Accountable Care Unit® care model
1Unit’s flagship program, the Accountable Care Unit (ACU®) care model, featuring Structured Interdisciplinary Bedside Rounds (SIBR® rounds). ACUs and SIBR rounds have been adopted and implemented at hospitals on 3 continents, 5 countries, 20 US states and 2 Canadian provinces.
Accountable Care Units are defined as geographic care areas consistently responsible for the clinical, cost, and satisfaction outcomes they produce.
ACUs have four complementary design features:
- Unit-based physician teams
- Structured Interdisciplinary Bedside Rounds (SIBR® rounds)
- Unit-level performance reporting
- Unit-level physician and nurse co-leadership
Organizing care teams by units creates predictability, cohesiveness, and better communication. At its core, the ACU is about bringing people together; to work together, to collaborate together, to care together. When you work together and look out for each other, it’s much easier to provide incredible care to patients, work doesn’t seem so hard and you’re reminded why you chose your career in the first place.
The ACU care model has grown to include the widest range of inpatient units, from medical, pediatric, geriatric, and cardiology units to intensive care, progressive care, long-term acute care, as well as general surgery, neurosurgery and orthopedic surgery units. The core principles remain, but careful expert customization for local needs ensures success.
The future of care is here.
ACU Briefing Video
What can the ACU Care Model do for your discipline?
Patient benefits reported:
- Loving SIBR rounds
- Happier patients
- Better engaged patients
- Opportunities to participate in decision making
- Getting questions answered
- Goal for the day discussed everyday
- Better informed, less uncertainty
- Increased family attendance at team rounds through set start time
- Plan for discharge from first team meeting
Nurse benefits reported:
- Knowing when the doctor will come to see the patients – no more guessing, no more uncertainty
- Better integration of nursing shifts
- Structured information passed between shifts – keep your ‘brain’ sheet but get the key information your colleagues might ask you about – learn more
- Plan of care shared between all team members for each patient during SIBR rounds
- Better access to doctors
Doctor benefits reported:
- Better communication with nurses and allied health
- Quicker resolution of issues
- Fewer pages
- Less hectic shifts
- Greater sense of control
Allied Health benefits reported:
- Better integration into planning
- Better communication with physician and nurse colleagues
- Quicker identification of barriers to discharge
- Better able to support continuing care needs
- Higher work satisfaction
Unit Leader benefits reported:
- More control on day-to-day processes & operations
- Happier unit staff
- Happier patients and families: less complaints
- Improved clinical, cost, and patient outcomes
- Decreased turnover
- More time for interpersonal relationships rather than administrative duties, e.g. recruiting and orienting new staff
- Quieter units
Hospital executive benefits reported:
- Happier staff
- Happier patients
- Better insight into unit processes
- Improved insight into staff competencies
- Better integration of stakeholder groups
- Improved sense of ‘team’ and ‘teamwork’ on units
- Clinical cost savings
- Reduced turnover
Length of Stay reductions per unit
- Pre (days)
- Post (days)
- Pre (days)
- Post (days)
Cost reductions per unit in 1 year
Structured Interdisciplinary Bedside Rounds
A major constraint in hospitals is the persistence of underperforming frontline clinical care teams. Hospital physicians and nurses have never been trained to coordinate efficiently and effectively with the patient and each other at the bedside.
It’s time for a change!
With 1Unit’s SIBR rounds, care teams come together working collaboratively with patients at the bedside, sharing critical-thinking based on new data points, cross-checking information accuracy, proactively identifying deviations from the expected course and making adjustments in real-time through a developed, shared and cohesive plan designed to best meet the patient’s needs.
With 1Unit’s services, hospitals can offer the practice-based training and real-time feedback that physicians, nurses, allied health and leaders need to ensure staff become experts and remain experts in SIBR rounds.
Through tens of thousands of observations in hospital units all over the world, we identified the specific behaviors essential for physicians and nurses to master high-performance SIBR rounds.
We originally created SIBR rounds for ourselves so we could be much more proactive for our patients. When we realized most hospitals have the same need, we created a solution for them, too. While many hospitals have learned that the secret to proactive care is successful interdisciplinary bedside rounds, most home-grown efforts are costly, typically overlook critical details, and are prone to fail. With the experience of more than 100 implementations in a variety of clinical settings, we know exactly what hospitals need for successful interdiscipline teamwork.
Make proactive care routine, make proactive care the new normal.
Outcomes of the ACU Care Model
1 = The Impact of Accountable Care Units on Patient Outcomes. manuscript in preparation.
2 = Portability and Success of a Clinical Microsystem Model in Improving Safety, Quality, and Cost at a Community Teaching Hospital. Oral presentation, Society of Hospital Medicine Annual Meeting, 2015, Washington DC
3 = Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of Multidisciplinary Healthcare 2017:8 33–37.