In my initial blog post, I wrote about the new David and Barbara Hirschhorn Pediatric Inpatient Unit opening this coming week at Sinai. I mentioned that the new unit facilitates the delivery of patient/family-centered care. Today, I'll elaborate on what this concept of patient/family centered care entails and how we implement this style of care in Pediatrics at Sinai.
In a major article this month in PEDIATRICS, the journal of the American Academy of Pediatrics, the authors Jerrold M. Eichner, M.D., and Beverly H. Johnson, M.D., wrote in a policy statement:
“Patient and family-centered care is grounded in collaboration among patients, families, physicians, nurses, and other professionals in clinical care, as well as for the planning, delivery, and evaluation of health care, and in the education of health care professionals and in research, as well.”
Patient/family-centered care is focused on recognizing that the family is integral to health care delivery for children. The key features of true family and patient-centered care focus on collaborative involvement with parents, siblings and extended family members in the health care conversations about their children. This translates to inclusion of the family and the child in all health care decision processes and a team approach to health care planning. It also means that listening to children and their concerns, engaging in two way conversations about symptom management, medical history, medication choice and reconciliation (confirming right medicine, right dose, right schedule) and treatment planning is essential to improved outcomes.
Some classical medicine pathways place the physician as the key decision maker. In some ways, this makes a certain amount of sense because the physician is usually the one with the greatest training and/or experience in the health care system. However, experience, research and time have demonstrated that the “top down” approach of physician-directed care planning can be less than satisfying to patients and families.
This approach can also be restrictive in thought processes and creativeness and can even be counterproductive to the best interests and cultural beliefs of the family/child. Such monophasic (single stage) thinking can lead to unintended consequences of poor compliance, distrust and poor satisfaction. It also leads to a higher rate of medical mistakes, medication errors and incorrect information about patient history.
By involving the family and the child in the health care discussion, everyone in the dialogue becomes a partner with a vested interest in the best outcome. Medications are confirmed as correctly prescribed, administered appropriately in the right dose and schedule and compliance is significantly increased. Multiple studies have demonstrated that this approach leads to safer practices, increases satisfaction with the health care continuum and improves outcomes. Incredibly, not only are outcomes better, but care is less costly (i.e. re-admissions and subsequent inappropriate emergency room use and adverse events are reduced).
Dr. Wiley discusses the philosophy below:
At Sinai's inpatient units -- pediatric floor, Neonatal Intensive Care Unit (NICU) and Pediatric Intensive Care Unit (PICU) -- the caregiver team makes hospital rounds in a family-centered manner. The entire team moves to the bedside and the patient information is presented with family members and the child present. Important elements of the history, symptom complex and medications are reviewed for accuracy and importance. Teaching is done for students and residents in a manner that also benefits the parents and patients. Plans for interventions, tests, labs and discharge are discussed as a team and information is shared in real time and confirmed for accuracy.
The new inpatient unit at the Samuelson children’s hospital was designed for this purpose. Rooms are larger, with single beds and bathrooms that are designed to provide maximal comfort and privacy for families and their hospitalized children. With a bed and a sleep chair, as well as a family eating area, more members of the family can be comfortably accommodated. The size of the rooms and the privacy afforded by the design invite the entire team to be present while still protecting and respecting the rights of the patient and family.
Our clinically and culturally diverse staff provide great benefits for assisting families and patients to communicate thoughts and views about health care choices and strategies that will enhance compliance, education and accuracy of information, as well as care plans. This facilitates communication within the team and, externally, to the referral physician.
Sinai Pediatrics is proud of the multi-year tradition of family-centered care with the patient at the epicenter of the health care continuum. We continue to have one of the lowest rates of readmission and ER use after respiratory illness hospitalizations of any health care system in our region. We ascribe this great record of success to the implementation of evidence-based care pathways and education about these care plans with families in our family and patient-centered care environment.
Current research supports this method as the best practice in health care. The Affordable Care Act plans to reward hospital systems for providing this quality in the future and encourages hospitals to adopt this culture. At the Herman & Walter Samuelson Children’s Hospital at Sinai this culture has been part of our DNA for more than a decade. We have been practicing this style for years before it became fashionable and recognized as the best standard.
-Written by Joseph M. Wiley, M.D., FAAP, associate program director, pediatric residency chief, Department of Pediatrics, The Herman and Walter Samuelson Children's Hospital at Sinai
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