A randomized trial of facilitated family-centered rounds

Family-centered rounds (FCR) are becoming the status quo for inpatient pediatric medical care; however, barriers still exist. The use of facilitators in FCR is gaining popularity. Although facilitators can increase comfort with FCR, the choice of preferred facilitator has not been studied by using rigorous methodology. In this study, we performed a randomized trial of facilitated FCR with bunnies and clowns, 2 commonly mentioned facilitators, and compared their results with the usual care condition.

The 3 floor teams were randomized to have rounds facilitated with bunnies and clowns or the usual care model facilitated by distracted residents and overbearing attending physicians. Infection control procedures were instituted. Outcome measures were parent satisfaction scores, use of anxiolytic agents during examinations as part of FCR, resident satisfaction, and the number of times presenters were interrupted by their attending. Differences between the experimental and control groups were analyzed by using ttests, chi2 statistics, and multiple regression analysis. Qualitative analyses were also performed by using participant-observers.

Bunnies had the best overall improvement in parent satisfaction, anxiety, and resident satisfaction. Both intervention groups were successful at reducing attending interruptions. The clown arm was suspended by the Data Safety Monitoring Board before study completion due to adverse events.

Facilitated FCR has the potential to improve satisfaction among parents, patients, and residents, and to decrease attending interruptions. Care needs to be taken, however, to avoid unanticipated adverse effects from potentially emotionally damaging interventions. Tularemia was not identified in any of our treatment conditions.