medicine. Although researchers have begun to understand the effect of FCR on providers and systematic health care outcomes, we provide a systematic review of the literature regarding families' experiences with FCR. OBJECTIVE To systematically review patient and family experiences with pediatric FCR. DATA SOURCES Our data sources included PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Scopus, and Embase. STUDY SELECTION Inclusion criteria included publication in a peer-reviewed journal between January 2007 and February 2017, written in the English language, pediatric population (patients 0-21 years), and specific measurement of a families' experience with FCR. DATA EXRACTION Data extracted were sample size, participating medical unit, measures of family experience, and overall results of family experience. RESULTS Twenty-eight studies were included. It is unclear whether participation in FCR increases family satisfaction compared with standard rounds; however, families report a strong desire to participate in FCR. Family benefits of FCR included increased understanding of information and confidence in the medical team, as well as reduced parental anxiety. LIMITATIONS There were only 2 studies in which researchers examined pediatric patients' experiences with FCR, and literature on the communication needs of non-English-speaking families was also limited. CONCLUSIONS Overall, it is suggested that families positively perceive their experience with FCR, although more research is needed to determine if satisfaction is greater in FCR versus standard rounds as well as to better understand different perspectives of adolescent patients and non-English-speaking families.
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Affiliation(s)
- Kelly E Rea
- Department of Pediatrics, Michigan Medicine and
| | | | | | - Kate M Saylor
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
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Chung H, Kallay T, Anas N, Bruno D, Decamps J, Evans D, Vilasagar N, Mink RB. Using an Audience Response System Smartphone App to Improve Resident Education in the Pediatric Intensive Care Unit. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2018; 5:2382120518770674. [PMID: 29707650 PMCID: PMC5912270 DOI: 10.1177/2382120518770674] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Abstract
In the Pediatric Intensive Care Unit (PICU), most teaching occurs during bedside rounds, but technology now provides new opportunities to enhance education. Specifically, smartphone apps allow rapid communication between instructor and student. We hypothesized that using an audience response system (ARS) app can identify resident knowledge gaps, guide teaching, and enhance education in the PICU. Third-year pediatric residents rotating through the PICU participated in ARS-based education or received traditional teaching. Before rounds, experimental subjects completed an ARS quiz using the Socrative app. Concomitantly, the fellow leading rounds predicted quiz performance. Then, discussion points based on the incorrect answers were used to guide instruction. Scores on the pre-rotation test were similar between groups. On the post-rotation examination, ARS participants did not increase their scores more than controls. The fellow's prediction of performance was poor. Residents felt that the method enhanced their education whereas fellows reported that it improved their teaching efficiency. Although there was no measurable increase in knowledge using the ARS app, it may still be a useful tool to rapidly assess learners and help instructors provide learner-centered education.
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Affiliation(s)
- Hoyoung Chung
- Division of Pediatric Critical Care Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- Department of Pediatrics, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Tom Kallay
- Division of Pediatric Critical Care Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- Department of Pediatrics, Los Angeles Biomedical Research Institute, Torrance, CA, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nick Anas
- Division of Pediatric Critical Care, CHOC Children’s Hospital, Orange, CA, USA
- Department of Pediatrics, University of California, Irvine, Irvine, CA, USA
| | - Diana Bruno
- Division of Pediatric Critical Care Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jose Decamps
- Division of Pediatric Critical Care Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- Department of Pediatrics, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Darci Evans
- Division of Pediatric Critical Care Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Niveditha Vilasagar
- Division of Pediatric Critical Care Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Richard B Mink
