On the inpatient units at MassGeneral Hospital for Children (MGHfC), providers gather every morning for rounds to discuss each patient’s care plan and goals for the day. Teams are comprised of a fellow, residents, an attending doctor, nurses and the patient’s family. In the Pediatric Intensive Care Unit (PICU), some teens and young adults have also joined the team as part of the Adolescent Rounding Project.
The Adolescent Rounding Project was introduced to the PICU in March 2016 by Eleanor McLaughlin, RN, a nurse in the unit and member of the MGHfC Family Advisory Council (FAC), and Phoebe Yager, MD, chief of the PICU. The project offers teens and young adult patients the opportunity to take part in rounds. For these patients, taking an active role in their health care is an important step toward independence, autonomy and self-advocacy. One year on, anecdotal evidence shows that patients and families believe they receive better care and are considered important members of the care team.
Including teens and young adults in rounds was already in practice on Ellison 18 and was received positively by patients, families and providers. In the PICU, families have been included in rounds for the past five years, but after attending a conference on improving family-centered care with other members of the MGHfC FAC in November 2015, McLaughlin was inspired to bring the practice to the PICU. McLaughlin conducted research with Yager, Arlene Kelleher, RN, MS, nursing director of the PICU, and Mandi Coakley, RN, PhD, staff specialist in the Department of Nursing before drafting a proposal. They found that adolescent rounding was not widely practiced throughout the country, but that where it was practiced had a positive impact on patient care.
As a nurse who works overnight, McLaughlin joined the FAC as her way to give back to the hospital in a way that worked with her schedule. “The FAC meetings are held at night, so I’d come in for the meeting before my shift started,” said McLaughlin. “After I attended the conference on family-centered care with other members of FAC, I thought adolescent rounding could be a project that would bring meaningful change to our patients and families.”
Teens and young adults want to take part in their health care, said McLaughlin, and as grow older, they should. “These patients have a right to be involved,” she said. “Those who are included in rounds are less anxious. They have a better understanding of what’s going on with their bodies and of the plan to return them to healthy individuals.”
Adolescent rounding, as the PICU team calls it, is conducted differently from typical rounds, said Kelleher. The care team gathers around the patient’s bedside, as opposed to in the corridor outside of the patient’s room. The team determines which patients can take part on a case-by-case basis. This is because of the nature of the PICU, which cares for critically ill children of all ages.
The project has also given patients a primary voice and allows them to take a new level of ownership in their care. “Many adolescents are making the transition to become more independent and to have a co-relationship with providers and their families. Participating in rounds allows them to feel more in charge and to advocate for themselves with their family’s support,” said Yager. “It grants them the opportunity to have a seat at the table where their care is being discussed.”
When the project was introduced, staff were enthusiastic to include adolescents in rounds. There were some concerns about whether doing so would affect the length of rounds, but a staff survey from May 2016, conducted by McLaughlin and Coakley showed no such impact. Instead, adolescent rounding has led to more thoughtful rounds presentations and informed discussions with families, said Yager.
“Adolescent rounding presents a wonderful opportunity for residents to improve their communication skills and to forge stronger relationships with the teenage patients in their care,” said Yager.
The FAC at MGHfC is a group of 15 parents who meet with hospital leadership and staff once per month. The FAC is dedicated to positive partnerships among providers, patients and parents. The group carries out many projects that aim to improve patient care and experiences. Learn more about the FAC at www.massgeneralforchildren.org/FAC.