A Low-Tech Solution to Providing High-Value Care at the Bedside

By Chris Moriates, MD

There is little doubt that over the next few years we will see a wave of increasingly sophisticated point-of-care tools to help clinicians determine the costs and relative value of their medical recommendations. I welcome that day, but I do not intend to idly sit by waiting for it.

Not all solutions need to be based on high-level algorithms or slick, user-friendly apps made for iPhones.

Last month I came across a perfect, low-tech solution that helped my medical team provide high quality, cost-effective care – in other words, “high-value care” – to a patient that was transferred the night prior to our academic medical center.

Buried in the stack of “outside hospital” records were the microbiology results. Every clinician is accustomed to reviewing these reports, which identify the “bug” that was cultured along with the sensitivities and resistances to different antibiotics. This is standard throughout medical systems. But, what was particularly novel about this report was it contained some additional simple information:Chris-300x178

Did you see it?

Next to each antibiotic sensitivity is a relative daily cost per dose for that antibiotic, captured by a simple $-$$$$$ code. Note that the bottom of this report has the legend for these dollar signs, ranging from $=$1-10/day to $$$$$ = >$150/day.

This type of minimal information has the power to change behaviors. As Neel Shah has previously pointed out on many occasions, this is something that Zagat Guide and Yelp had figured out years ago.

As a busy clinician standing in the hallway with my team, it is so easy to look at these results and immediately make an informed decision about which antibiotic will work and will cost the least.

No fancy app required.

Every laboratory should be able to implement this tomorrow. And this model could be expanded to other areas of clinical care as well. Every clinician should be able to make simple high-value care decisions between equally effective choices with this sort of ease.


Christopher Moriates, MD (Twitter: @ChrisMoriates) is an Assistant Clinical Professor at UCSF. He is the Co-Chair of the UCSF Division of Hospital Medicine High-Value Care Committee. He is a Series Editor for “Teachable Moments,” JAMA Internal Medicine.

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