I’ve been shouting this message from my rooftop for years* – patients who communicate effectively and actively engage in their care have better outcomes and a reduced risk of medical errors. However, for hospitalized patients, this can be tricky. Ideally, doctors would include patients and/or family members in their daily “rounds” conversations. But, not all hospitals allow, or encourage, patient and family participation. There are many benefits to participating in hospital rounds, so it’s worth your effort to participate, for yourself or on behalf of a loved one.
What exactly are rounds?
Hospital rounds are an important daily communication process involving doctors and doctors-in-training (and sometimes other medical staff), patients and families. The goal of rounds is to create and communicate a plan for each patient’s care for the day. The structure, including who participates, varies widely by hospital, specialty, doctor and geographic location. In some hospitals, doctors conduct “family centered rounds” at the patient’s bedside, with the family present and involved. In contrast, some hospitals hold rounds in conference rooms, excluding patients and families.
Patient participation in rounds has a positive impact.
A recent study at pediatric hospitals was designed to determine whether medical errors, family experience, and communication processes improved after implementing family centered rounds. Researchers studied over 3,100 admissions in 7 US pediatric inpatient units between 12/2014 – 1/2017. The study reviewed the benefits of implementing a “rounds” program called I-PASS, developed at Boston Children’s Hospital and used by dozens of pediatric hospitals.
What does the I-PASS program involve?
I-PASS rounds begin at the patient’s bedside, not in the hall. Each session starts with asking the patient or family if they have any questions or concerns. Then the health care providers provide updates and review the treatment plan – all in a way that minimizes medical jargon and makes everything clear. The staff follows a structure for each, and at the end, staff ask patients and families to “read back” what they understood about the care plan. The program also includes the use of structured, written real-time summaries of rounds, a formal training program for medical staff, and strategies to support the process.
The results are persuasive.
The study found that family participation in rounds led to a significant reduction in dangerous medical errors. The overall rate of medical errors didn’t change (combined rates for both harmful and non-harmful errors). But, and here’s the great news, the rate of harmful errors fell by 38%! These harmful errors, also called preventable adverse events can range from incorrect medication doses to delays in consultations with specialists.
Additionally, there was an increase in the likelihood of families sharing concerns and an increase in nurse engagement in rounds. And more people felt like they were part of the care team, which can only be a positive development.
Moreover, using I-PASS did not significantly changed the amount of time staff spend on rounds, or the amount of trainee teaching.
Can other hospital follow this example?
Yes, but not without some effort. Actively including patients and families in rounds will require hospitals and doctors to shift their thinking towards patient centered care. But it’s not impossible, and the adoption of family centered rounds is growing in the US. Interestingly, hospitals in the United Kingdom have used family centered rounds for decades.
What can you do?
If a doctor provides you with a chance to participate in daily rounds, say yes! As a family caregiver, try to make every effort to attend these meetings, even though they often occur early in the morning. I understand the reluctance to wake up at the crack of dawn to meet with doctors, I hate getting up early! But it’s important and well worth your efforts.
If you have a loved one in the hospital, realize that he/she might not be able to communicate effectively with doctors due to illness and/or treatments. And it goes without saying that parents should attend rounds to advocate for their children, even when their children are teenagers.
Here are some suggestions to keep in mind while participating in rounds:
- Make a list of questions and concerns beforehand and share them with the team. To make sure you don’t forget anything, jot notes throughout each day on a pad kept at the patient’s bedside.
- If you don’t understand the terminology, ask for clarification.
- If you don’t understand what the doctor says, ask him/her to repeat the information in a way you can understand.
- Don’t be afraid to speak up if something doesn’t seem right!
- If the no one asks, tell the team you would like to repeat what you’ve heard to make sure you understand correctly.
- Ask for a written summary of the issues discussed.
More information on the importance of effective communication.
* Read these blog posts to learn more about the impact of patient-doctor communication:
- Patient-Doctor Communication. What’s the Impact on Patient Health?
- What’s a Frequent Cause of Hospital Readmissions? Miscommunication.
- Improve Your Communication with Your Doctor – It Might Save Your Life.
- Should you Speak Up if You Think Your Doctor is Wrong? YES!