- Division of Pediatric Critical Care Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- Department of Pediatrics, Los Angeles Biomedical Research Institute, Torrance, CA, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Lopez C, Hanson CC, Yorke D, Johnson JK, Mill MR, Brown KJ, Barach P. Improving communication with families of patients undergoing pediatric cardiac surgery. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2016.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cox ED, Jacobsohn GC, Rajamanickam VP, Carayon P, Kelly MM, Wetterneck TB, Rathouz PJ, Brown RL. A Family-Centered Rounds Checklist, Family Engagement, and Patient Safety: A Randomized Trial. Pediatrics 2017; 139:peds.2016-1688. [PMID: 28557720 PMCID: PMC5404725 DOI: 10.1542/peds.2016-1688] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Family-centered rounds (FCRs) have become standard of care, despite the limited evaluation of FCRs' benefits or interventions to support high-quality FCR delivery. This work examines the impact of the FCR checklist intervention, a checklist and associated provider training, on performance of FCR elements, family engagement, and patient safety. METHODS This cluster randomized trial involved 298 families. Two hospital services were randomized to use the checklist; 2 others delivered usual care. We evaluated the performance of 8 FCR checklist elements and family engagement from 673 pre- and postintervention FCR videos and assessed the safety climate with the Children's Hospital Safety Climate Questionnaire. Random effects regression models were used to assess intervention impact. RESULTS The intervention significantly increased the number of FCR checklist elements performed (β = 1.2, P < .001). Intervention rounds were significantly more likely to include asking the family (odds ratio [OR] = 2.43, P < .05) or health care team (OR = 4.28, P = .002) for questions and reading back orders (OR = 12.43, P < .001). Intervention families' engagement and reports of safety climate were no different from usual care. However, performance of specific checklist elements was associated with changes in these outcomes. For example, order read-back was associated with significantly more family engagement. Asking families for questions was associated with significantly better ratings of staff's communication openness and safety of handoffs and transitions. CONCLUSIONS The performance of FCR checklist elements was enhanced by checklist implementation and associated with changes in family engagement and more positive perceptions of safety climate. Implementing the checklist improves delivery of FCRs, impacting quality and safety of care.
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Affiliation(s)
| | | | | | - Pascale Carayon
- Center for Quality and Productivity Improvement,,Department of Industrial and Systems Engineering, and
| | - Michelle M. Kelly
- Departments of Pediatrics,,Center for Quality and Productivity Improvement
| | - Tosha B. Wetterneck
- Family Medicine and Community Health,,Medicine, School of Medicine and Public Health,,Center for Quality and Productivity Improvement,,Department of Industrial and Systems Engineering, and
| | | | - Roger L. Brown
- Department of Research Design and Statistics, School of Nursing, University of Wisconsin–Madison, Madison, Wisconsin
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Boztepe H, Kerimoğlu Yıldız G. Nurses perceptions of barriers to implementing family-centered care in a pediatric setting: A qualitative study. J SPEC PEDIATR NURS 2017; 22. [PMID: 28198079 DOI: 10.1111/jspn.12175] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/05/2016] [Accepted: 01/16/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE This was a qualitative study conducted to explore the views of nurses regarding the practice of family-centered care (FCC). DESIGN AND METHODS Eighteen nurses working in different units of a children's hospital in Turkey were included in the study. In-depth interviews were conducted with the nurses to obtain detailed information about their perspectives on FCC activities. RESULTS Two main themes emerged from the data, each with subthemes. The first theme pertained to the nurses' opinions on FCC, and the second theme included their views on parents' participation during nursing rounds. PRACTICE IMPLICATIONS This study indicated that nurses had positive views of FCC activities and that they recognized the need for the family's continuing presence in the child's life, which were important findings. However, they stated that families' cultural characteristics were an obstacle. Therefore, to better implement this model, nurses should not only understand the model conceptually but also understand the rights, roles, and responsibilities of parents. To practice FCC appropriately, nurses need to have sufficient resources, appropriate education, and support from their managers.
