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On Friday I wrote about issues in patient safety, and I will continue in that vein today

. One big focus of the Children's hospital over the last two years, has been the introduction and development of patient and family centered care (PFCC). There are many aspects to health care that make it patient and family centered. One major aspect is acknowledging the role that families play in the lives  of patients, and recognizing that respect for families is an important part of how we care for patients.

It seems easy for providers to acknowledge this in pediatrics, since our patients are often too young to understand the implications of their diagnosis, or the descriptions of proposed treatment, and we are legally compelled to explain results and discuss proposed treatment plans with legal guardians. However, even in the children's hospital, it has taken some work to make certain that families are included in daily work rounds by the medical team, and the twice daily shift report nurses give to each other when transferring care from one to the other. We have, however, been working vigilantly to monitor how we are doing, to be sure we are speaking the right language, and that everything is clear to every member of the team every day. We are not perfect, but the journey has begun, and we continue to work on it daily.

On our pediatric inpatient unit, we have been doing "patient-centered rounds" now for over a year. Rounds occur in the morning with as many members of the health care team present as possible. The junior resident, or the medical student who has been following the patient "presents" inside the room (rather than in the hallway or in a conference room), and the family members are invited to add to or correct the information given during the process. A discussion ensues, led by the attending physician, and a plan is made for the day that is shared at the time with all the interns, residents, students, nurses, and most importantly the patient and family.

While somewhat stressful to the students and junior residents in the beginning, by the end of a week they are very comfortable with the process. When I have asked the students for feedback, many of them have noted that there were errors in our knowledge that were corrected by having the discussion be open and transparent. Families, knowing the plan for the day, can be our allies in supporting the plan, and helping to prevent harm, waste and error.

What would you want for yourself or your loved one if you were in the hospital?

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