Transforming health care as a team: Pasqua Hospital’s Accountable Care Unit

RQHR ACU

When care members are better connected with one another, patients receive the safest, highest quality care possible.  That’s the philosophy of Unit 4A at the Pasqua Hospital in Regina, where patients are reaping the benefits from a new care model, called the Accountable Care Unit.

Created by a Dr. Jason Stein at Emory University Hospital in Atlanta, the Accountable Care Unit, or ACU, incorporates a team-based approach to patient care, where daily visits are provided in patient’s rooms by physicians, nurses and other care staff.  The team, sometimes four or more people in size, travels from patient to patient to share information and updates about care plans, at the same time every day.  In every way, the rounding that occurs is patient and family-centred.  Patients are actively engaged in discussion and decisions around their care, and care providers are held accountable by patients, family members and each other for their part in ensuring care is delivered.

“Accountable care gets rid of the chaos and fosters teamwork with all people providing care and with a much improved relationship with the patient and their families. It’s so obvious to me that this is what we’re supposed to be doing.”  (Dr. Ron Taylor, project co-lead)

Though it’s a model of care that has been introduced in a few leading hospitals around the globe, the RQHR’s Accountable Care Unit is the first pilot project in Canada

The plan is to demonstrate a transformation in the way that care is delivered to the patients on 4A.  Miscommunications that can occur when care teams are not in the same place at the same time are significantly reduced, and patients are talked with instead of talked at.  In fact, it’s not unheard of to hear laughter at the bedside; a far cry from the traditional experience of a hospital stay.

Ray Tourigny, 78, experienced the difference first-hand when he was admitted to Unit 4A at the Pasqua after surgery in April.  While the overall experience on and off the unit was positive, he felt there was something different about 4A.

“When I got to the unit, I was depressed. The team of people on the unit really talked to me and turned my attitude around.  They got me on a better path so I was able to go home.”  (Ray Tourigny, patient)

His wife Carol agrees.  “We knew when to expect them each day and knew they would answer all of our questions.  They knew our names and really involved us in the process.  It really is a wonderful program.”

Establishing the Accountable Care Unit is a key project for the Regina Qu’Appelle Health Region this year; one that aligns to our Strategic Priority of enhancing the patient experience and improving quality and safety. It also has a positive impact on how patients flow through our system.  According to Dr. Taylor, in hospitals with established accountable care units, patient mortality rates have been seen to drop between 30 and 50 per cent and length of stay falls 10-15 per cent.  If we can achieve this same success in our Region, positive effects will be seen in all corners of the health system, including in our Emergency Departments, a key entry point for most of our in-hospital patients.  Decreasing the overall Emergency Department length of stay is a priority both for the RQHR, and our partners at the Ministry of Health.

In hospitals with established accountable care units, patient mortality rates have been seen to drop between 30 and 50 per cent and length of stay falls 10-15 per cent. 

Though the pilot project won’t officially kick off until January, the unit has already begun integrating elements of the Accountable Care model into their care approach, and the feedback to date has been overwhelmingly positive.  Patient complaints have been significantly reduced; instead replaced with patient letters indicating this is the right thing to do.  Staff satisfaction has also increased, and the unit is projecting less staff turnover and absenteeism in the future.

Achieving this type of transformational change is not as easy as it may seem.  Dedicated planning, funding, workshops, scheduling and especially relationship building on the unit are all necessary components to make this project a success.  But judging by the response from our patients and their families, so far it’s been worth it.

One recent piece of patient feedback says it all:  “This is the way healthcare should be.”

Photo: The Accountable Care Unit team that are part of this transformational change. Photo credit: medical media

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