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Affiliation(s)
- Handan Boztepe
- Assistant Professor, Pediatric Nursing Department, Nursing Faculty, Hacettepe University, Ankara, Turkey
| | - Gizem Kerimoğlu Yıldız
- Research Assistant, Pediatric Nursing Department, Florence Nightingale Nursing Faculty, Istanbul University, Istanbul, Turkey
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Williams L. Impact of Family-Centered Care on Pediatric and Neonatal Intensive Care Outcomes. AACN Adv Crit Care 2017; 27:158-61. [PMID: 27153304 DOI: 10.4037/aacnacc2016579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Lori Williams
- Lori Williams is Clinical Nurse Specialist, Universal Care Unit, American Family Children's Hospital, University of Wisconsin Hospital and Clinics, Mail Code C850, 1675 Highland Avenue, Madison, WI 53792
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Luthy C, Francis Gerstel P, Pugliesi A, Piguet V, Allaz AF, Cedraschi C. Bedside or not bedside: Evaluation of patient satisfaction in intensive medical rehabilitation wards. PLoS One 2017; 12:e0170474. [PMID: 28170431 PMCID: PMC5295719 DOI: 10.1371/journal.pone.0170474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/06/2017] [Indexed: 12/03/2022] Open
Abstract
Background Concerns that bedside presentation (BsP) rounds could make patients uncomfortable led many residency programs to move daily rounds outside the patients’ room (OsPR). We performed a prospective quasi-experimental controlled study measuring the effect of these two approaches on patient satisfaction. Methods Patient satisfaction was measured using the Picker questionnaire (PiQ). Results are expressed in problematic percentage scores scaled from 0 = best-100 = worst. During three months, 3 wards of a 6 ward medical rehabilitation division implemented BsP and 3 control wards kept their usual organization of rounds. In total, 90 patients of each group were included in the study and completed the PiQ. Results Socio-clinical characteristics were similar in both groups: mean age = 67 years (SD = 13), mean Charlson comorbidity index = 8.6 (2.4); mean length of stay = 22 days (12). During their stay, patients in the BsP units had a mean of 14.3 (8) BsP rounds and 0.5 (0.8) OsPR; control patients had a mean of 0.9 (0.7) BsP and 14.8 (7.3) OsPR (p<0.0001). Patients in BsP units reported lower problematic scores regarding coordination of care (39% vs 45%, p = 0.029), involvement of family/friends (29 vs 41%, p = 0.006) and continuity/transition (44% vs 54%, p = 0.020); two questions of the PiQ had worse scores in the BsP: trust in nurses (46.7% vs 30 %, p = 0.021) and recommendation of the institution (61.1% vs 44.4%. p = 0.025). No worsening in dimensions such as respect for patient preferences was seen. Conclusions BsP rounds influenced the patient-healthcare professionals’ encounter. These rounds were associated with improved patient satisfaction with care, particularly regarding interprofessional collaboration and discharge planning.
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Affiliation(s)
- Christophe Luthy
- Division of General Medical Rehabilitation, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
- * E-mail:
| | | | - Angela Pugliesi
- Division of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Valérie Piguet
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - Anne-Françoise Allaz
- Division of General Medical Rehabilitation, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
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Zurca AD, Fisher KR, Flor RJ, Gonzalez-Marques CD, Wang J, Cheng YI, October TW. Communication With Limited English-Proficient Families in the PICU. Hosp Pediatr 2016; 7:9-15. [PMID: 27979992 DOI: 10.1542/hpeds.2016-0071] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Health care disparities have been described for children of limited English-proficient (LEP) families compared with children of English-proficient (EP) families. Poor communication with the medical team may contribute to these worse health outcomes. Previous studies exploring communication in the PICU have excluded LEP families. We aimed to understand communication experiences and preferences in the 3 primary communication settings in the PICU. We also explored LEP families' views on interpreter use in the PICU. PATIENTS AND METHODS EP and Spanish-speaking LEP families of children admitted to the PICU of a large tertiary pediatric hospital completed surveys between 24 hours and 7 days of admission. RESULTS A total of 161 of 184 families were surveyed (88% response rate); 52 were LEP and 109 EP. LEP families were less likely to understand the material discussed on rounds (odds ratio [OR] 0.32, 95% confidence interval [CI] 0.11-0.90), to report that PICU nurses spent enough time speaking with them (OR 0.15, 95% CI 0.05-0.41), and to report they could rely on their nurses for medical updates (OR 0.07, 95% CI 0.02-0.25) controlling for covariates, such as education, insurance type, presence of a chronic condition, PICU length of stay, and mortality index. LEP families reported 53% of physicians and 41% of nurses used an interpreter "often." CONCLUSIONS Physician and nurse communication with LEP families is suboptimal. Communication with LEP families may be improved with regular use of interpreters and an increased awareness of the added barrier of language proficiency.
