The idea of bringing daily ICU rounds, even once or twice a week, into patient rooms is a concept best described in the pediatric critical care literature. It’s something that last year our group tried to start in our burn ICU, and I will openly confess that I’ve been a dismal failure at it. It’s not that I’m uncomfortable with getting into the room and talking with patients and families about what’s going on- anyone who works with me knows it’s quite the opposite- but simply that I have struggled to figure out “best practices” and workflow to make these type of rounds effective for all of the parties involved in our interdisciplinary care team. Every time I think about it, I find myself both challenged and overwhelmed, largely because my perception is that our daily interdisciplinary rounds (not always at the bedside) work just fine, though they are admittedly not patient and family centered.
So, the theoretical benefits of family-centered rounds: increased family involvement and understanding, trainee role modeling, and enhanced team communication. And the theoretical down sides? Physical barriers, trainee apprehension, and time limitations.
Interestingly, physician interest in conducting family-centered rounds seems to be driven by the physician’s perception of the efficacy of rounding in this way: there’s an association between a belief in the benefits and the likelihood to do them, and there’s an association between perception of barriers and not conducting them. And, of course, the conduct of family-centered rounds requires that the physician leading them have tremendous situational awareness and an ability to manage the environment in order for them to be most effective. Then there’s the whole sticky wicket of the fact that family-centered rounds may provide a foundation for family-centered care, they cannot alone insure that family-centered care is delivered.
After reading all of those things, I was still ambivalent at best. I want to believe, and I want to deliver on our group’s agreement. But how do we do this best? How can I do this in a way that doesn’t feel contrived for me?
Fortunately, some guidance is present in this study, which provides descriptions of the “art” of bedside rounds as conducted on the medicine service. While it’s not 100% relevant, I definitely see some tips in there I can employ- and in some ways I am motivated to “start small” by keying on a handful of patients rather than the entire ICU for each session.
So, here’s my late summer and Fall teaching and communication goal, out here for all of you to see. I have a few weeks off service to ponder this and see what it will really look like, and a resident interested in education to help me pilot it starting in August.
Will it succeed, or will I at least overcome my antipathy? Stay tuned!