University of Wisconsin–Madison

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)

  • Cox, E.D., Jacobsohn, G.C., Rajamanickam, V.P., Carayon, P., Kelly, M.M., Wetterneck, T.B., Rathouz, P.J. and Brown, R.L. (2017) A family-centered rounds checklist intervention, family engagement, and patient safety: A randomized trial. Pediatrics, 139(5).

    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.

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