Patient- and Family-centered Rounding: A Single-site Look into the Room.

INTRODUCTION: The American Academy of Pediatrics recommends Patient- and Family-centered Rounds (PFCRs) to improve communication between the healthcare team and families while allowing the latter to participate in medical decision-making. PFCRs have a secondary goal of increasing rounds' efficiency and providing a positive learning environment for residents and students. There are many published best practices for PFCR. Our study provides an observational evaluation of PFCR in an academic tertiary medical center using a checklist created from such published best practices. METHODS: We created a standardized observation checklist based on published guidelines. Study members observed 200 individual rounding encounters using this instrument. All inpatient, nonsurgical rounding teams in the fall of 2014 were included and analyzed using descriptive statistics. RESULTS: The average rounding encounter included 9 team members, lasted 9 minutes and 24 seconds, with the medical team entering the patient room for 80.0% of encounters. Families were invited to participate in 60% of the encounters. Lay language was utilized in 62% of the encounters, although 99.5% of the encounters staff used medical terminology. Nursing was present in 64.5% of encounters but presented in only 13.5% of those encounters. The teaching-attending modeled patient interaction behaviors such as eye contact, nodding, and leaning forward in 31%-51% of encounters. CONCLUSIONS: Despite published best practices, medical teams at a large tertiary care center did not adhere to many components of published PCFR guidelines. Future studies should focus on family and physician experience to identify improvement strategies for rounds.

The Impact of Nurse-Led Innovations and Tactics During a Pandemic.

The COVID-19 pandemic hit southeast Michigan hard and a rapid influx of patients forced Beaumont Health to shift rapidly into an emergency management model with a laser focus on transforming clinical care and administrative processes to meet complex patient care needs. Navigating this landscape required agility, surge planning, strong interprofessional teams, transformational leadership, nurse-led innovations, support, and transparency to manage the ever-changing environment. This article explains nursing's response and nurse-led innovations that were implemented to meet the needs of the community, patients, and staff, as well as lessons learned to ensure preparedness for any potential future surge.

Optimizing Electronic Release of Imaging Results through an Online Patient Portal.

Purpose To determine an optimal embargo period preceding release of radiologic test results to an online patient portal. Materials and Methods This prospective discrete choice conjoint survey with modified orthogonal design was administered to patients by trained interviewers at four outpatient sites and two institutions from December 2016 to February 2018. Three preferences for receiving imaging results associated with a possible or known cancer diagnosis were evaluated: delay in receipt of results (1, 3, or 14 days), method of receipt (online portal, physician's office, or phone), and condition of receipt (before, at the same time as, or after health care provider). Preferences (hereafter, referred to as utilities) were derived from parameter estimates (ß) of multinomial regression stratified according to study participant and choice set. Results Among 464 screened participants, the response and completion rates were 90.5% (420 of 464) and 99.5% (418 of 420), respectively. Participants preferred faster receipt of results (P < .001) from their physician (P < .001) over the telephone (P < .001). Each day of delay decreased preference by 13 percentage points. Participants preferred immediate receipt of results through an online portal (utility, -.57) if made to wait more than 6 days to get results in the office and more than 11 days to get results by telephone. Compared with receiving results in their physician's office on day 7 (utility, -.60), participants preferred immediate release through the online portal without physician involvement if followed by a telephone call within 6 days (utility, -0.49) or an office visit within 2 days (utility, -.53). Older participants preferred physician-directed communication (P < .001). Conclusion The optimal embargo period preceding release of results through an online portal depends on the timing of traditional telephone- and office-based styles of communication. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Arenson et al in this issue.

Waiting for Radiology Test Results: Patient Expectations and Emotional Disutility.

PURPOSE: To measure patient willingness to wait and emotional disutility of waiting for outpatient imaging test results. METHODS: A prospective HIPAA-compliant multicenter outpatient quality improvement survey was administered by a trained interviewer to 218 outpatients from November 1, 2016, to February 1, 2017. The survey was vetted by patient- and family-centered care advocates with experience in survey design and underwent precognitive testing for readability. Six clinical scenarios were tested. Descriptive statistics were calculated. RESULTS: The response (93% [202 of 218]) and completion (93% [188 of 202]) rates were excellent. Anxiety (28% [57 of 202]), depression (26% [53 of 202]), and cancer (23% [46 of 202]) histories were common. Median stated expectations for imaging test results receipt were 3 days after a screening examination (interquartile range [IQR] 5 days); 2 days after chest x-ray for chest pain (IQR 3) or MRI or CT for back pain (IQR 2); and 1 day after chest x-ray for pneumonia (IQR 2), MRI or CT for brain tumor (IQR 2), or CT for cancer treatment (IQR 3). If imaging results are not received, the median time patients stated they would wait to call their provider was 1 to 5 days (varied by indication). Waiting for imaging results exerts an emotional change in 45% (91 of 202) of individuals, with the majority (85% [77 of 91]) experiencing anxiety (minimal 28%, mild 45%, moderate 22%, severe 4%, extreme 1%). CONCLUSIONS: Patients expect outpatient imaging results within 1 to 3 days and will call providers by 1 to 5 days. Waiting for test results commonly induces anxiety.

