Location, location, location: New unit-based care model gaining traction in hospitals
Dr. Harry helped implement an ACU at her institution about a year and a half ago and now serves as the medical director for that unit. So far, they have been able to reduce length of stay on the unit from an average of 5.3 days to 4 days and reduce costs by more than $800,000 since implementation.
"But more importantly," she said, "the ACU has been able to get physicians, nurses, pharmacists, case management, and therapy out of their individual silos and encourage collaboration."
"Having solo practitioners who care about their patients is not enough," Dr. Harry said. The model of care also needs to simplify the environment and increase communication among everyone who cares for patients to avoid errors and mitigate potential harm.
Dr. Harry also advises against taking the ACU model apart and applying just one piece. "It’s the combination of geographic units, interdisciplinary rounds, paired leadership, and data monitoring that will achieve results," she said.
Dr. Stein said he expects the model will continue to take hold. "There’s an understanding that we need a convergent solution," he said. "We need a solution that stops nibbling around the edges."
Care teams find new energy
Palmetto Health in Columbia, S.C., launched its first ACU in April, so it’s too soon to tell if they will see significant improvements in quality or cost. But the model has already brought "new life" to the physicians and nurses on the unit, said Carolyn Swinton, chief nursing officer at Palmetto Health Richland, a level I trauma academic medical center.
"There were team members on that unit who had been there for 20 years who we thought had lost their spark and their commitment, and they knocked it out of the park," Ms. Swinton said. "They were very engaged."
Palmetto Health wanted to try out the ACU concept as part of a broader push to improve the experience for patients and families. And they also saw it as a way to standardize the communication and care processes within the hospital, Ms. Swinton said.
So last fall, they traveled to Emory University to observe the ACU model in action and receive training about how to implement it. Earlier this year, they selected a unit where they already had strong physician engagement. The providers on the unit held a retreat where they developed a unit covenant and even practiced how they would talk to patients during the interdisciplinary bedside rounds.
Palmetto modified the Emory approach to the ACU slightly. In addition to having providers from pharmacy and social work, they added a nurse technician who could provide information about ambulation, toileting, and dietary intake.
The effect on morale within the unit was immediate.
"There was one nurse who was in tears," Ms. Swinton said. "She said it meant so much to her to have an opportunity to show her commitment and her skill and her passion for this work."
And Ms. Swinton said she also heard from the unit’s attending physician that the new process made her day easier, because everyone on the team knew the plan of care.
"The team is happy; you can feel it," she said. "On the unit, people are stepping up. They’re collaborating."
The next step is to begin rolling out the ACU concept unit by unit. They have identified a slate of units and plan to switch over one unit at a time every 120 days, Ms. Swinton said.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