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Affiliation(s)
| | | | - Remigio J Flor
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Jichuan Wang
- Center for Translational Research, Children's National Health System, Washington, DC; and
| | - Yao I Cheng
- Center for Translational Research, Children's National Health System, Washington, DC; and
| | - Tessie W October
- Division of Pediatric Critical Care Medicine, and.,The George Washington University School of Medicine and Health Sciences, Washington, DC
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Au SS, Roze des Ordons A, Soo A, Guienguere S, Stelfox HT. Family participation in intensive care unit rounds: Comparing family and provider perspectives. J Crit Care 2016; 38:132-136. [PMID: 27888716 DOI: 10.1016/j.jcrc.2016.10.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 10/05/2016] [Accepted: 10/28/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe and compare intensive care unit (ICU) patient family member and provider experiences, preferences, and perceptions of family participation in ICU rounds. METHODS Cross-sectional survey of ICU family members and providers of patients admitted to 4 medical-surgical ICUs from September 2014 to March 2015. MEASUREMENTS AND MAIN RESULTS Surveys were completed by 63 (62%) family members and 258 (43%) providers. Provider respondents included physicians (9%), nurses (56%), respiratory therapists (24%), and other ICU team members (11%). Although 38% of providers estimated only moderate family member interest in participating in rounds, 97% of family members expressed high interest. Family members and providers reported listening (95% vs 96%; P=.594) and sharing information about the patient (82% vs 82%; P=.995) as appropriate roles for family members during rounds, but differed in their perceptions on asking questions (75% vs 86%; P=.043) and participating in decision making (36% vs 59%; P=.003). Compared with family members, providers were more likely to perceive family participation in rounds to cause family stress (7% vs 22%; P=.020) and confusion (0% vs 28%; P<.001). CONCLUSION Family members and providers share some perspectives on family participation in ICU rounds although other perspectives are discordant, with implications for communication strategies and collaborative decision making.
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Affiliation(s)
- Selena S Au
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
| | | | - Andrea Soo
- Department of Critical Care Medicine, Alberta Health Services, Calgary, Alberta, Canada
| | - Simon Guienguere
- Department of Critical Care Medicine, Alberta Health Services, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
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Seltz LB, Preloger E, Hanson JL, Lane L. Ward Rounds With or Without an Attending Physician: How Interns Learn Most Successfully. Acad Pediatr 2016; 16:638-44. [PMID: 27283038 DOI: 10.1016/j.acap.2016.05.149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/24/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore pediatric interns' perspectives on the educational value of general pediatric ward rounds, in particular their rounding experiences with and without an attending physician. METHODS Qualitative study using individual interviews of pediatric interns (2013-2014) rotating on 2 general pediatric inpatient services at different institutions with different rounding team structures. In accordance with grounded theory methodology, data were analyzed using the constant comparative method. Codes were built using an iterative approach and organized into themes. RESULTS Twenty pediatric interns participated in 25 interviews. Data analysis yielded 4 themes: what is being learned; learning environment on rounds; learning and work; and ways of learning. Senior residents generally taught practical aspects of patient care and attending physicians taught broader concepts with references to the medical literature. Rounds without an attending physician were perceived as less formal and promoted collaborative discussions with senior residents. Interns were more uncomfortable during rounds with an attending physician but appreciated how that facilitated their learning. Although patient care tasks provided opportunities for experiential learning, interns frequently perceived them to impede learning during rounds. Intern learning during ward rounds occurred via self-directed learning, interactive learning, and through caring for patients. Brief, clinically relevant teaching pearls and questioning clinical reasoning in a respectful manner were helpful. CONCLUSIONS Interns learn different content and learn in different ways depending on the presence or absence of an attending physician at rounds. There might be educational value from rounding with teams that include and do not include an attending physician.