Patient-Centered Assessment of the Value of Oral Contrast Material.

PURPOSE: The aim of this study was to measure the value of oral contrast material from the patient's point of view. METHODS: A prospective HIPAA-compliant survey was administered from August 30, 2016, to March 9, 2017, at two outpatient centers to consecutive outpatients immediately after oral contrast material consumption for abdominopelvic CT. The survey included validated measures of temporary health disutility and oral contrast-specific questions vetted by patient advocates with experience in survey design. Descriptive statistics were calculated. RESULTS: The response rate (93% [218 of 234]) and completion rate (100% [218 of 218]) were excellent. When given a hypothetical choice to not drink oral contrast, most subjects (89% [193 of 218]) stated that they would always drink it for fear of missing an important finding, and only 5 (2%) stated that they would never drink it regardless of risk. Twenty (9%) said that the decision to drink oral contrast would depend on the level of risk, with 18 (8%) indicating that they would accept a 0.01% to 1.00% risk for missing an important finding if they did not have to drink oral contrast. Most patients rated the oral contrast taste as tolerable (55% [120 of 218]); a minority rated it bad or terrible (10% [21 or 218]). Thirty-six subjects (17%) experienced concern or unease (8 minimal, 15 mild, 10 moderate, 3 extreme) when they learned that they had to drink oral contrast, and 36 (17%) experienced oral contrast-induced nausea or abdominal discomfort (10 minimal, 15 mild, 10 moderate, 1 extreme). CONCLUSIONS: If oral contrast material has any diagnostic benefit, most outpatients (89%) would rather drink it than accept any risk for missing an important finding.

Family Presence and Participation: Pediatrics Leading the Way ... And Still Evolving.

Patient- and family-centered care began in pediatrics more than two decades ago, and pediatric care has continued to lead the way in acknowledging and supporting family presence and participation in patient care and decision-making. However, many adult hospitals still have "visiting" policies that restrict the potential for true partnerships with families and other care partners. A national campaign, Better Together: Partnering with Families, developed by the Institute for Patient- and Families-Centered Care (IPFCC), urges all hospitals--pediatric and adult--to welcome families 24/7. Despite the leadership of pediatrics in family-centered care, even in children's hospitals, policy and practice must continue to evolve to strengthen partnerships with families, as described in a profile of C.S. Mott Children's Hospital and the University of Michigan Health System.

Type 1 diabetes mellitus and school: a comparison of patients and healthy siblings.

Children and adolescents with type 1 diabetes mellitus (T1DM) are at risk for a variety of problems at school. Well-controlled studies using data collected in schools, however, are limited. The purposes of this study are to determine whether selected school problems are associated with T1DM and to investigate an association between these problems and medical variables. Teachers rated 95 diabetic students (M = 11.8; SD = 3.0 yr old) and 95 of their siblings (M = 12.1; SD = 3.0 yr old) regarding academic skills, work completion, day-to-day variability, and classroom attention. Medical and school records also were accessed. The T1DM group had lower academic skills ratings overall (p < 0.02), especially in writing (p < 0.01), a trend toward poorer classroom attention (p < 0.08), and many more missed school days (p < 0.001). Diabetics on intensive therapy protocols had better academic ratings overall (p < 0.02), including in math (p < 0.03) and fewer missed school days (p < 0.03), but they unexpectedly were rated as having more classroom behaviors that jeopardize work completion (p < 0.05) than counterparts on conventional therapy. Among all diabetics, glycated hemoglobin (HbA(lc)) levels were moderately related to each academic skill rating (r = -0.34 to -0.37; p < 0.01) and strongly related to classroom attention (r = 0.53; p = 0.000). T1DM itself appears to be a relatively minor influence to several important aspects of school. Furthermore, although intensive therapy alone may well promote school success, meticulous glycemic control, however achieved, appears more important in mitigating prospective classroom attention and academic problems.