Presentation
HE9 - Environmental Barriers And Facilitators To Family-Centered Rounds In Pediatric Critical Care Settings
SessionPoster Session 1
DescriptionRounding in healthcare settings involves the clinical team making routine trips to the patient room to evaluate the patient and devise a care plan (Lynch, 2015). In ICUs, multiple rounds occur throughout the day based on purpose, location, and timing (Mittal, 2014), including morning, surgical, and post-admission rounds (Gurses & Xiao, 2006). Due to the nature of patient illnesses in ICUs, multidisciplinary rounds are most effective in making patient care decisions (Gurses & Xiao, 2006; Lane et al., 2013).
This study discusses the morning rounds that an attending physician and their team lead to create a plan for the day (Tripathi et al., 2015). Traditionally, morning rounds were conducted without families’ and patients’ involvement in decision-making. Nevertheless, with the advent of patient and family-engaged care (PFEC), most clinical teams encourage family-centered multidisciplinary morning rounds, also known as family-centered rounds (FCRs). Literature suggests that rounds are divided into three stages, but due to a lack of information about these, this exploratory study begins by exploring the clinical workflows during the pre-, rounds, and post-rounding stages, followed by understanding the location of different team members, computers, tasks conducted, and location of family-engagement. Since FCRs are the only time the entire patient team gathers physically at or near the patient bedside to evaluate the patient and formulate a care plan. Therefore, adequate and appropriately designed ICU systems and spaces are pertinent to encourage interaction among the team members and families.
The Institute of Medicine (US) Committee on Quality of Health Care in America (2001) recommends family engagement as a key to improving the quality and safety of healthcare, and FCRs support that by increasing collaboration and communication among the team and with family members (Landry et al., 2007; Stickney et al., 2014; Tripathi et al., 2015). Therefore, this study uses a systems approach to evaluate the pediatric ICU-built environment and its influence on family and staff experiences, communication, and collaboration during FCRs.
The study uses the Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model of work system and safety as the core framework because of its adaptation to collaborative processes within healthcare settings. First, it puts the person(s) in the center of the work system, following a healthcare work system where the patient is most important, followed by their family and staff members. Second, it recognizes the importance of engagement within healthcare settings and incorporates professional-patient collaborative processes between providers and patients that form the basis for patient and family engagement (Holden et al., 2013). The third factor is the categorization of outcomes into desirable and undesirable outcomes to understand the performance of the work system. Furthermore, SEIPS 2.0 utilizes a feedback loop to improve outcomes and processes by adapting to the work system (Holden et al., 2013).
To collect data about the different systems that contribute to FCRs, an embedded mixed-method approach was used, conducting work system analysis, rounding observations, workflow mapping, surveys, interviews, and environmental assessments at three different pediatric ICUs in the Southeastern United States.
The findings from this study shed light on the Work system for each rounding stage and the desirable and undesirable outcomes for each. Furthermore, it shows how different spaces and tools are utilized to conduct various rounding-related tasks, the trends at all three pediatric ICUs, and the interruptions caused during rounds. This study also highlights various design and systems implications that can be incorporated into pediatric ICU designs to improve the rounding experience.
This study discusses the morning rounds that an attending physician and their team lead to create a plan for the day (Tripathi et al., 2015). Traditionally, morning rounds were conducted without families’ and patients’ involvement in decision-making. Nevertheless, with the advent of patient and family-engaged care (PFEC), most clinical teams encourage family-centered multidisciplinary morning rounds, also known as family-centered rounds (FCRs). Literature suggests that rounds are divided into three stages, but due to a lack of information about these, this exploratory study begins by exploring the clinical workflows during the pre-, rounds, and post-rounding stages, followed by understanding the location of different team members, computers, tasks conducted, and location of family-engagement. Since FCRs are the only time the entire patient team gathers physically at or near the patient bedside to evaluate the patient and formulate a care plan. Therefore, adequate and appropriately designed ICU systems and spaces are pertinent to encourage interaction among the team members and families.
The Institute of Medicine (US) Committee on Quality of Health Care in America (2001) recommends family engagement as a key to improving the quality and safety of healthcare, and FCRs support that by increasing collaboration and communication among the team and with family members (Landry et al., 2007; Stickney et al., 2014; Tripathi et al., 2015). Therefore, this study uses a systems approach to evaluate the pediatric ICU-built environment and its influence on family and staff experiences, communication, and collaboration during FCRs.
The study uses the Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model of work system and safety as the core framework because of its adaptation to collaborative processes within healthcare settings. First, it puts the person(s) in the center of the work system, following a healthcare work system where the patient is most important, followed by their family and staff members. Second, it recognizes the importance of engagement within healthcare settings and incorporates professional-patient collaborative processes between providers and patients that form the basis for patient and family engagement (Holden et al., 2013). The third factor is the categorization of outcomes into desirable and undesirable outcomes to understand the performance of the work system. Furthermore, SEIPS 2.0 utilizes a feedback loop to improve outcomes and processes by adapting to the work system (Holden et al., 2013).
To collect data about the different systems that contribute to FCRs, an embedded mixed-method approach was used, conducting work system analysis, rounding observations, workflow mapping, surveys, interviews, and environmental assessments at three different pediatric ICUs in the Southeastern United States.
The findings from this study shed light on the Work system for each rounding stage and the desirable and undesirable outcomes for each. Furthermore, it shows how different spaces and tools are utilized to conduct various rounding-related tasks, the trends at all three pediatric ICUs, and the interruptions caused during rounds. This study also highlights various design and systems implications that can be incorporated into pediatric ICU designs to improve the rounding experience.
Event Type
Poster Presentation
TimeMonday, March 314:45pm - 6:15pm EDT
LocationFrontenac Foyer
Digital Health (DH)
Simulation and Education (SE)
Hospital Environments (HE)
Medical and Drug Delivery Devices (MDD)
Patient Safety and Research Initiatives (PS)