The traditional model of hospital care is in need of an overhaul. Patients are scattered throughout hospitals, and are cared for by a multitude of different providers who don’t always work as teams. On one 32-bed unit in Regina Qu’Appelle, for example, there are 15 to 20 physicians seeing patients at any one time. Care on such fragmented wards is not consistent, nor does it support true engagement of patients and their families.
In January, Regina Qu’Appelle launched what it believes – and evidence from elsewhere shows – is the solution to many of these problems. Their new Accountable Care Unit, on Pasqua Hospital’s Unit 4A, comprises 35 family medicine beds covered by two hospitalists who have no other patients they are responsible for. Providers do structured interdisciplinary bedside rounding that involves the patient/family, and measure and report on their unit’s performance. Under the ACU model, care team members are accountable to each other to ensure patients receive the safest, highest quality care possible. The unit is co-led by a nurse and a physician.
The ACU model, which was developed Dr. Jason Stein at Emory University Hospital in Atlanta, is now being used successfully in Australia (New South Wales) and the US. It has been shown to increase patient satisfaction, decrease mortality, and shorten lengths of stay. Accountable Care Units have more staff and patient satisfaction, and increased staff engagement. ACU teams are better prepared and more proactive, deliver more reliable care, and save money — largely through more appropriate use of services such as blood work and x-rays, and staffing. Dr. Stein is supporting the pilot in Regina Qu’Appelle.
The pilot is a key strategy for Regina Qu’Appelle this year that aligns with its goals to improve quality and safety, enhance patient flow, and contribute to sustainability. It is being funded by the Ministry of Health and the region.
Dr. Kish Lyster, who helped develop the ACU at Pasqua Hospital in Regina, says their early results are very promising. “We can deliver care in a way that works for patients, providers, and the system. I believe the ACU model will demonstrate that”
“It makes sense to take a look at the patient and design a system around them.” (Dr. Kish Lyster)
Providers working on the new unit are convinced this is a better way to care for patients. A physician observed: “At the risk of sounding like someone who is drinking the Kool-Aid, having reached the stage we are at now, and seen the changes and opportunities that exist in organizing care this way…if this does not become standard operating procedure, I will have to look for another job because I cannot imagine working somewhere that doesn’t support the value this is creating.”
“…if this does not become standard operating procedure, I will have to look for another job because I cannot imagine working somewhere that doesn’t support the value this is creating.” (Physician working on the ACU)
A nurse working on the ACU had this say: “I don’t know how it’s 2016 and we haven’t done this yet. It just makes sense. It makes sense for patient safety, and for patient advocacy. Just to have the physician there and support me as nurse, and know that he or she has my back and I can communicate face-to-face with that physician. That’s very important to patient safety.”
The final word goes to a patient who has received care in the unit: “This is the way health care should be.”