Ask Dr. Bell: What’s the Best Way to Do Inpatient Teaching Rounds?

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Children's View

Ask Dr. Bell Family-centered care is integral to our mission at Children’s Hospital of Philadelphia. We recognize that families bring unique knowledge about their children that is critical to providing the best and safest care.

About 15 years ago, Lisa Zaoutis, MD, pediatric hospitalist and Program Director of CHOP’s Pediatrics Residency Program, came across a concept she believed could take our family-centered approach to a new level: family-inclusive rounds.

Traditionally, inpatient teaching rounds at CHOP were done behind closed doors. It was a rigorous meeting in which residents, attending physicians and medical students reviewed a child’s progress and discussed their plan of care for the day. The setting afforded the attending a greater chance to explore the knowledge gaps of the learners and provide didactic teaching, while still optimizing patient care decisions.

Family-inclusive rounds moved this process to the patient’s room and involved family members, nursing staff, and often other members of the clinical team in the discussion. A recent study found that, in general, family-inclusive rounds improve families’ satisfaction with and understanding of their child’s care as well as their ability to advocate on their child’s behalf. But families aren’t the only ones who benefit, says Zaoutis.

A new approach

While attending physicians have had to develop a more diplomatic style in exploring the knowledge of the learners, the presence of the patient, family and nurses provides vital insight and new educational opportunities.

“Physicians get a valuable snapshot of the patient, and parents and nurses are front-row observers and participants in the discussion,” says Zaoutis.

Nurses feel empowered, the attending gets to watch the residents interact with the family, and the family gets to see that an entire team is working together for their child.

“Trainees are eager for the time at the bedside with the attending physicians to learn skills that no whiteboard can offer,” says Zaoutis.

Family-inclusive rounds take longer — about two to three minutes more per patient. If you’re visiting 30 patients, that adds up. But that time is gained back because fewer questions arise throughout the day.

“Half the questions nurses and parents have are answered just by listening to the discussion,” says Zaoutis.

With a more family-centered approach to rounds, the entire care team and family are able to develop a shared understanding of the care plan and goals. Everyone wins.