Teaching rounds is a critical learning experience for most health care professionals, yet trainees perceive that high-value care principles are rarely role-modeled.1-3 In fact, students report that the overuse of medical tests at the bedside undermined the high-value care concepts that they were taught in more formal settings.2 The flipside of that is that when attending physicians do teach about high-value care practice in the clinical setting it is more strongly correlated with resident-reported high-value care behaviors compared to formal curricula.4
A team from Seattle Children’s Hospital have developed and tested a “High-Value Care Rounding Tool” to measure the content and frequency of high-value care discussions during rounds.5,6 This tool can serve as a valuable guide, as well as a source for feedback, to ingrain these discussions into rounds.
Offer anticipatory guidance to prevent a complication of a medical issue or unplanned readmission
Narrow Down the chronic and/or home medication list or discharge medication list
Praised a team member for not doing an unnecessary test and/or treatment
How a test may or may not “change,” “impact,” or “affect” management
Balance between the clinical benefits of care and its harms
Care alternatives, including less expensive test and/or treatment (cost) and/or observation
Avoid or cancel a low-value test (daily CBC; ESR and CRP),therapy or monitoring (pulse oximeter), or consult
Discussion about whether the patient requires ongoing hospitalization
Customize care plan to incorporate patient and/or family in the context of a specific medical decision (also could include “goals” and “values”)
Discussion about what “worries” or “concerns” the patient and/or family in the context of a specific medical decision (also could include “goals” and “values”)
CBC, complete blood cell count; CRP, C-creative protein; ESR, erythrocyte sedimentation rate.
Medical students and other trainees can introduce value into rounds using the “SOAP-V” model, which modifies the traditional SOAP (Subjective-Objective-Assessment-Plan) presentation to include a discussion of value (SOAP-V).7
The SOAP-V model prompts the student to consider:
This creates a cognitive forcing function to begin to incorporate concepts of value into daily patient care, as well as gives medical students a “managing up” role for introducing these discussions into rounds. However, remember that we must always primarily consider outcomes when making decisions about value. This SOAP-V tool has now been successfully used at multiple medical schools during internal medicine, pediatrics and other clinical rotations.
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The authors of this tool sought to bring a systematic measurement tool to the teaching of high value care at the bedside. Read more to learn about the effects of using this tool in practice.
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