Pediatric Family-Centered Rounds:
Engaging Families in Bedside Rounds to Promote Pediatric Patient Safety

Overview: Each year, 7 million children are hospitalized in the United States, exposing them to risk for medical errors. Children suffer three times as many medical errors as adult patients. Since children are not fully capable of employing the communication techniques recommended for adult patients to reduce errors, engagement of families in the child's healthcare is essential. To facilitate family engagement, current recommended practice is to conduct bedside rounds in patients’ rooms with the family present. Although more institutions are conducting rounds at the child's bedside while attempting to engage families, no institution has objectively assessed whether these rounds are successful in improving safety or engaging families.

Aims: The overarching goal of this study is to leverage family engagement in bedside rounds to improve the safety of care provided for hospitalized children. This project:

  • evaluates how family engagement during bedside rounds influences safety for hospitalized children;
  • uses systems engineering approaches to implement an intervention to foster family engagement;
  • compares the effectiveness of pre- and-post intervention bedside rounds with regard to safety and family engagement; and
  • assesses how family engagement mediates the intervention on safety.

This work creates an informative method for interventions to improve family engagement. By determining whether and how family engagement can improve patient safety, this project offers physicians a valid source regarding the benefits of family engagement. By educating physicians of the findings, policies for care provision during pediatric hospitalizations can be implemented. The project will support future evaluations of interventions to improve family engagement and pediatric patient safety.

Funding: Agency for Healthcare Research and Quality (AHRQ)

Elizabeth Cox, MD, PhD
Associate Professor, Department of Pediatrics,
School of Medicine and Public Health
University of Wisconsin-Madison

Pascale Carayon, PhD
Procter & Gamble Bascom Professor in Total Quality
Department of Industrial and Systems Engineering
Director, Center for Quality and Productivity Improvement
University of Wisconsin-Madison

Michelle M. Kelly, MD
Associate Professor, Department of Pediatrics
School of Medicine and Public Health
University of Wisconsin-Madison

Roger Brown, PhD
Professor, School of Nursing
Director, Research Design Methodology and Statistics Unit
University of Wisconsin-Madison

Randi Cartmill, MS
Researcher, Center for Quality and Productivity Improvement
University of Wisconsin-Madison

Lori Dubenske, PhD
Assistant Clinical Professor, Department of Psychiatry
School of Medicine and Public Health
University of Wisconsin-Madison

Doctoral students
Yaqiong Li
Anping Xie (graduated with PhD in 2013)

Benjamin, J.M., Cox, E.D., Trapskin, P.J., Rajamanickam, V.P., Jorgenson, R.C., Weber, H.L., Pearson, R.E., Carayon, P. & Lubcke, N.L. (2015). Family-Initiated Dialogue About Medications During Family-Centered Rounds. Pediatrics, 135(1), 94-101.

Xie, A., Carayon, P., Cartmill, R., Li, Y., Cox, E.D., Plotkin, J.A., & Kelly, M.M. (2015). Multi-stakeholder collaboration in the redesign of family-centered rounds process Applied Ergonomics, 46, 115-123.

Xie, A., Carayon, P., Cox, E.D., Cartmill, R., Li, Y., Wetterneck, T.B., & Kelly, M.M. (2015). Application of participatory ergonomics to the redesign of the family-centred rounds process. Ergonomics, (ahead-of-print), 1-19.

Carayon, P., Li, L., Kelly, M.M., DuBenske, L.L., Xie, A., McCabe, B., Orne, J., & Cox, E.D. (2014). Stimulated recall methodology for assessing work system barriers and facilitators in family-centered rounds in a pediatric hospital. Applied Ergonomics, 45 (6), 1540-1546. PMCID: PMC4119819

Kelly, M.M., Cox, E.D., Xie, A., Li, Y., Cartmill, R., & Carayon, P. (2014). Evaluating the implementation of family-centered rounding checklist. Paper presented at the 2014 Annual Pediatric Academic Society Meeting, Vancouver BC, Canada.

Xie, A., Kelly, M.M., Cox, E.D., Cartmill, R.S., Li, Y., & Carayon, P. (2014). A participatory ergonomics approach to family-centered rounds process redesign. Paper presented at the 2014 Symposium on Human Factors and Ergonomics in Health Care: Leading the Way, Chicago, IL.

Cox, E.D., Carayon, P., Hansen, K.W., Rajamanickam, V.P., Brown, R.L., Rathouz, P.J., Dubenske L.L., Kelly, M.M. & Buel, L.A. (2013). Parent perceptions of children's hospital safety climate. BMJ Quality & Safety, 22(8), 664-671.

Kelly, M.M., Xie, A., Carayon, P., DuBenske, L.L., Ehlenbach, M.L., & Cox, E.D. (2013). Strategies for improving family engagement during family-centered rounds. Journal of Hospital Medicine, 8 (4), 201-207. PMCID: PMC3955089

Xie, A. (2013). A participatory ergonomics approach to family-centered rounds process redesign: The case of family-centered rounds in a pediatric hospital. PhD Dissertation, (Order No. 3594091), University of Wisconsin - Madison.

Li, Y., Carayon, P., Xie, A., Kelly, M.M., Cartmill, R.S., Wetterneck, T.B., & Cox, E.D. (2013). Work system challenges to implementing a family-centered rounds checklist. Poster presented at the 2013 International Symposium on Human Factors and Ergonomics in Healthcare: Advancing the Cause, Baltimore, MD.

Xie, A., Carayon, P., Kelly, M.M., Li, Y., Cartmill, R.S., DuBenske, L. L., Brown, R.L., & Cox, E. D. (2012). Managing different perspectives in the redesign of family-centered rounds in a pediatric hospital. Proceedings of the Human Factors and Ergonomics Society (HFES) Annual Meeting, 56 (1), 1733-1737.

Children's Hospital Safety Climate Questionnaire

The Children’s Hospital Safety Climate (CHSC) Questionnaire is a tool that health care administrators, researchers, and clinicians can use to evaluate parents’ perceptions of the patient safety climate of children’s hospitals.

The Family-Centered Rounds Toolkit

The Family Centered Rounds Toolkit provides information about the development and implementation of an intervention aimed at improving family engagement during family-centered rounds.