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

Area of Science:

• Health Services Research
• Medical Education
• Healthcare Management

Background:

• Establishing a high-value care (HVC) culture is crucial for institutional improvement.
• Bedside rounds are identified as a key setting for promoting HVC behaviors.
• Understanding the dynamics of HVC discussions at the bedside is limited.

Purpose of the Study:

• To investigate the frequency and nature of high-value care discussions during bedside rounds.
• To identify who participates in and initiates these HVC discussions.

Main Methods:

• A prospective observational study was conducted at a tertiary children's hospital.
• The HVC Rounding Tool was used to capture the prevalence of HVC discussions.
• Raters recorded discussion initiators and topics for observed patient encounters.

Main Results:

• HVC discussions occurred in 29% of 660 observed patient encounters.
• Attending physicians/fellows initiated 41% of discussions, followed by residents/students (31%), families (12%), and nurses (7%).

Conclusions:

• Bedside HVC discussions are infrequent, with attending physicians dominating initiation.
• The potential contributions of non-physician team members to HVC culture may be underutilized.
• Further multi-institutional studies are needed to assess national trends and impact on outcomes.