Prospective Observational Study on High-Value Care Topics Discussed on Multidisciplinary Rounds

Abstract

OBJECTIVES: Establishing a high-value care (HVC) culture within an institution requires a multidisciplinary commitment and participation. Bedside rounds provide an ideal environment for role modeling and learning behaviors that promote an HVC culture. However, little is understood regarding the types of HVC discussions that take place at the bedside and who participates in those discussions. METHODS: A prospective observational study at a tertiary-care, university-affiliated, free-standing children’s hospital. The prevalence of HVC discussions was captured by using the HVC Rounding Tool, a previously developed instrument with established validity evidence. For each observed HVC discussion, raters recorded who initiated the discussion and a description of the topic. RESULTS: Raters observed 660 patient encounters over 59 separate dates. Of all patient encounters, 29% (191 of 660; 95% confidence interval: 26%–33%) included at least 1 observed HVC discussion. The attending physician or fellow initiated 41% of all HVC discussions, followed by residents or medical students (31%), families (12%), and nurses (7%). CONCLUSIONS: Despite a recent focus on improving health care value and educating trainees in the practice of HVC, our study demonstrated that bedside discussions of HVC are occurring with a limited frequency at our institution and that attending physicians initiate the majority of discussions. The capacity of the nonphysician team members to contribute to establishing and sustaining an HVC culture may be underused. Multi-institutional studies are necessary to determine if this is a national trend and whether discussions have an impact on patient outcomes and hospital costs.