COLLATING PROGRAMS OF
Clinical Change

Journal of Hospital Medicine ACU article

JHM ACU article

The first peer-reviewed journal article describing the Accountable Care Unit care model (ACU® care model) and Structured Interdisciplinary Bedside Rounds (SIBR® rounds).

Hospitals have not been optimized to support the functions of multi-disciplinary care teams. In fact, a significant limitation of modern hospitals is the ability to provide high-quality patient centered care. Frequently, this is often a consequence of consistently underachieving frontline care teams. For healthcare to reach its aspirational levels of care delivery, the delivery of care must change. A variety of factors undermine the delivery of high-quality healthcare:

  • Stakeholder groups functioning in silos,
  • Illusion of teams and teamwork, and
  • Reliance on chance interactions, pages, phones and clinical notes

In context

These factors are typically a consequence of a lack of geographic localization. Consider how many patients an average doctor treats each day. Then, for those patients, think about how many units they are probably situated on. Also, factor in the variety of staff working on each of those units. Now factor in time spent:

  • Traveling between each unit,
  • Finding the patient,
  • Finding and reading the medical chart,
  • Figuring out who the patient’s nurse is, and then
  • Finding that nurse.

Finally, think about establishing some kind of rapport with that bedside nurse to be ready to have a discussion with the patient about their plan of care and plan for discharge as a team. This is the foundation of 1Unit refers to as ‘reactive care’. The counterpoint being that of ‘proactive care’, realized through ACUs and SIBR rounds.

The Solution

Proactive hospitals units and teams, if designed to be high-functioning, would benefit from a normalized care model that snaps together frontline care providers into a team structure that can consistently develop and progress a team based plan of care and plan for discharge. The JHM ACU article describes such a concept (Accountable Care Units) and its deployment in an acute medical unit.

Especially relevant, the effects of this change are significant with reductions in in-hospital mortality and length of stay!

Follow on information

For a deeper understanding of the ACU care model and SIBR rounds we suggest you read this article and our description of both here: Accountable Care Unit care model.

Additional information about reactive versus proactive care can be found here.

Please use the citation below to source the JHM ACU article.

Citation
Stein, J., Payne, C., Methvin, A., Bonsall, J.M., Chadwick, L., Clark, D., Castle, B.W., Tong, D. & Dressler, D.D., 2015. Reorganizing a hospital ward as an accountable care unit. Journal of hospital medicine, 10, 36-40.

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