Parent Presence on Morning Rounds in the Pediatric ICU: Perspectives, Goals, and Expectations of Parents and Providers

Abstract

The American Academy of Pediatrics has recommended adoption of “family-centered rounds” (FCRs), which incorporate parents into work rounds with the goals of improving communication and involving parents in decision-making. Surveys show high levels of parental satisfaction with the practice, but healthcare providers (HCPs) express hesitations. Because little is known about the perspectives underlying these attitudes, we sought to compare parents’ and providers’ attitudes towards, and goals and expectations for, family participation on morning rounds. We conducted a mixed-methods study of parents and providers in a medical/surgical intensive care unit (MSICU). Parents and HCPs were surveyed regarding attitudes towards and experiences with rounds. Semi-structured interviews of parents and focus groups of HCPs were conducted, and transcripts were analyzed using qualitative methods. A total of 100 parents and 131 HCPs completed surveys. While 92% of parents preferred to attend rounds, only 54% of HCPs preferred parental presence. There were also differences in perceptions of parental understanding, with HCPs less likely to perceive that parents understood the format and content of rounds (p<0.001). A total of 21 parents and 24 HCPs participated in interviews and focus groups, respectively. Parents and HCPs agreed that parents should leave rounds understanding their child’s status and daily plan. There was disagreement, however, regarding the appropriate role of parents on rounds. Parents viewed rounds as a forum to ask questions, whereas HCPs felt rounds were not a time for in-depth discussion with families. Parents expected transparency from the team, while providers reported self-editing to avoid parental discomfort. Our study identifies areas of incongruity between parent and provider expectations regarding parental presence on rounds that may contribute to differences in satisfaction. These findings can inform implementation of faculty development around FCRs as well as improved parental preparation for FCRs, which may facilitate efficient use of time during rounds and better calibrate parent and provider goals and expectations.