Case Studies

Patient- and Family-Centered Rounds at Cincinnati Children's Hospital


Cincinnati Children’s Hospital Medical Center
Cincinnati, OH
577 Beds

Cincinnati Children’s Hospital Medical Center is an academic teaching hospital. In 2001, the institution began the Robert Wood Johnson Foundation’s Pursuing Perfection initiative that includes the development of an interdisciplinary group of patients and parents to redesign patient-centered care delivery.

The Problem
Families were historically not included in rounding or in supporting the providers who conducted rounds. Families did not witness the decision-making process for future treatments and, as a result, rarely participated.

The Solution
Family representatives suggested that parents attend teaching rounds to improve communication. Cincinnati Children’s Hospital Medical Center started with small changes to the rounding system to improve communication and analyze results. Families were interviewed throughout the trial implementation to describe their experiences, and changes were incorporated as necessary. The medical center also instituted a patient and family experience committee to address concerns as they happened while the family was still in the hospital. Staff could then strengthen the lines of communication and mitigate negative perceptions and respond feedback as much as possible. The intervention focused on the entire inpatient population at Cincinnati Children’s Hospital Medical Center.

The bundle of interventions that comprise family-centered care at Cincinnati Children’s Hospital Medical Center include (1) determining patient preference for family-centered rounds, (2) using a patient/family preference card, (3) standardizing the format for rounds that solicit parent concerns, (4) developing a plan of care for each patient, such as preparing daily goals and listing them on a board in the patient’s room as well as in the electronic medical record and (4) agreeing on discharge criteria in a manner that the family can comprehend. The nurse caring for the patient should be in the room during rounds. In this family-centered model, patients and families are benefiting from providers who are available to answer questions and concerns.

The Result
Cincinnati Children’s Hospital Medical Center monitored feedback from all involved parties: nurses, residents, attending physicians and families. The process evolved based on this feedback, and within one year, family-focused teaching rounds were standard throughout the organization. The medical center monitored patient and family satisfaction scores as well as anecdotal information from providers participating in the rounds to see where changes could be made.

Lessons Learned
Families determine their preferred rounding process when their child is admitted, with staff explaining the process and opportunities for their participation. Initially, patients and families were given cards upon admission to indicate their rounding preference. Realizing that patient and family perspectives related to rounding may change during the course of the hospital stay, many inpatient units now offer patients and families the opportunity every day to participate in the rounding process.

Contact Information
Uma Kotagal
(513) 636-0178

This case study was originally featured in the HPOE guide: "Engaging Health Care Users: A Framework for Healthy Individuals and Communities," published January, 2013.

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