Virtual Family-Centered Rounds in the Neonatal Intensive Care Unit: A Randomized Controlled Pilot Trial

Published:March 18, 2021DOI:



      To measure the feasibility, reach, and potential impact of a virtual family-centered rounds (FCR) intervention in the neonatal intensive care unit.


      We conducted a randomized controlled pilot trial with a 2:1 intervention-to-control arm allocation ratio. Caregivers of intervention arm neonates were invited to participate in virtual FCR plus standard of care. We specified 5 feasibility objectives. We profiled intervention usage by neonatal and maternal characteristics. Exploratory outcomes included FCR caregiver attendance, length of stay, breast milk feeding at discharge, caregiver experience, and medical errors. We performed descriptive analyses to calculate proportions, means, and rates with 95% confidence intervals (CI).


      We included 74 intervention and 36 control subjects. Three of the five feasibility objectives were met based on the point estimates. The recruitment and intervention uptake objectives were not achieved. Among intervention arm subjects, recruitment of a caregiver occurred for 47 (63.5%, 95% CI 51.5%–74.4%) neonates. Caregiver use of the intervention occurred for 36 (48.6%, 95% CI 36.8%–60.6%) neonates in the intervention arm. Feasibility objectives assessing technical issues, burden, and data collection were achieved. Among the attempted virtual encounters, 95.0% (95% CI 91.5%–97.3%) had no technical issues. The survey response rate was 87.5% (95% CI 78.2%–93.8%). Intervention arm neonates had 3.36 (95% CI 2.66%–4.23) times the FCR caregiver attendance rate of subjects in the control arm.


      A randomized trial to compare virtual FCR to standard of care in neonatal subjects is feasible and has potential to improve patient and caregiver outcomes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sisterhen LL
        • Blaszak RT
        • Woods MB
        • et al.
        Defining family-centered rounds.
        Teac Learn Med. 2007; 19: 319-322
        • Landry M-A
        • Lafrenaye S
        • Roy M-C
        • et al.
        A randomized, controlled trial of bedside versus conference-room case presentation in a pediatric intensive care unit.
        Pediatrics. 2007; 120: 275-280
        • Curley C
        • McEachern JE
        • Speroff T.
        A firm trial of interdisciplinary rounds on the inpatient medical wards: an intervention designed using continuous quality improvement.
        Med Care. 1998; : AS4-AS12
        • Rosen P
        • Stenger E
        • Bochkoris M
        • et al.
        Family-centered multidisciplinary rounds enhance the team approach in pediatrics.
        Pediatrics. 2009; 123: e603-e608
        • Kuo DZ
        • Sisterhen LL
        • Sigrest TE
        • et al.
        Family experiences and pediatric health services use associated with family-centered rounds.
        Pediatrics. 2012; 130: 299-305
        • Committee on Hospital Care and Institute for Patient- and Family-Centered Care
        Family-centered care and the pediatrician's role.
        Pediatrics. 2003; 112: 691
        • Committee on Hospital Care and Institute for Patient- and Family-Centered Care
        Patient-and family-centered care and the pediatrician's role.
        Pediatrics. 2012; 129: 394
        • Ray JG
        • Urquia ML
        • Berger H
        • et al.
        Maternal and neonatal separation and mortality associated with concurrent admissions to intensive care units.
        CMAJ. 2012; 184: E956-E962
        • Safran C.
        The collaborative edge: patient empowerment for vulnerable populations.
        Int J Medical Inform. 2003; 69: 185-190
        • Greene MM
        • Rossman B
        • Patra K
        • et al.
        Depressive, anxious and perinatal post-traumatic distress in mothers of very low birth weight Infants in the NICU.
        J Dev Behav Pediatr. 2015; 36 (JDBP.): 362
        • Greene MM
        • Rossman B
        • Patra K
        • et al.
        Maternal psychological distress and visitation to the neonatal intensive care unit.
        Acta Paediatr. 2015; 104: e306-e313
        • Alkozei A
        • McMahon E
        • Lahav A.
        Stress levels and depressive symptoms in NICU mothers in the early postpartum period.
        J Maternal-Fetal Neonatal Med. 2014; 27: 1738-1743
        • Mahoney AD
        • White RD
        • Velasquez A
        • et al.
        Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019.
        J Perinatol. 2020; 40: 36-46
      1. U.S. Department of Health and Human Services. Office for Civil Rights. Notification of enforcement discretion for telehealth remote communications during the COVID-19 nationwide public health emergency. Available at: Published 2021. Accessed February 17, 2021.

