title: An Evaluation of Family-Centered Rounds in the PICU: Room for Improvement Suggested by Families and Providers.
abstract: OBJECTIVE
  To identify areas for improvement in family-centered rounds from both the family and provider perspectives.
  
  
  METHODS
  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.
  
  
  METHODS
  PICU in a single, tertiary children's hospital.
  
  
  METHODS
  Families of children admitted to the PICU, physicians, and nurses.
  
  
  METHODS
  None.
  
  
  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.
authors.affiliation: 1Department of Critical Care Medicine, Children's National Health System, Washington, DC. 2Department of Pediatrics, George Washington University School of Medicine, Washington, DC.
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Levin
authors.forename: Kiondra R
authors.initials: KR
authors.lastname: Fisher
authors.forename: Krista D
authors.initials: KD
authors.lastname: Cato
authors.forename: Adrian D
authors.initials: AD
authors.lastname: Zurca
authors.forename: Tessie W
authors.initials: TW
authors.lastname: October
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D010290:Parents; D011368:Professional-Family Relations; D011446:Prospective Studies; D058996:Quality Improvement; D056164:Teaching Rounds / Q000379:methods* / Q000592:standards; D013997:Time Factors