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Affiliation(s)
- L Barry Seltz
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
| | - Erin Preloger
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Janice L Hanson
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Lindsey Lane
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
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Kimbrough TN, Heh V, Wijesooriya NR, Ryan MS. Family-centered rounds and medical student performance on the NBME pediatrics subject (shelf) examination: a retrospective cohort study. MEDICAL EDUCATION ONLINE 2016; 21:30919. [PMID: 27087016 PMCID: PMC4834362 DOI: 10.3402/meo.v21.30919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/22/2016] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine the association between family-centered rounds (FCR) and medical student knowledge acquisition as assessed by the National Board of Medical Examiners (NBME) pediatric subject (shelf) exam. METHODS A retrospective cohort study was conducted of third-year medical students who graduated from Virginia Commonwealth University School of Medicine between 2009 and 2014. This timeframe represented the transition from 'traditional' rounds to FCR on the pediatric inpatient unit. Data collected included demographics, United States Medical Licensing Examination (USMLE) Step 1 and 2 scores, and NBME subject examinations in pediatrics (PSE), medicine (MSE), and surgery (SSE). RESULTS Eight hundred and sixteen participants were included in the analysis. Student performance on the PSE could not be statistically differentiated from performance on the MSE for any year except 2011 (z-score=-0.17, p=0.02). Average scores on PSE for years 2009, 2010, 2013, and 2014 were significantly higher than for SSE, but not significantly different for all other years. The PSE was highly correlated with USMLE Step 1 and Step 2 examinations (correlation range 0.56-0.77) for all years. CONCLUSIONS Our results showed no difference in PSE performance during a time in which our institution transitioned to FCR. These findings should be reassuring for students, attending physicians, and medical educators.
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Affiliation(s)
- Tiffany N Kimbrough
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA;
| | - Victor Heh
- CORE Research Office, Heritage College of Osteopathic Medicine, Ohio University, Dublin, OH, USA
| | | | - Michael S Ryan
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
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Foster M, Whitehead L, Maybee P. The Parents', Hospitalized Child's, and Health Care Providers' Perceptions and Experiences of Family-Centered Care Within a Pediatric Critical Care Setting: A Synthesis of Quantitative Research. JOURNAL OF FAMILY NURSING 2016; 22:6-73. [PMID: 26706128 DOI: 10.1177/1074840715618193] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Family-centered care (FCC) purports that unlimited presence and involvement of the family in the care of the hospitalized child will optimize the best outcome for the child, family, and institution. A systematic appraisal was conducted of peer-reviewed, English-language, primary quantitative research conducted within a pediatric critical care setting reported from 1998 to 2014. The aim of this review was to explore the parents', hospitalized child's, and health care providers' perception of FCC within pediatric critical care. Fifty-nine articles met the criteria that generated themes of stress, communication, and parents' and children's needs. This review highlighted that communication tailored to meet the parents' and child's needs is the key to facilitating FCC and positive health outcomes. Health care providers need to be available to provide clinical expertise and support throughout the health care journey. Future initiatives, education, and research are needed to evaluate the benefits of parent- and child-led FCC practice.
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Affiliation(s)
- Mandie Foster
- 1 University of Otago, Christchurch, New Zealand
- 2 Christchurch Hospital, New Zealand
| | - Lisa Whitehead
- 3 Edith Cowan University, Joondalup, Western Australia, Australia
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Lecorguillé M, Thébaud V, Sizun J. [Family-centered rounds in hospital settings]. Arch Pediatr 2016; 23:405-10. [PMID: 26774896 DOI: 10.1016/j.arcped.2015.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/30/2015] [Indexed: 11/19/2022]
Abstract
Family-centered care is an approach to the planning, delivery, and evaluation of healthcare based on partnership between parents and professionals. Family-centered rounds (FCRs) are a practical application in hospital settings. They are multidisciplinary rounds with active participation of the parents in the decision-making process. FCRs appear to have a positive impact on parents' satisfaction, information provision, and comprehension of care plans. Three concerns have been underlined: time management, confidentiality, and teaching students. FCR implementation is a process that requires in-depth thinking on the philosophy of care, staff information and training, and a specific organizational change.
