RightCare Rounds Toolkit

RightCare Rounds is an educational initiative that incorporates evidence-based discussion in the format of a case presentation to promote appropriate patient care. This program aims to help clinicians recognize and prevent overuse and underuse, while taking into consideration social contexts and patient preferences. This toolkit provides step-by-step instructions for how to implement RightCare Rounds in any institution.
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Overview

(a) The RightCare Rounds Program

RightCare Rounds is an educational initiative that uses the familiar format of a case presentation, incorporating evidence-based discussion to promote appropriate patient care. While conferences such as morning report or noon conference have traditionally focused on uncovering elusive diagnoses or uncommon findings, RightCare Rounds is structured to address the whole patient and the entire continuum of care.

The RightCare Rounds program aims to provide clinicians with the tools to recognize and prevent overuse and/or underuse while simultaneously uncovering local opportunities to provide the best possible care for patients. Particular emphasis is placed on social contexts, diagnosing patient preferences, and reviewing clinical evidence as a means to optimizing care and limiting harms from medical overuse and/or underuse. This program is meant to be flexible and can be tailored according to an individual institution’s needs.

RightCare Rounds promotes a new paradigm: Doing “as much as possible for the patient, and as little as possible to the patient.”

  • This framework recognizes that the goal of medicine is to heal and to provide the best possible care at the lowest possible burden to our patients
  • Clinicians and trainees discuss a case from their own experience, in which seeming overuse or underuse created a situation of actual or potential harm, then work collaboratively to discuss and debate an individualized course of the RightCare for the patient
  • Participants reflect on ways the patient could have been better served earlier in the process, and conceive of innovations in communication, work flow, staffing arrangements, programs, or policies that could be implemented to improve care delivery in the future

 

(b) Background

  • Traditional case conferences such as morning report or noon conference often focus on elusive or unexpected problems where insufficient testing or procedures led to delayed diagnosis or treatment
  • Conferences such as Morbidity and Mortality rounds typically focus on improving the quality of care delivered, often in the context of errors in diagnosis, treatment, or systems level factors, leading to harm
  • While such conferences remain valuable educational tools, RightCare Rounds provides an opportunity to reflect more deeply on patient preferences, social or cultural contexts, systems-level dysfunction that is too often “business as usual,” and the many drivers of overuse and underuse that may get in the way of appropriate medical care

 More on RightCare 101 can be found here: http://lowninstitute.org/learn/overuse-101/

 

(c) Intended Audience

Toolkit Audience

This toolkit is geared toward health care professionals interested in implementing a case-based educational conference aimed at avoiding unnecessary care and promoting the RightCare for patients. It was written specifically for Chief Residents participating in the RightCare Rounds program and preparing to lead RightCare Rounds in their institutions.

RightCare Program Audience

RightCare Rounds is appropriate for clinicians and trainees within any of the allied health professions. It is well suited to occur within existing educational time slots, for example, morning report, ward teaching rounds, noon conferences, pre-clinic conference, or departmental grand rounds. Inpatient or ambulatory settings are equally suited for this conference.

 

(d) Why Is RightCare Rounds Important?

  • Avoiding unnecessary care and promoting a culture of RightCare reduces harm and reinforces the concept of “best care at the lowest burden”
  • The Institute of Medicine (IOM) recently estimated the annual excess cost from systemic waste in the US to be $765 billion
    • $210 billion in unnecessary services
    • $55 billion in missed opportunities for disease prevention
  • Both physicians’ and patients’ understanding of the effects of intervention is distorted by information asymmetry, preference misalignment, and a deep cultural belief that more health care is better
  • There is evidence to suggest that in many countries, health care usage correlates less with the needs of the population being served than the supply of health care resources
  • Social determinants are estimated to exert a more powerful influence on health than anything else (including health care)
  • Both the 2012 National Healthcare Disparities Report and the 2012 National Healthcare Quality Report found that almost none of the disparities in access to care are improving
  • Disparities in health care access and quality can result in unnecessary direct and indirect costs; eliminating health disparities for minorities would have reduced direct medical care expenditures by $229.4 billion and reduced indirect costs associated with illness and premature death by approximately $1 trillion during 2003–2006