P2D190: Enhancing Patient and Family Participation in Rounds with Implementation of a Standardized Communication Tool: A Quality Improvement Project

Purpose/Objectives: Person- and family-centered care (PFCC) is considered the gold standard for all hospitalized pediatric patients. To enhance PFCC in our Pediatric Intensive Care Unit (PICU), we set out to improve compliance with a PFCC bundle found within the Society of Critical Care Medicine (SCCM) guidelines for family-centered care in the neonatal, pediatric and adult ICU. The specific aim was to utilize family journals to increase the engagement of patients and families in the PICU on multidisciplinary rounds by 50% within 6 months.

Design/Methods: Our team first used a PFCC gap analysis tool provided by the SCCM . Next a prioritization matrix was created that identified the provision of information leaflets about the ICU setting and ICU diaries for family members as important additions to our system. Using these recommendations, we initiated a Plan-Do-Study-Act cycle with the collection of baseline data and creation of our family journal that would combine both information about the PICU and a diary for families into one book. As an outcome measure, we observed for an increase in family presence on rounds and directly surveyed families regarding satisfaction with the journal. As a process measure, we evaluated the delivery of the journal to families. As a balancing measure we observed change in time spent rounding on each patient pre- and post- implementation of the family journal. We met every month for six months to review results and discuss ideas for change to be utilized in the subsequent PDSA cycle.

Results: To evaluate the impact of the family journal to help engage families in multidisciplinary rounds, we followed family presence on rounds, delivery of the journal to families, parental satisfaction of the journal, and time spent on rounds pre- and post- journal implementation. Our goal was to improve patient and/or parental presence on rounds by 50% (from 52% to 75-80%). We were able to achieve 76% presence on rounds at the end of our PDSA cycles. We were also able to steadily increase the delivery of journals from 0% at the beginning to 65% through multiple PDSA cycles focusing on this process. Time spent on rounds did not change significantly, going from an average of 6.5 minutes to 8.03 minutes per patient. Lastly, amongst families that received the journal, the average satisfaction with the journal measured 4.5/5 on a Likert scale.

Conclusion/Discussion: While there is much more to be explored as we continue to work towards enhancing PFCC within our unit, the successful implementation of a family journal has served to improve engagement of family members on multidisciplinary rounds. Next steps include use of video technology, visual cues in patient rooms and on staff computers, and input from the family advisory council.