P1.019: Development of an interdisciplinary, interprofessional, family-centered rounding framework for critically ill children

Background: Daily interprofessional and family-centered care rounds are evidence-based interventions to improve team communication and family-centered care, however, they are inconsistently used in the care of children globally. While current evidence-based rounding frameworks, such as Patient-family centered-IPASS developed by Khan et al, are effective, they do not consider the challenges faced in diverse settings. Furthermore, no rounding framework guides inclusion of multiple disciplines or physician subspecialties, an integral part of care of complex subspecialty patients such as critically ill children with cancer. This study develops a comprehensive, interdisciplinary, interprofessional and family-centered rounding framework to support future implementation efforts in diverse settings.

Methods: A rapid ethnographic approach was used to observe interdisciplinary, interprofessional and family-centered rounds (IDIP-FCR) in the Pediatric Intensive Care Unit and inpatient wards at a dedicated pediatric oncology hospital in the United States. Data were collected as field notes during two months of non-participatory observations. Field notes were then expanded to include more detailed accounts of observations. This was followed by thematic analysis of expanded notes using MAXQDA software to identify IDIP-FCR outcomes and processes. Further analysis of observed processes was conducted to identify specific functions of IDIP-FCR. Research team meetings with 9 experts of diverse disciplines, professions, methodologic expertise, including patient and family representation were held to develop a preliminary functional IDIP-FCR framework.

Results: Sixty-four rounding instances were observed by three team members and identified themes were discussed in three research meetings. Observations identified processes used in IDIP-FCR, which were analyzed to understand and identify core functions essential to the practice of IDIP-FCR. Core functions include interdisciplinary/professional communication, interdisciplinary/profession decision making, family engagement and family decision making. Interdisciplinary/professional communication functional component encompasses all processes that facilitate communication between different disciplines and professions in the rounding team. Interdisciplinary/professional decision making describes shared decision making among healthcare providers as a functional goal of IDIP-FCR. Family-engagement and decision making includes all processes that actively include families during rounds and involve them in decision making respectively. These core components were then incorporated into a functional model of IDIP-FCR, which provides adaptability to challenges faced in diverse settings by focusing on the functions of rounds rather than rounding processes.

Conclusion: This preliminary rounding framework describes core functions, processes, and intended outcomes of an IDIP-FCR to improve interdisciplinary/professional and family communication in the care of critically ill children with cancer. Practice of IDIP-FCR per this framework is hypothesized to achieve the overall goal to improve interdisciplinary/professional and family-centric communication in the care of critically ill children with cancer. Future work will include perspectives of global clinicians providing childhood cancer care to refine this framework and inform strategies for global implementation.