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Initiative to increase family presence and participation in daily rounds on a paediatric acute care cardiology unit

Published online by Cambridge University Press:  04 May 2023

Dana B. Gal Open the ORCID record for Dana B. Gal [Opens in a new window] ,
Colleen M. Pater Open the ORCID record for Colleen M. Pater [Opens in a new window] ,
Mackenzie McGinty ,
Greta Lobes ,
Christy Tuemler ,
Paula M. Eldridge ,
Brittany Frakes ,
Elisa Marcuccio Open the ORCID record for Elisa Marcuccio [Opens in a new window] ,
Samuel P. Hanke  and
Michael G. Gaies
Dana B. Gal*
Affiliation:
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA Division of Cardiology, Heart Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
Colleen M. Pater
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital, Cincinnati, OH, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
Mackenzie McGinty
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital, Cincinnati, OH, USA
Greta Lobes
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital, Cincinnati, OH, USA
Christy Tuemler
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital, Cincinnati, OH, USA
Paula M. Eldridge
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital, Cincinnati, OH, USA
Brittany Frakes
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital, Cincinnati, OH, USA
Elisa Marcuccio
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital, Cincinnati, OH, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
Samuel P. Hanke
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital, Cincinnati, OH, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
Michael G. Gaies
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital, Cincinnati, OH, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
*
Corresponding author: Dr D. B. Gal, Department of Pediatrics, Keck School of Medicine, University of Southern California, 4650 Sunset Blvd. Los Angeles, CA 90027, USA. E-mail: dgal@chla.usc.edu
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Abstract

Introduction:

Family-centred rounds benefit families and clinicians and improve outcomes in general paediatrics, but are understudied in subspecialty settings. We sought to improve family presence and participation in rounds in a paediatric acute care cardiology unit.

Methods:

We created operational definitions for family presence, our process measure, and participation, our outcome measure, and gathered baseline data over 4 months of 2021. Our SMART aim was to increase mean family presence from 43 to 75% and mean family participation from 81 to 90% by 30 May, 2022. We tested interventions with iterative plan-do-study-act cycles between 6 January, 2022 and 20 May, 2022, including provider education, calling families not at bedside, and adjustment to rounding presentations. We visualised change over time relative to interventions with statistical control charts. We conducted a high census days subanalysis. Length of stay and time of transfer from the ICU served as balancing measures.

Results:

Mean presence increased from 43 to 83%, demonstrating special cause variation twice. Mean participation increased from 81 to 96%, demonstrating special cause variation once. Mean presence and participation were lower during high census (61 and 93% at project end) but improved with special cause variation. Length of stay and time of transfer remained stable.

Conclusions:

Through our interventions, family presence and participation in rounds improved without apparent unintended consequences. Family presence and participation may improve family and staff experience and outcomes; future research is warranted to evaluate this. Development of high level of reliability interventions may further improve family presence and participation, particularly on high census days.

Keywords

Family-centered roundingacute care cardiologyinpatient cardiologyquality improvement
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 1 , January 2024 , pp. 44 - 49
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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References

