Calardo Sarah J, Tomlinson Lesya, Bhatia Darshita, Weis Amy, Port Courtney
Department of Pediatrics, Inova L. J. Murphy Children's Hospital, Falls Church Va.
Department of Pediatrics, University of Virginia School of Medicine, Inova campus, Falls Church, Va.
Pediatr Qual Saf. 2022 Oct 27;7(6):e614. doi: 10.1097/pq9.0000000000000614. eCollection 2022 Nov-Dec.
Family-centered rounding (FCR) allows the medical team to partner with patients in medical decision-making, improving communication, and enhancing safety. However, FCR may compromise aspects of the resident education experience. In a survey of pediatric residents at our children's hospital, only 20% felt FCR provided the best educational experience. We designed this project to increase the percentage of residents with a positive perception of the educational experience on FCR from 20% to 80% in 6 months.
This project utilized The Model for Improvement and sequential plan-do-study-act cycles. A needs assessment identified educational activities negatively impacted by FCR. We then designed a hybrid FCR process with formal presentations outside patient rooms followed by traditional bedside FCR. Our primary measure was the percentage of residents positively perceiving the FCR educational experience. Our balancing measures included rounding duration and family satisfaction and comprehension.
Residents who perceive FCR to be the best educational experience improved from a baseline of 21% to 76%, with a calculated response rate of 79%. Patients receiving FCR remained above 80%. All surveyed families understood their care plans and remained satisfied with the information provided, although 21% were concerned about the number of people present on rounds during the COVID-19 pandemic. Forty-three percent of hospitalist rounds exceeded the allotted time.
The hybridization of FCR to include formal presentations may improve the resident learning experience while preserving family satisfaction and comprehension.
以家庭为中心的查房（FCR）使医疗团队能够在医疗决策中与患者合作，改善沟通并提高安全性。然而，FCR可能会损害住院医师教育体验的某些方面。在我们儿童医院对儿科住院医师的一项调查中，只有20%的人认为FCR提供了最佳的教育体验。我们设计了这个项目，旨在在6个月内将对FCR教育体验持积极看法的住院医师比例从20%提高到80%。
本项目采用了改进模型和连续的计划-执行-研究-改进循环。需求评估确定了受FCR负面影响的教育活动。然后，我们设计了一种混合FCR流程，在病房外进行正式汇报，随后进行传统的床边FCR。我们的主要衡量指标是对FCR教育体验持积极看法的住院医师比例。我们的平衡指标包括查房时长、家庭满意度和理解度。
认为FCR是最佳教育体验的住院医师比例从基线的21%提高到了76%，计算得出的回应率为79%。接受FCR的患者比例保持在80%以上。所有接受调查的家庭都理解了他们的护理计划，并对所提供的信息感到满意，尽管21%的家庭对COVID-19大流行期间查房时在场的人数表示担忧。43%的住院医师查房超过了规定时间。
将正式汇报纳入FCR的混合模式可能会改善住院医师的学习体验，同时保持家庭满意度和理解度。
