Results from Canada’s First Accountable Care Unit

RESULTS FROM CANADA’S FIRST ACCOUNTABLE CARE UNIT

A focused look at a recent submission to the Canadian Society of Hospital Medicine’s annual conference 2017. The submission is made available here with approval from the study authors (details below) and it highlights the outcomes of Canada’s first Accountable Care Unit.

Authors

Ron Taylor MD FCFP CCFP(EM )[1],

Scott Bishop MSc [1],

Sherilyn Bray RN BSN MHA [1],

Roseann Nasser RD MSc FDC [1],

Taryn Lorencz RN MN [1],

John Ash MAL MCML [1],

Lori Garchinski RN BSN MHS [1],

David McCutcheon MD MBA CHE FRCPI MICGP [1] ,

Heather Keller RD PhD FDC [2]
1 – Pasqua Hospital, Regina Qu’Appelle Health Region (RQHR), Regina, Canada ; 2 – University of Waterloo, Waterloo, Canada

Background

Accountable Care Units (ACUs) are hospital units which seem well suited for the specialty of hospital medicine. ACUs are hospital units organized to
combine:

  1. Unit-based physician teams
  2. Structured Interdisciplinary Bedside Rounds (SIBR)
  3. Unit-based performance reports and
  4. Unit-level nurse-physician leadership dyads.

While high-quality evidence is still lacking, ACUs have been associated with reductions in in-hospital mortality, complications of care, costs, and length-of-stay. ACUs have also seen improvements in teamwork and staff satisfaction [1,2,3].

We sought to determine the feasibility of implementing an ACU in a Canadian hospital and the effect this would have on outcomes of length-of-stay, 30-day readmissions, mortality, code blues’, patient satisfaction, patient advocate complaints, staff satisfaction, and nursing overtime costs.

Process measures included tracking number of patients receiving SIBR, elapsed time for SIBR, and discussion of target date of discharge at SIBR.

Clinical performance metrics were used to gauge the effectiveness of unit based reports as feedback to influence future performance. Clinical performance outcomes included documentation of: rationale for absence of VTE prophylaxis (VTE-P), rationale for urinary catheters, nutritional screening on admission, and nutritional intake during hospital stay. We also tracked rates of pneumococcal vaccination for eligible patients and actual patient weights.

Methods

We reorganized Ward 4A, a 35-bed medicine/family medicine unit in the Pasqua Hospital. Pasqua Hospital is a 252-bed community hospital in Regina, Saskatchewan and is a part of the Regina Qu’Appelle Health Region (RQHR).

Project management and staff training began in 2015. Full day ACU training sessions were conducted for the staff of 4A by 1Unit, a physician-led company which helps hospitals implement ACUs.

The 4A ACU launched with all four ACU features on February 24, 2016. We compared 6-month data from the 4A ACU with a control unit. Where baseline data was available, we also compared the unit to itself pre- and post-ACU implementation.

Data sources included the Health Information Management Services, the Patient Advocate Office, a Team STEPPS 2.0 survey, and nursing documentation. Data was stored in an offline database.

Notably, during the time of our implementation and evaluation, the More2Eat (M2E) Study ran concurrently on 4A, one of 5 such sites across Canada. The M2E Study used metrics that focused on: 1) frequency of malnutrition screening on admission; and 2) frequency of patient weight documented in the chart.

The M2E variables were tracked for near-real-time feedback in an offline database, but the reported outcomes were sent from a secondary M2E database.

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