Reducing Racial Disparities in Caregiver Presence During Family-Centered Rounds

Families identifying as members of marginalized racial groups may be less likely to attend family-centered rounds (FCR) and receive associated benefits. At our institution, caregivers of Black patients admitted to Hospital Medicine (HM) were less likely to be physically present on FCR than their white counterparts (72.2% vs 81.8%). We sought to increase the percentage of caregivers present, physically or by telephone, on HM FCR for Black patients from 72.2% to 83% in 5 months.

We conducted a quality improvement initiative at a large, urban, freestanding children's hospital. Our primary measure was physical or telephone presence of a caregiver during FCR, disaggregated by caregiver-reported patient race. We formulated key drivers, including early identification of Black patients at higher risk of poor communication. We conducted plan-do-study-act cycles. We tracked the percentage of caregivers of Black and white patients present on FCR using annotated 2-line run charts and statistical process control charts.

Over 15 months of interventions, the percentage of caregivers present on FCR increased to 81.7% in caregivers of Black patients and 85.2% in caregivers of white patients. This improvement was not initially sustained. Therefore, we returned to active interventions to achieve reimprovement. We detected special cause variation after implementing 2 interventions: (1) discussing caregiver preferences regarding their presence during FCR on admission and (2) calling all caregivers who were not physically present during rounds.

We successfully improved the presence of caregivers on FCR while also decreasing the racial gap in caregiver presence.