Properly designed, hospital units have potential to optimize outcomes for patients, staff, and trainees. Such units would be of great value if they converge high highperforming teams with active management while promoting principles of safety, timeliness, effectiveness, efficiency, equitable care, and patientcenteredness.
We sought to redesign a medical ward to systematically integrate physician trainees into an Accountable Care Unit (ACU) model with a specific focus on team performance and training using Structured Interdisciplinary Bedside Rounds (SIBR) to promote communication, mutual accountability, and patientcentered care.
We transformed a medical unit into an ACU at a large university hospital. We define an ACU as a ward responsible for the clinical, service, and cost outcomes generated and highlight its four key features: (1) unitbased teams, (2) SIBR, (3) unitlevel performance data, and (4) nurseprovider management partners accountable for unit outcomes. Each month the ACU leadership sets expectations with attending staff, frontline nursing staff, and trainees. Expectations include using firstnames as a basis for communication, sharing accountability for verbalizing and advancing a daily plan of care for each patient, adhering to the SIBR script and qualitysafety checklist, maintaining an atmosphere of constructive feedback, and cross monitoring individual and team performance. We launched an ACU on September 1, 2011 at Emory University Hospital, a 579bed teaching hospital. The first ACU is a 24bed unit staffed by two unitbased physician teamseach composed of one hospital medicine attending, one resident, three interns, and two medical students. Each unitbased team has 85% of its daily patient census cohorted to the ACU. Team rounding (SIBR) occurs every day, starts punctually in the midmorning, and requires 3060 minutes per team. SIBR always includes the bedside nurse, the physician team, and the nurse manager; weekdays, a clinical pharmacist and social worker join (Figure). Unitlevel outcomes (mortality, infection rates, glycemic control, patient satisfaction, and lengthofstay) are reported to the physician and nurse management partners.
Redesigning hospital care using the structure, process, and management model of an ACU appears feasible in a teaching hospital and may represent a valuable way for hospital medicine programs to align patientcenteredness, quality, and leadership while simultaneously teaching housestaff to work in a highly efficient teambased care model. Improved outcomes will depend on process factors of the system change such as leadership skills of unit management and developing nursing and physician comanagement bestpractices.
Figure 1Structured interdisciplinary bedside rounds diagram.
To cite this abstract:Methvin A, Castle B, Payne C, Dressler D, Odetoyinbo D, Smith D, Stein J, Vazquez J, Burleson M. Accountable Care Unit on a Medical Ward in a Teaching Hospital: A New Care Model Designed to Improve Patient and Hospital Outcomes. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97734. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/accountable-care-unit-on-a-medical-ward-in-a-teaching-hospital-a-new-care-model-designed-to-improve-patient-and-hospital-outcomes/. Accessed May 26, 2019.