TABLE 1

The HVC Rounding Tool and Frequency of Individual HVC Topics by Domain

HVC Discussions Observed Among 660 Patient Encounters, nObservation Percent (95% CI)
Quality topics discussed during rounds
 Offer anticipatory guidance to prevent a complication of a medical issue or unplanned readmission132 (1–3)
 Narrow down the chronic and/or home medication list or discharge medication list152 (1–4)
 Praised a team member for not doing an unnecessary test and/or treatment71 (1–2)
 How a test may or may not “change,” “impact,” or “affect” management112 (1–3)
 Balance between the clinical benefits of care and its harms345 (4–7)
Cost topics discussed during rounds
 Care alternatives, including less expensive test and/or treatment (cost) and/or observation173 (2–4)
 Avoid or cancel a low-value test (daily CBC; ESR and CRP), therapy or monitoring (pulse oximeter), or consult508 (6–10)
 Discussion about whether the patient requires ongoing hospitalization233 (2–5)
Patient-values topics discussed during rounds
 Customize care plan to incorporate patient and/or family values and/or goals447 (5–9)
 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”)305 (3–6)
  • CBC, complete blood cell count; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate.