Written by Kimiko Dunbar
Spoon Feed
Division of family-centered rounds into a hybrid format – medical team huddle outside the room, then a structured conversation with family, improved caregiver experience but increased rounding time.
Hybrid “family-centered rounds” – upgrade or rounding twice?
Family-centered rounds (FCR) are strongly supported by the AAP to include patients and families in decision making and improve the patient and family experience. While students and other trainees benefit from such public conversations on rounds, they are often pressured to limit discussion around differential diagnosis to what might be palatable to the family; students want to demonstrate their consideration of all diagnoses, even unlikely serious ones.
This quasi-experimental study assessed the impact of a brief interdisciplinary medical huddle prior to patient- and family-centered rounds on caregiver experience. In this model (initially implemented as a means to limit time in patient rooms at the height of the COVID-19 pandemic), medical teams engage in a brief discussion outside the room using a SOAP format, followed by a structured conversation with families, which focuses on their perception of how the patient is doing and their concerns (see figure below). Families of hospitalized children completed surveys before (n=51) and after (n=61) implementation. Post-intervention scores significantly improved for clarity of communication (P=0.005), concern-addressing (P=0.009), and overall satisfaction (top-box responses 76% vs. 56%, P<0.001). However, rounding duration increased (17.6 vs. 13.9 minutes, P<0.001). Importantly, this was a non-randomized design and did not include patients with a primary language other than English.
How does this change my practice?
I’m going to try this! I often feel the tension between FCR and medical education when students limit their differential diagnosis or generate unnecessary anxiety when presenting in front of families. Additionally, for residents, FCR can unravel into overly casual presentations, limiting the opportunities for education and a structured review of the data. I worry that this creates a double-rounding effect and wonder about the ability of this structure without buy-in from all attending physicians. Regardless, I think I’ll give it a go the next time I’m on a service.
Source
The Effect of a Brief Medical Huddle on Patient and Family Experience During Rounds. Hosp Pediatr. 2025 Apr 1;15(4):318-324. doi: 10.1542/hpeds.2024-007998. PMID: 40068809
