P0610 - The Roadmap to Success: Creating Unit-Based Teams to Increase Family Centered Rounding and Improve Care Team Communication

Introduction: Family Centered Rounding (FCR) allows the medical team to partner with patients and families in medical decisions, improving patient satisfaction, advocacy, communication, and safety. However, daily implementation is uncommon due to lack of time, lack of training, and lack of standardization.

Objective: This project’s aim was to increase the percentage of patients receiving FCR from 59% to 90% in 6 months.

Methods: The Model for Improvement and sequential PDSA cycles were utilized. The process of assigning patients to physician teams was delineated, patient care teams were restructured, and FCR was standardized. The percentage of patients on their geographic team-based unit (process measure) was collected daily. Convenience sampling was used to obtain the frequency of FCR, care team communication measured via “trio rounding” between physician, nurse, and caregiver (outcome measures), and duration of rounds (balancing measure).

Results: Within the first four PDSA cycles, the goal was achieved. Patients receiving FCR increased from 60 (68%) to 91 (93%) (Figure 1). The percentage of patients geographically assigned improved from a mean of 42% (25th, 75th percentiles 38, 41) to 96% (25th, 75th percentiles 95, 100). Trio rounding frequency significantly improved with an increase from 35% (n=33) to 81% (n=93). Additionally, rounds exceeding the allotted time remained stable from 36% (n=5) to 30% (n=3). However, these improvements were not sustained. With frequent admitting resident turnover, rising patient census, and competing priorities, the percentage of patients on assigned unit-based teams and those receiving FCR had much variation, though always remaining above initial baseline values. Additional PDSA cycles tested changes to combat these barriers and again achieved success with the most recent data showing 94% (n=119) of patients receiving FCR and 93% (25th, 75th percentiles 88, 100) of patients geographically assigned to their unit-based team (Figure 2).

Conclusion: By increasing the percentage of patients on unit-based teams, patients received FCR increased by 30% (95% CI 19, 40) without prolonging rounding time. Continual analysis allowed for targeted interventions when improvement was not sustained. Results may be generalizable to similarly sized hospitals and residency programs. Future interventions will focus on sustaining improvement, increasing FCR effectiveness, and ensuring continued resident education. A parallel study investigating resident education during FCR is currently underway.