2008/2009 Challenge Grantee
Medical College of Georgia / Georgia Health Sciences University
Center for Patient- and Family-Centered Care Improving Patient Rounds
Walter Moore, MD and Christine O’Meara, MA, MPH January 25, 2011
How did your project impact patient-centered care (PCC) at your institution?
- Raised the level of awareness that PFCC can be carried out in an adult care setting
- Demonstrated PFCC rounds are beneficial for patients and their family caregivers
- Helped educate leadership in the Department of Medicine
- Laid the foundation of increasing emphasis on supporting quality of care and that patients’ families play a role in this
- Increased awareness of family involvement in care
- Supported MCG’s philosophy of care
- Incorporated PFCC educational materials/deliverables into clinical staff training and resident education
Brief project summary
The IPR project goal was to implement patient- and family-centered care (PFCC) rounds in a general medicine unit in an adult-care inpatient setting as a quality improvement initiative. The project initially followed and measured the performance of one service team practicing PFCC Rounds on a general internal medicine unit with the aim of studying the impact on patient, family, staff, and doctors-in-training satisfaction; unit costs; residents’ and unit efficiency; quality; and safety.
Educational effectiveness and team performance in PFCC Rounds were assessed through the use of the PFCC Rounds observation checklist; written evaluations by students, residents and attending physicians; and student debriefing during focus group sessions. Participating nursing staff were debriefed to ascertain their perceived benefits and challenges associated with rounding with the medical team. Debriefing patients and families following the rounds encounters provided additional insights and information into the patient/family experience and the value of patient/family engagement during rounds.
Project results included:
- Just-in-time PFCC education and PFCC Rounds orientation for students and residents, as well as PFCC professional development for nursing staff and attending physicians practicing in the general internal medicine unit study site
- Identifying steps and strategies to implementing PFCC Rounds applicable to other adult-care units
- Discovering and overcoming specific obstacles to implementing PFCC Rounds
- Expanding the role of patient advisors as partners in PFCC education and research
Several tools resulting from the pilot, including a blueprint for initiating and developing PFCC Rounds and a quick reference PFCC Rounds Observation checklist will be helpful to other health care institutions and academic medical centers as they initiate interdisciplinary, bedside PFCC Rounds or modify their existing rounds. These tools can aid attending physicians and residents desiring to integrate and model PFCC practices as they engage patients and their families at the bedside.
What were the accomplishments of your project?
- Demonstrated PFCC Rounds are doable in an adult care inpatient setting
- Expanded the role of patient advisors into quality improvement, research, and resident and medical student education and training
- Faculty, clinical nursing staff, residents, students, and patient advisors’ engagement in the project was maintained through monthly newsletters in which patient advisors were also contributing authors
- Engaged patients and their families had an enhance patient experience
- Patients and their families reciprocate
- Development of evidence-based PFCC checklist
- Development of PFCC Rounds Guidebook: Navigating Patient- and Family-Centered Care Rounds: A GUIDE TO ACHIEVING SUCCESS and PFCC GUIDELINES Card educational and training tools
What did you learn from your project?
- Our goals were ambitious, we should have begun with more targeted goals as some data was not feasible to collect (i.e. tracking pages, text messaging to assess time savings)
- Establishing this project using a case-control approach would have strengthened the methodology
- Identified the need to financially support PFCC quality improvement in order to carry out and sustain the initiative; more funding was needed
- Dissemination can be difficult
- PFCC practices are variable among physicians and front-line nursing staff
- PFCC role modeling for doctors-in-training is a critical tool for teaching PFCC
- If attending faculty are not supportive of PFCC rounds at the bedside, it won’t happen
- Clinical nursing staff were reluctant to round with physician teams initially but through interdisciplinary rounds they experienced improved communication and see PFCC interdisciplinary rounds as beneficial to nursing staff, patients, and their families
- The interdisciplinary team should include social workers and other disciplines or specialties involved in patient’s care
- Patients and families were engaged and appreciated improved communication and a team approach
How have you disseminated your project findings/project curriculum?
- Conference presentations
- Veterans Administration Leadership National Conference Las Vegas, NV – August 25, 2010 with an estimated 3,000 attendees
- Planetree Annual Conference Baltimore, M– October 4-7, 2009 podium presentation to approximately 75-100 attendees
- Accreditation Council on Graduate Medical Education (ACGME) meeting Grapevine, TX – March 5-8, 2009 with 20 attendees
- Workgroup session on PFCC Rounds implementation planning – VA VISN 7 Executive Leadership Meeting Atlanta, GA – September 9, 2010 with 16 attendees
- Two breakout sessions VA National leadership meeting August 23, 2010 with 25-30 attendees in the morning and 10-15 attendees in the afternoon
- Medical Resident Education
- Family Medicine Residents PFCC introduction and mobile device application testing – December 15, 2010 with 12 participants
- MCG new medical resident’s orientation – June 25, 2010; 135 PFCC Guidelines cards for orientation packets
- MCG Residents noon conference – March 3, 2009; incorporated PFCC Rounds checklist into new resident orientation and packets
- VA VISN 7 Executive Leadership Meeting (Southeast VA Network representing Alabama, Georgia, and South Carolina) Atlanta, GA – September 9, 2010 with 100 attendees
- Graduate Medical Education Administrators Meeting Columbia, SC – February 12, 2010
- PFCC Learning Labs – Professional development for MCGHealth clinical staff (ongoing)
- Web site dissemination
- Information sharing with Beverley Johnson, Executive Director of the Institute for Patient- and Family-Centered Care, who, in-turn has presented the information at regional venues
- PFCC Rounds Guidebook and PFCC Guidelines Card distribution and sales
- Converting PFCC Guidelines and Checklist Card to mobile device application for faculty, staff, residents, students, and general public (in development)
Have you been able to sustain your project after the one year grant period and if so, how?
- We have not been able to sustain the PFCC Rounds program due primarily to the premature death of Pat Sodomka, former Senior Vice President of Patient Family Centered Care at MCG Health, Inc. and PFCC champion in February 2010.
- The PFCC Rounds coordination would be more likely to be sustained through the efforts of a dedicated staff coordinator; there exists a lack of funding resources to sustain this coordinator role.
Have you been able to expand your project within your institution/ to other institutions? How?
- While we have been unable to expand the project within our institution, we have been a resource to other institutions through training, the provision of technical assistance, and PFCC Rounds educational materials distribution.
- The PFCC guidelines card and checklist developed through this project is being used in MCG professional development through PFCC Learning Labs.
What recommendations would you make to prospective grantees?
- Target your proposal
- Involve a biostatistician early in proposal development
- Engage in the Human Assurance Committee/Institutional Review Board (HAC/IRB) process early in proposal development
- Review previously funded Picker Institute projects and scale your project accordingly
- Engage patient advisors as members of the project team from proposal development to implementation and dissemination
What recommendations would you make to current Challenge Grantees?
- Document your process in multi-media formats (video, photographs, audio tapes)
- Your multi-media documentation becomes a dissemination tool
Any other comments.
The introduction of interdisciplinary PFCC Rounds in an adult care in-patient setting represents a culture change. As part of this process, executive leadership is essential and it is critically important to engage nursing leadership, physician departmental leadership, and graduate medical education leadership in the planning and implementation stages. Maintain involvement and interest of key stakeholders and patient advisors with periodic updates and acknowledgement of vital support.