Committee On Hospital C, Institute For P, Family-Centered C. Patient- and family-centered care and the pediatrician’s role. Pediatrics 2012; 129: 394–404. DOI 10.1542/peds.2011-3084.CrossRefGoogle Scholar
Khan, A, Spector, ND, Baird, JD, et al. Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study. BMJ 2018; 363: k4764. DOI 10.1136/bmj.k4764.Khan.CrossRefGoogle ScholarPubMed
Destino, LA, Shah, SS, Good, B. Family-centered rounds: past, present, and future. Pediatr Clin North Am 2019; 66: 827–837. DOI 10.1016/j.pcl.2019.03.008.10.1016/j.pcl.2019.03.008CrossRefGoogle ScholarPubMed
Mittal, V. Family-centered rounds. Pediatr Clin North Am 2014; 61: 663–670. DOI 10.1016/j.pcl.2014.04.003.10.1016/j.pcl.2014.04.003CrossRefGoogle ScholarPubMed
Kipps, AK, Albert, MS, Bomher, S, Cheung, S, Feehan, S, Kim, J. Schedule-based family-centered rounds: a novel approach to achieve high nursing attendance and participation. Pediatr Qual Saf 2020; 5: e265. DOI 10.1097/pq9.0000000000000265.10.1097/pq9.0000000000000265CrossRefGoogle Scholar
Hoerst, A, Bakar, A, Cassidy, SC, et al. Variation in care practices across pediatric acute care cardiology units: results of the pediatric acute care cardiology collaborative (PAC(3)) hospital survey. Congenit Heart Dis 2019; 14: 419–426. DOI 10.1111/chd.12739.10.1111/chd.12739CrossRefGoogle Scholar
Mott, AR, Neish, SR, Challman, M, Feltes, TF. Defining pediatric inpatient cardiology care delivery models: a survey of pediatric cardiology programs in the USA and Canada. Congenit Heart Dis 2017; 12: 294–300. DOI 10.1111/chd.12438.10.1111/chd.12438CrossRefGoogle ScholarPubMed
Harahsheh, AS, Kipps, AK, Hart, SA, et al. High acuity therapy variation across pediatric acute care cardiology units: results from the pediatric acute care cardiology collaborative hospital surveys. Pediatr Cardiol 2021; 42: 1074–1081. DOI 10.1007/s00246-021-02584-3.10.1007/s00246-021-02584-3CrossRefGoogle ScholarPubMed
Anderson, JB, Chowdhury, D, Connor, JA, et al. Optimizing patient care and outcomes through the congenital heart center of the 21st century. Congenit Heart Dis 2018; 13: 167–180. DOI 10.1111/chd.12575.CrossRefGoogle Scholar
Anttila, A, Rappaport, DI, Tijerino, J, Zaman, N, Sharif, I. Interpretation modalities used on family-centered rounds: perspectives of spanish-speaking families. Hosp Pediatr 2017; 7: 492–498. DOI 10.1542/hpeds.2016-0209.10.1542/hpeds.2016-0209CrossRefGoogle ScholarPubMed
Parente, V, Stark, A, Key-Solle, M, et al. Caregiver inclusivity and empowerment during family-centered rounds. Hosp Pediatr 2022; 12: e72–e77. DOI 10.1542/hpeds.2021-006034.CrossRefGoogle ScholarPubMed
Gal, DB, Char, DS, Anderson, JB, Cooper, DS, Madsen, NL. Family-centered care and acute care cardiology: borrowing lessons from other disciplines. Cardiol Young 2022; 32: 1718–1720. DOI 10.1017/S1047951122003080.10.1017/S1047951122003080CrossRefGoogle ScholarPubMed
Rogers, A, Lynch, K, Toth, H, Weisgerber, M. Patient and family centered (Tele)rounds: the use of video conferencing to maintain family and resident involvement in rounds. Acad Pediatr 2020; 20: 765–766. DOI 10.1016/j.acap.2020.05.026.10.1016/j.acap.2020.05.026CrossRefGoogle ScholarPubMed
Kosack, A, Carson, SL, Montenegro, EYB, et al. Improving patient experience scores using simultaneous interpretation on family-centered rounds. Hosp Pediatr 2022; 12: 1019–1035. DOI 10.1542/hpeds.2022-006696.CrossRefGoogle ScholarPubMed
Benneyan, JC, Lloyd, RC, Plsek, PE. Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care 2003; 12: 458–464. DOI 10.1136/qhc.12.6.458.CrossRefGoogle ScholarPubMed
Muething, SE, Kotagal, UR, Schoettker, PJ, Gonzalez del Rey, J, DeWitt, TG. Family-centered bedside rounds: a new approach to patient care and teaching. Pediatrics 2007; 119: 829–832. DOI 10.1542/peds.2006-2528.10.1542/peds.2006-2528CrossRefGoogle Scholar
Christianson, K, Kalinowski, A, Bauer, S, et al. Using quality improvement methodology to increase communication of discharge criteria on rounds. Hosp Pediatr 2022; 12: 156–164. DOI 10.1542/hpeds.2021-006127.CrossRefGoogle ScholarPubMed
Oshimura, JM, Downs, SM, Saysana, M. Family-centered rounding: can it impact the time of discharge and time of completion of studies at an academic children’s hospital? Hosp Pediatr 2014; 4: 228–232. DOI 10.1542/hpeds.2013-0085.10.1542/hpeds.2013-0085CrossRefGoogle ScholarPubMed
Wrobleski, DM, Joswiak, ME, Dunn, DF, Maxson, PM, Holland, DE. Discharge planning rounds to the bedside: a patient- and family-centered approach. Medsurg Nurs 2014; 23: 111–116.Google Scholar
Lopez, KN, Baker-Smith, C, Flores, G, et al. Addressing social determinants of health and mitigating health disparities across the lifespan in congenital heart disease: a scientific statement from the American heart association. J Am Heart Assoc 2022; 11: e025358. DOI 10.1161/JAHA.122.025358.CrossRefGoogle ScholarPubMed
Davey, B, Sinha, R, Lee, JH, Gauthier, M, Flores, G. Social determinants of health and outcomes for children and adults with congenital heart disease: a systematic review. Pediatr Res 2021; 89: 275–294. DOI 10.1038/s41390-020-01196-6.10.1038/s41390-020-01196-6CrossRefGoogle ScholarPubMed
Demianczyk, AC, Behere, SP, Thacker, D, et al. Social risk factors impact hospital readmission and outpatient appointment adherence for children with congenital heart disease. J Pediatr 2019; 205: 35–40 e1. DOI 10.1016/j.jpeds.2018.09.038.10.1016/j.jpeds.2018.09.038CrossRefGoogle ScholarPubMed
Resar, RK. Making noncatastrophic health care processes reliable: learning to walk before running in creating high-reliability organizations. Health Serv Res 2006; 41: 1677–1689. DOI 10.1111/j.1475-6773.2006.00571.x.10.1111/j.1475-6773.2006.00571.xCrossRefGoogle ScholarPubMed
Weick, KE, Sutcliffe, KM. Managing the Unexpected: Resilient Performance in An Age of Uncertainty. 2nd edn. Jossey-Bass, San Francisco, 2007.Google Scholar
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