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Affiliation(s)
- M Lecorguillé
- École de sage-femme, université de Brest, 29200 Brest, France
| | - V Thébaud
- Faculté de médecine et des sciences de la santé, EA 4686, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France
| | - J Sizun
- Faculté de médecine et des sciences de la santé, EA 4686, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France; Pôle de la femme, de la mère et de l'enfant, CHU de Brest, 29220 Brest, France.
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A Survey of Rounding Practices in Canadian Adult Intensive Care Units. PLoS One 2015; 10:e0145408. [PMID: 26700860 PMCID: PMC4689549 DOI: 10.1371/journal.pone.0145408] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/03/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe rounding practices in Canadian adult Intensive Care Units (ICU) and identify opportunities for improvement. DESIGN Mixed methods design. Cross sectional survey of Canadian Adult ICUs (n = 180) with purposefully sampled follow-up interviews (n = 7). MEASUREMENTS AND MAIN RESULTS Medical directors representing 111 ICUs (62%) participated in the survey. Rounding practices varied across ICUs with the majority reporting the use of interprofessional rounds (81%) that employed an open (94%) and collaborative (86%) approach, occurred at the patient's bedside (82%), and started at a standard time (79%) and standard location (56%). Most participants reported that patients (83%) and family members (67%) were welcome to attend rounds. Approximately half of ICUs (48%) used tools to facilitate rounds. Interruptions during rounds were reported to be common (i.e., ≥ 1 interruption for ≥ 50% of patients) in 46% of ICUs. Four themes were identified from qualitative analysis of participant responses to open-ended survey questions and interviews: multidisciplinarity, patient and family involvement, factors influencing productivity, and teaching and learning. CONCLUSIONS There is considerable variation in current rounding practices in Canadian medical/surgical ICUs. Opportunities exist to improve ICU rounds including ensuring the engagement of essential participants, clearly defining participant roles, establishing a standardized approach to the rounding process, minimizing interruptions, modifying the role of teaching, utilizing a structured rounding tool, and developing a metric for measuring rounding quality.
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An Evaluation of Family-Centered Rounds in the PICU: Room for Improvement Suggested by Families and Providers. Pediatr Crit Care Med 2015; 16:801-7. [PMID: 26181298 DOI: 10.1097/pcc.0000000000000486] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify areas for improvement in family-centered rounds from both the family and provider perspectives. DESIGN Prospective, cross-sectional mixed-methods study, including an objective measure (direct observation of family-centered rounds) and subjective measures (surveys of English-speaking families and providers) of family-centered rounds. SETTING PICU in a single, tertiary children's hospital. SUBJECTS Families of children admitted to the PICU, physicians, and nurses. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two hundred thirty-two family-centered round encounters were observed over a 10-week period. Family-centered round encounters averaged 10.5 minutes per child. Multivariable regression analysis revealed that family presence was independently associated with length of family-centered rounds (p < 0.002) despite family talk time accounting for an average of 25 seconds (4%) of the encounter. Non-English-speaking families were less likely to attend family-centered rounds compared with English-speaking families even when physically present at the patient's bedside (p < 0.001). Most commonly families and providers agreed that family-centered rounds keep the family informed and reported positive statements about family presence on family-centered rounds; however, PICU fellows did not agree that families provided pertinent information and nurses reported that family presence limited patient discussions. The primary advice families offered providers to improve family-centered rounds was to be more considerate and courteous, including accommodating family schedules, minimizing distractions, and limiting computer viewing. CONCLUSIONS Family presence increased the length of family-centered rounds despite a small percentage of time spoken by families, suggesting longer rounds are due to changes in provider behavior when families are present. Also, non-English-speaking families may need more support to be able to attend and benefit from family-centered rounds. Lastly, in an era of full family-centered rounds acceptance, families and most providers, except fellows, report benefit from family presence during family-centered rounds. However, providers should be aware of the perception of their behaviors to optimize the experience for families.
