Children’s families: Making the rounds

As a teaching hospital for Harvard Medical School with partnerships with 31 schools of Nursing, multiple levels of students and trainees are involved in the care of all patients at Children’s Hospital Boston. Every patient may be seen a combination of consulting doctors, nurses, child life specialists, clinical assistants and more.

In order to share information more efficiently, the entire care team gathers for “rounds” each morning, to review each patient’s condition, plan for the day’s care and discuss goals that need to be met for discharge. At Children’s, these rounds often include the real experts when it comes to a child’s care—the patient’s family.

“The simple truth is that parents know their children best,” says Marcie Brostoff, MS, RN, director of Nurse Education/Staff Development. “Why wouldn’t you include them in in-depth discussions about their child’s care? What better way to get to the single source of truth?” For many families, the only reason they weren’t participating in rounds was that they didn’t know that they were invited. To rectify this, the Family-Centered Rounding Rapid Results Team was assembled, led by Brostoff and sponsored by Eileen Sporing, MSN, RN, FAAN, SVP, Patient Care Operations and Chief Nursing Officer, Jim Kasser, MD, surgeon-in- chief, and Richard Antonelli, MD, medical director for Integrated Care and Physician Relations/Outreach, with Susan Shaw, MS, RN, director, Clinical Operations, acting as lead sponsor. Made up of members of the medical and nursing staff, as well as representatives from Children’s Family Advisory Council, the team’s goal was to improve the opportunities for patients and families to participate in rounds within 90 days.

They’ve developed a new brochure, family education sheet and buttons to help spread the word, but perhaps the most important tool is the new preference card. The card, which encourages families to specify whether they’d like to participate in rounds, where they’d prefer to meet with clinicians and what topics they’d like to discuss, is given to families immediately upon arrival at Children’s. “Over 50 percent of our families are here for one night only,” says Brostoff, “so it’s important that we invite them to participate in rounds as soon as they get here.”

The group also developed a series of guiding principles for Family-Centered Rounds, including the fact that all families are invited to participate in their child’s rounds—whether they’re here for the first time or the fiftieth. The goal of clear and effective communication for all parties is key—medical jargon is limited in order to make sure everyone invested in a child’s care is on the same page. Lastly, it’s made clear that rounds at Children’s are meant to be a learning experience—for both families and clinicians.

Tami Rich has been a Children’s parent for more than 18 years. Her son, Jameson, was born with complex heart defects, resulting in more than 50 hospital stays in his first two years of life, a pacemaker at age 9 and—according to Rich—every complication known to man. “When you’re the parent of a kid with a complicated condition, ” she says, “you find yourself reading all of the literature and studies, to the point where your knowledge of the condition may be much more thorough than some of the medical students coming through your door.”

Families on 10E, 10NW and 9E were surveyed in September to get baseline statistics about how well they felt they were being informed about their child’s care, and what the most effective and convenient method of receiving that information was. The Rapid Results Team spent two weeks training and educating the staff on those units about the principles of Family-Cen- tered Rounding, and another two weeks of active rounding. When the post-survey results are tallied in November, the goal is for the majority of families to select rounding as the best, preferred way to keep informed about their child’s care.

“All you want sometimes is to know that someone’s listening to you,” says Lisa Burgess, who has been coming to Children’s with her son, Jamie, since 1985, and has participated in Family-Centered Rounding since before it had a name. “At Children’s, I was allowed to be part of Jamie’s care team long before it was fashionable.” Not all families choose to participate, but for those who do, the experience can be invaluable. “There are some very basic things that a hospital doesn’t need to be fancy about,” says Lynnie Reed, Family Initiative Coordinator for the Center for Families, and a Children’s parent herself, who serves on the Family Advisory Council. “The idea of giving families a choice is one of them. To be part of your child’s care team is an empowering thing.”

To watch a video about Family Centered Rounding, visit http://on.chbos.org/ FamilyRounding.

We're recruiting new members. For more information, email susan.shanske@childrens.harvard.edu, or lynnie.reid@childrens.harvard.edu.