        • Yager PH
        • Clark M
        • Cummings BM
        • et al.
        Parent participation in pediatric intensive care unit rounds via telemedicine: feasibility and impact.
        J Pediatr. 2017; 185 (e183): 181-186
        • Østervang C
        • Vestergaard LV
        • Dieperink KB
        • et al.
        Patient rounds with video-consulted relatives: qualitative study on possibilities and barriers from the perspective of healthcare providers.
        J Med Internet Res. 2019; 21: e12584
        • Eldridge SM
        • Chan CL
        • Campbell MJ
        • et al.
        CONSORT 2010 statement: extension to randomised pilot and feasibility trials.
        bmj. 2016; : 355
        • Toomey SL
        • Zaslavsky AM
        • Elliott MN
        • et al.
        The Development of a Pediatric Inpatient Experience of Care Measure: child HCAHPS.
        Pediatrics. 2015; 136: 360-369
        • Giordano LA
        • Elliott MN
        • Goldstein E
        • et al.
        Development, implementation, and public reporting of the HCAHPS survey.
        Med Care Res Rev. 2010; 67: 27-37
        • Bates DW
        • Boyle DL
        • Vander Vliet MB
        • et al.
        Relationship between medication errors and adverse drug events.
        J Gen Intern Med. 1995; 10: 199-205
        • Bates DW
        • Cullen DJ
        • Laird N
        • et al.
        Incidence of adverse drug events and potential adverse drug events: implications for prevention.
        JAMA. 1995; 274: 29-34
        • Kaushal R.
        Using chart review to screen for medication errors and adverse drug events.
        Am J Health Syst Pharma. 2002; 59: 2323-2325
        • Starmer AJ
        • Spector ND
        • Srivastava R
        • et al.
        Changes in medical errors after implementation of a handoff program.
        N Engl J Med. 2014; 371: 1803-1812
        • Billingham SA
        • Whitehead AL
        • Julious SA.
        An audit of sample sizes for pilot and feasibility trials being undertaken in the United Kingdom registered in the United Kingdom Clinical Research Network database.
        BMC Med Res Methodol. 2013; 13: 104
        • Kistin C
        • Silverstein M.
        Pilot studies: a critical but potentially misused component of interventional research.
        JAMA. 2015; 314: 1561-1562
        • Leon AC
        • Davis LL
        • Kraemer HC.
        The role and interpretation of pilot studies in clinical research.
        J Psychiatric Res. 2011; 45: 626-629
        • Moore CG
        • Carter RE
        • Nietert PJ
        • et al.
        Recommendations for planning pilot studies in clinical and translational research.
        Clin Transl Sci. 2011; 4: 332-337
        • Epstein EG
        • Sherman J
        • Blackman A
        • Sinkin RA.
        Testing the feasibility of Skype and FaceTime updates with parents in the neonatal intensive care unit.
        Am J Crit Care. 2015; 24: 290-296
        • Hron JD
        • Parsons CR
        • Williams LA
        • et al.
        Rapid Implementation of an inpatient telehealth program during the COVID-19 pandemic.
        Appl Clin Informa. 2020; 11: 452-459
        • Ong SY
        • Stump L
        • Zawalich M
        • et al.
        Inpatient telehealth tools to enhance communication and decrease personal protective equipment consumption during disaster situations: a case study during the COVID-19 Pandemic.
        Appl Clin Infors. 2020; 11: 733-741
        • Umoren RA
        • Gray MM
        • Handley S
        • et al.
        In-Hospital telehealth supports care for neonatal patients in strict isolation.
        Am J Perinatol. 2020; 37: 857-860
        • Gaulton J
        • Ziegler K
        • Chang E.
        Virtual practices transform the care delivery model in an intensive care unit during the coronavirus pandemic.
        Nejm Catalyst Innov Care Delivery. 2020;
        • Kraemer HC
        • Mintz J
        • Noda A
        • et al.
        Caution regarding the use of pilot studies to guide power calculations for study proposals.
        Arch Gen Psychiatry. 2006; 63: 484-489