Rationale / Evidence in Brief - Family Integration
Family members, as a critical member of the infant’s care team, have invaluable input into their child’s past medical experiences and future goals. Having all team members present and creating the conditions for strong teamwork is critical for effective handoffs, and family members are part of the team.
The Joint Commission encourages that handoffs include sharing and receiving of information as a multidisciplinary team—with the patient and family there at the same time.8 A study from Miami Children’s Hospital found that parents reported participating in bedside shift reports helped them understand their child’s conditions and needs.30
Similarly, when Cincinnati Children’s Liberty Campus hospital medicine service implemented a bedside physician-physician handoff, they found that “superior handoffs” relied on stakeholder involvement (whether at the bedside or not) and deferring to parental preference for involvement (e.g., giving families the authority to decide where and how handoff occurs).28 They also found that including families in handoff did not add significant time burden, as handoff was able to be completed in 2-3 minutes per patient.
The AAP also suggests that including patients and families in handoff, particularly for high acuity patients, is important. They suggest that having multidisciplinary team rounds at the bedside ensures that the family is aware that a new provider has assumed care, allows the family to communicate any concerns or changes, and ensures they are updated with any new information.21
In addition, it ensures that the transfer in care does not result in an undesired shift in goals, priorities, and plans from the family’s perspective.10 With respect to handoffs related to changes of service, it has been reported in the adult literature that 85% of patients surveyed were unaware that service changeover had ever taken place. To improve the process, many patients recommended a formalized, face-to-face introduction involving the patient/family and both providers during which the outgoing provider would introduce the new provider.31
While engaging patients and family in care transitions, it is important not to rely on the patient or family members to communicate vital information on their own to providers. Support systems are necessary to facilitate parent and family participation in handoffs. In addition to including families in handoff, it is important to include an assessment of the social determinants of health as part of the handoff process. As A. Catlin suggested in a letter to the editor in Journal of Perinatology, “if we are to train the neonatologist to work in a team, to consider where the baby came from, how it came to be in the neonatal intensive care unit and where it is going, we need to begin right at handoff.”32