Virtual Family Rounds in the NICU Show Real Benefits a Clinical Trial Alone Missed

When a newborn ends up in the neonatal intensive care unit, parents are thrust into one of the most disorienting experiences in medicine. Every day, the clinical team gathers for rounds, a structured huddle in which physicians, nurses, and specialists review each infant’s status, weigh treatment decisions, and plan the next steps of care. Family-centered rounds were designed to pull parents into that conversation at the bedside, letting them hear the plan directly, ask questions, and participate as partners rather than bystanders. But what happens when a parent cannot physically be there, whether because of work, distance, other children at home, or the lingering realities of a pandemic-era hospital? A research team at the University of California, Davis has spent years testing a technological answer to that question, and their newest study offers an unusually honest look at how the answer actually performs in the messy real world of a working NICU.

The innovation under scrutiny is virtual family-centered rounds, abbreviated vFCR by the researchers. Instead of requiring parents to stand at the incubator, the approach gives them a telehealth window into rounds, connecting them by video so they can hear the team discuss their baby’s care in real time. The concept sounds simple, and in many ways it is, but embedding it into a hospital workflow is anything but. To understand whether the intervention worked, why it worked where it did, and where it stumbled, the team led by Jennifer L. Rosenthal conducted an implementation evaluation of a completed randomized clinical trial, publishing their findings in BMC Health Services Research. The trial itself, registered as NCT05762835, compared virtual family-centered rounds against standard in-person rounds over a twelve-month period in the NICU.

What makes this study methodologically interesting is that it treats the clinical trial not as the end of the story but as the beginning of a deeper question. Randomized trials are superb at estimating whether an intervention changes a measured outcome on average, but they are notoriously poor at explaining how an intervention functions in practice, for whom, and under what conditions. That is the domain of implementation science, and the UC Davis team leaned on two of its most widely used frameworks. The first is RE-AIM, an acronym for Reach, Effectiveness, Adoption, Implementation, and Maintenance, which forces evaluators to look beyond raw efficacy and ask whether an intervention actually reaches its intended population, whether settings adopt it, how consistently it is delivered as designed, and whether it can be sustained over time. The second is the PRISM model, the Practical, Robust, Implementation and Sustainability Model, which maps the contextual factors, from organizational culture to patient-level barriers, that shape those RE-AIM outcomes.

To capture both the numbers and the lived experience, the researchers used a convergent mixed methods design. On the quantitative side, they performed a cross-sectional analysis of neonatal intensive care unit hospitalizations using electronic health records alongside surveys completed by parents and guardians. On the qualitative side, they conducted and thematically analyzed interviews with 29 parents and 25 providers. The two streams of evidence were then synthesized in a joint display table organized by the five RE-AIM dimensions, allowing the team to see where the statistical picture and the human picture agreed and, just as importantly, where they diverged. During the twelve-month trial, 486 families were randomized, with 325 assigned to the virtual rounds intervention and 161 to the control group receiving standard family-centered rounds.

The findings that emerged from this triangulation are nuanced in a way that single-method studies rarely achieve. The team identified three overarching thematic findings that shaped the implementation outcomes. First, the success of virtual rounds depended heavily on how parents and providers actually experienced and used the technology. Provider delivery style influenced the degree to which rounds remained genuinely family-centered, and parents’ prior familiarity with the healthcare system shaped how engaged they could be through the virtual channel. In other words, the same video link could be a rich participatory experience for one family and a passive, confusing broadcast for another, depending on who was running the round and how much health literacy the parent brought to the encounter.

Second, the researchers found that virtual family-centered rounds had real limitations as a substitute for being physically present, yet they also expanded participation and improved communication in ways that standard rounds could not. The telehealth format exposed workflow barriers that made consistent delivery of family-centered care difficult, a reminder that adding a video call to a busy clinical huddle is not a frictionless upgrade. Clinicians must juggle cameras, screens, and audio while maintaining the intimate, fast-paced rhythm of bedside rounds, and any hiccup in that choreography risks turning the parent from a participant into an afterthought. At the same time, for families who would otherwise have missed rounds entirely, the virtual option transformed their access to information about their own child.

Third, and perhaps most consequentially for health equity, the study concluded that virtual rounds were broadly beneficial, particularly for families facing structural barriers such as inflexible jobs, transportation challenges, or living far from the hospital. Yet maintaining equitable implementation proved stubbornly difficult because adoption depended on individual providers, and digital barriers, the uneven landscape of devices, connectivity, and technological confidence, persisted. An intervention that only helps families when a particular physician chooses to use it well, or when a family happens to have a reliable smartphone and a quiet place to call from, risks reproducing the very disparities it was designed to close. The authors flag this provider-dependent adoption and digital divide as central challenges to the sustainability of the innovation.

Across most RE-AIM dimensions, the quantitative and qualitative findings converged, which strengthens confidence in the overall picture. But the divergence the team uncovered is arguably the most scientifically provocative result. When it came to parent-reported quality of life outcomes, the qualitative interviews suggested that the intervention conferred genuine benefits, while the quantitative analysis found null effects. This is a classic and important pattern in mixed methods research: statistical instruments may be too blunt, too poorly timed, or too insensitive to capture the kind of subtle improvements in communication, trust, and peace of mind that parents describe in their own words. The authors conclude that this implementation evaluation identified perceived benefits of virtual family-centered rounds that the quantitative assessment alone did not reveal, while simultaneously surfacing implementation challenges that will determine whether the telehealth innovation survives contact with everyday hospital life.

The broader lesson extends well beyond one NICU in Sacramento. Telehealth exploded during the COVID-19 pandemic and has since settled into an uneasy equilibrium, championed by patients who value access and viewed warily by systems still figuring out how to pay for it, staff it, and quality-check it. This study offers a template for evaluating such innovations rigorously: pair the trial with an implementation evaluation, use RE-AIM to structure the questions, use PRISM to organize the context, and let parents and clinicians explain what the dashboards cannot see. It also delivers a sobering message to health systems tempted to declare telehealth a solved problem. The technology is the easy part. The hard part is the human choreography, the consistent provider buy-in, and the equity safeguards that determine whether a video link becomes a bridge or just another barrier. As the authors put it in their conclusion, addressing these challenges will enhance the ability of the intervention to achieve broad impact, and for the hundreds of thousands of families who pass through intensive care units each year, that impact is measured in something no survey scale fully captures: the feeling of being present, informed, and heard while their child fights to come home.

Subject of Research: Implementation evaluation of virtual family-centered rounds in the neonatal intensive care unit using the RE-AIM framework

Article Title: Implementation evaluation of virtual family-centered hospital rounds using the RE-AIM framework: a mixed methods study

Article References: Horath, E. T., Hoffman, K. R., Ketchersid, A., Haynes, S. C., Tancredi, D. J., Marcin, J. P., Romano, P. S., Young, H. M., & Rosenthal, J. L. (2026). Implementation evaluation of virtual family-centered hospital rounds using the RE-AIM framework: a mixed methods study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15759-6

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15759-6

Keywords: telemedicine, family-centered rounds, neonatal intensive care, implementation science, RE-AIM framework, PRISM model, mixed methods, health equity, pediatrics, clinical trial, patient-centered care, health services research