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Berkwitt A, Grossman M. A Qualitative Analysis of Pediatric Patient Attitudes Regarding Family-Centered Rounds. Hosp Pediatr 2015; 5:357-362. [PMID: 26136309 DOI: 10.1542/hpeds.2014-0198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVES The American Academy of Pediatrics recommends family-centered rounds (FCR) as standard practice for the inpatient setting. To date, there is limited research investigating the attitudes of pediatric patients regarding this shift in practice. The goal of this study was to explore pediatric patients' perspectives of their experiences during FCR. METHODS We conducted a qualitative descriptive study based on results from 22 semi-structured interviews of school-aged and adolescent inpatients from September 2012 through October 2013. English-speaking patients, aged 7 to 18 years, who participated in FCR were eligible for inclusion. Transcripts were initially analyzed by using a constant comparative method. After completion of this initial analysis, a third reviewer independently reviewed all transcripts to verify the accuracy of the final coding scheme. RESULTS The final coding scheme consisted of 5 main themes: team size, medical team interactions, content discussed on FCR, setting expectations, and timing and location of FCR. In general, patients expressed a wide array of positive, negative, and neutral impressions within each theme relating to their experiences with FCR. CONCLUSIONS Patient comments regarding their experience with FCR offer unique perspectives from previously studied participants, including physicians, nurses, students, and parents. Future research aimed at evaluating the bedside rounding process should incorporate patients' views to realize the complete FCR experience.
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Affiliation(s)
- Adam Berkwitt
- Yale University School of Medicine, New Haven, Connecticut
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Abdel-Latif ME, Boswell D, Broom M, Smith J, Davis D. Parental presence on neonatal intensive care unit clinical bedside rounds: randomised trial and focus group discussion. Arch Dis Child Fetal Neonatal Ed 2015; 100:F203-9. [PMID: 25711125 PMCID: PMC4413798 DOI: 10.1136/archdischild-2014-306724] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 01/26/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are limited data to inform the choice between parental presence at clinical bedside rounds (PPCBR) and non-PPCBR in neonatal intensive care units (NICUs). METHODS We performed a single-centre, survey-based, crossed-over randomised trial involving parents of all infants who were admitted to NICU and anticipated to stay >11 days. Parents were randomly assigned using a computer-generated stratified block randomisation protocol to start with PPCBR or non-PPCBR and then crossed over to the other arm after a wash-out period. At the conclusion of each arm, parents completed the 'NICU Parental Stressor Scale' (a validated tool) and a satisfaction survey. After completion of the trial, we surveyed all healthcare providers who participated at least in one PPCBR rounding episode. We also offered all participating parents and healthcare providers the opportunity to partake in a focus group discussion regarding PPCBR. RESULTS A total of 72 parents were enrolled in this study, with 63 parents (87%) partially or fully completing the trial. Of the parents who completed the trial, 95% agreed that parents should be allowed to attend clinical bedside rounds. A total of 39 healthcare providers' surveys were returned and 35 (90%) agreed that parents should be allowed to attend rounds. Nine healthcare providers and 8 parents participated in an interview or focus group, augmenting our understanding of the ways in which PPCBR was beneficial. CONCLUSIONS Parents and healthcare providers strongly support PPCBR. NICUs should develop policies allowing PPCBR while mitigating the downsides and concerns of parents and healthcare providers such as decreased education opportunity and confidentiality concerns. TRIAL REGISTRATION NUMBER Australia and New Zealand Clinical Trials Register number, ACTRN12612000506897.
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Affiliation(s)
- Mohamed E Abdel-Latif
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australian Capital Territory, Australia,School of Clinical Medicine, Australian National University, Woden, Australian Capital Territory, Australia
| | - Danette Boswell
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australian Capital Territory, Australia
| | - Margaret Broom
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australian Capital Territory, Australia
| | - Judith Smith
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australian Capital Territory, Australia
| | - Deborah Davis
- ACT Health Directorate, Woden, Australian Capital Territory, Australia,Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
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Implementation of Patient-Centered Bedside Rounds in the Pediatric Intensive Care Unit. J Nurs Care Qual 2015; 30:160-6. [DOI: 10.1097/ncq.0000000000000107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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