In April of this year, St. Paul's Hospital began a new way to care for patients called Accountable Care in their 7th floor medicine unit. It has been five months since this new model of care was implemented and much has changed.
Accountable Care Unit at St. Paul's Hospital
Having physicians, nurses and interdisciplinary care providers (including occupational and physical therapists, pharmacists, dieticians, social workers, etc) located with their patients on one unit is one of the cornerstone components of an Accountable Care Unit (ACU). This differs significantly from traditional structures where health care providers could have patients on a number of units located throughout the hospital.
Melissa Babcock, 7th Medicine Nurse Manager and Dr. Anne Pausjenssen, general medicine internist
"Working on the Accountable Care Unit has reenergized me," says Dr. Anne Pausjenssen, an internist and physician lead for St. Paul's Hospital's 7th Medicine. "Because all my patients are in one unit, I can attend to issues and concerns as they come up, instead of being out of the loop until a nurse can track me down. I greatly value the interactions I have with all the members of the care team and really feel part of a productive and coordinated unit."
"Nurses were often spending a lot of time trying to locate doctors as the status of a patient changed throughout the day," says Melissa Babcock, nursing manager for 7th Medicine. "The ACU structure, which places physicians and other vital care team members within the unit itself, has greatly improved communication. The daily interaction has created a much deeper trust and understanding that is better for our staff and for our patients."
Another cornerstone is having joint physician and nursing leadership on the unit. This too is very different than what happens on traditional units where nursing managers lead alone.
"The ACU model means Anne and I work together when it comes to managing the unit," says Babcock. "Communication is better, there is trust on all sides, and collaboration and timely problem-solving means we are doing a better job of caring for patients and staff."
"Having an ACU has meant more structure to daily work on the unit," adds Dr. Pausjenssen. "That has meant the unit feels like a much calmer place. And those structures have allowed us to introduce a lot of quality improvement work, like daily patient safety checks, to reduce potential harm."
The patient safety checks include daily prevention of blood clots, blood sugar monitoring, and review of catheter and IV use, all of which prevent potential life-threatening situations or infections.
"It's very collaborative in how we approach improvement," says Babcock. "And I think that support and trust has really moved things forward."
Accountable Care Units have four key components that drive their success:
- Team approach including physicians, nurses, occupational and physical therapists, dietitians, pharmacists, social workers and Client Patient Access Services (CPAS), and others physically located together on the unit;
- Structured bedside rounds that involve all members of the care team, including the patient and family, and meet at the same time every day;
- Measuring patient outcomes at unit level rather than hospital or health system level; and
- Nurse and physician co-leadership (on traditional units, physicians are not included in unit management).
The accountable care model is part of a larger provincial Connected Care Strategy to improve emergency wait times and patient flow, and strength team based care in hospital and in the community.