In contrast, the patient-and family-centered movement began in the mid-20th century as a response to the separation trauma experienced by hospitalized children and their families [9]. Hospitals responded by liberalizing their visiting policies and encouraging direct care-giving by parents. FCC was further bolstered by consumer-led movements in the 1960s and 1970s, and by federal legislation in the 1980s targeting children with special health care needs. FCC gained national recognition in 2001 when the Institute of Medicine emphasized that involving patients and families in health care decisions increased the quality of their care [2]. Subsequently, the AAP endorsed FCC as a guiding approach to pediatric care in their 2003 report “Family-centered care and the pediatrician’s role” [1]. As part of this report, the AAP recommended that bedside presentations with active engagement of families become the standard of care. FCRs developed at several children’s hospitals in the US in the following years, with the first conceptual model of FCR published by Muething et al in 2007 [10].
Definition of Family-Centered Rounds
While no consensus definition of FCR exists, the most frequently cited description comes from Sisterhen et al who describe FCR as “interdisciplinary work rounds at the bedside in which the patient and family share in the control of the management plan as well as in the evaluation of the process itself” [11]. Three key features should be noted in this definition. First, FCR requires the active participation of family members, not merely their presence. In this way, patient and family voices are heard and their preferences solicited with respect to clinical decision-making. Second, FCR take place at the bedside, in alignment with the 2003 AAP policy statement that standard practice should be to conduct attending rounds with full case presentations in patient rooms in the presence of family. Third, FCR are typically interdisciplinary, involving patients and their families, physicians and trainees, nurses, and other ancillary staff (such as interpreters, case managers, and pharmacists) [1,10,11,12].
Since the IOM report, FCRs have gained substantial national momentum. A PRIS (Pediatric Research in Inpatient Setting) network study in 2010 published the first survey of pediatric hospitalist rounding practices in the US and Canada [12]. The study reported that 44% of pediatric hospitalists conducted FCRs, and about a quarter conducted rounds as hallway rounds or sit down rounds. Academic hospitalists were significantly more likely to conduct FCRs compared with non-academic (48% vs. 31%; P < 0.05) hospitalists. In accordance with Muething et al’s experience with FCRs in the Cincinnati model, the survey respondents did not associate FCR with prolonged rounding duration [10,12]. FCRs were also associated with greater bedside nurse participation [12]. Given the momentum behind FCC and the oft-cited benefits of FCR, it can only be presumed that the number of pediatric hospitals conducting FCR has significantly increased since the PRIS study was published in 2010.
FCRs Can Improve Quality of Care for Hospitalized Children
FCRs bring together multiple stakeholders involved in the patient’s care in the same place at the same time everyday. This allows for shared-decision making, identification of medical teams by families, and allows for direct and open communication between parents and medical teams [1,10–12]. The key stakeholders on a FCR team include the patient and family members and the medical team. The medical team includes attending physician, fellow, resident, and students, bedside nurse, care coordinator/case manager and other ancillary services. Although not enough data is available on who should attend rounds, case mangers and bedside nurse along with medical team and patients and families were found to be crucial in the general inpatient setting [12].