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By Dr. Michael DiMaria
It goes without saying that nobody knows a child better than his or her family. That’s why we at the Heart Institute at Children’s Hospital Colorado believe that healthcare staff and patient families should be partners. Because ultimately, the goal of family-centered rounds is to get your child home, feeling well and able to participate in all of the things that go into being a healthy, happy kid.
Family-centered rounds were introduced in many children’s hospitals across the country for several reasons, but one of the primary motives is that families like to be involved in the healthcare decisions of their children. Plus, the way we practice medicine has shifted to a cooperative model where the family’s involvement is just as important as the doctors’.
To understand what this change means for families, let’s start by talking about what to expect during morning rounds at the Heart Institute. First thing in the morning, after the incoming team of providers has gotten up to speed on developments from the overnight shift, the group (family and healthcare staff) gathers at each patient’s bedside.
The goal is to review the events of the last day, discuss how the patient is doing and come up with the plan for the next day. This is an important time for everyone on the medical team and the family to get on the same page.
Often times, especially at a teaching hospital, a large crowd will be present. In order to make things flow more quickly and easily, the attending physician may ask that any questions or concerns be raised at the end of the presentation.
Rounds will also include a brief description of the day’s events, a review of the physical exam, then a bunch of numbers like lab values, fluid intake and output, ventilator settings, etc. At the end of all of this comes the assessment and plan where the presenter will discuss his or her impression of how the patient is doing.
This will sound something like, “From a respiratory standpoint, I think we can try to decrease the oxygen from 2 to 0.5 liters per minute. From a nutritional standpoint, I think that Sam can try to eat a solid diet today.” This process will continue until all of the active medical issues have been addressed.
There are several points during the rounds when your family’s input will be especially helpful. Ultimately, you know your child the best, which is why we think parents are the best source of historical information.
Because hospital staff may come and go twice a day (most have 12-hour shifts), being able to give each team an idea of the overall trend of your child’s symptoms can be very helpful. Similarly, it can be difficult for people who don’t know your child to tell what sorts of behaviors are personality-related and which are indicators that things are not quite right.
Your child’s nurse will be at the bedside, advocating for the family, bringing up unresolved issues, and clarifying your family’s role in the plan. A fellow or mid-level provider (nurse practitioner or physician assistant) will present the patient to the group, meaning that he or she will be responsible for knowing all the details about your child and summarizing them efficiently to the group.
Nurse practitioners are typically experienced nurses who do additional training in order to adopt a role that involves medical decision making. Physician assistants are healthcare professionals that function in a similar capacity, as part of a team alongside physicians.
How did the presenter come to be in this position? After graduating from medical school and receiving an M.D., he or she completed a one-year internship and a two-year residency. Pediatricians who want to sub-specialize in cardiology do an additional three to four years of training, called a fellowship.
After finishing training, a doctor becomes an attending physician – the person in charge of the team. The attending will be listening, teaching and guiding the trainee through the process of assembling the data and figuring out what to do next. Various other people may be present, including pharmacists, nutritionists, nursing leadership and physical therapists.
When patients and care providers first encounter family-centered rounds, some may find it uncomfortable to have conversations about sensitive topics in the presence of a large group. Of course, there is the option for the family to have a more private conversation with only essential members of the team, should there be concerns about privacy.
Typically, a patient’s family will need to continue some care at home after being discharged from Children’s Colorado. So, part of having a child in the hospital is learning about the disease and the treatments while you’re here. Being an informed caretaker will better enable your family members to identify when problems occur at home and what to do about them.
In fact, a measure of our success as care providers is whether or not your family feels comfortable once your child is discharged. Our hope is that family-centered care results in a close working relationship, shared knowledge and unified goals of families and hospital staff.