A care model in which physicians and nurses do bedside rounds as a team can reduce average length of stay (LOS) and in-hospital mortality, according to a recent Harvard Business Review blog post written by a group healthcare providers from Emory Healthcare in Atlanta.
In September 2010, members of a quality-improvement program at Emory University Hospital in Atlanta reorganized a 24-bed medical unit where six hospital medicine teams had seen patients into an Accountable Care Unit (ACU). They designed the ACU to have four key features: unit-based physician teams; structured interdisciplinary bedside rounds [PDF]
Physicians were assigned to units so more than 90% of their patients could be located on the same floor, which allows scheduling of a permanent daily start time for bedside rounds. This consistent schedule allows the entire health care team to round together. It also makes it easier for family members to know when rounds are happening so they can ask questions and learn about the care plan.
“Rather than having six different hospital medicine teams rounding on eight different units every day, we thought it would make more sense to have those teams round on a single unit each day where all their patients were cohorted together,” says hospitalist Jason Stein, MD, SFHM, and lead author of the HBR blog post. Dr. Stein is director for quality in the division of hospital medicine at the Emory University School of Medicine and an innovation advisor to the Center for Medicare and Medicaid Innovation, a unit within the Centers for Medicare and Medicaid Services.
According to the blog post, in the first year that the ACU model was implemented, the average LOS for hospitalized patients decreased from 5 days to 4.5 days and in-hospital mortality declined from 2.3 deaths per 100 encounters to 1.1 deaths per 100 encounters. The ACU model was recognized as the top innovation the 2012 SHM Annual Meeting.
Dr. Stein and fellow blog authors noted two challenges in the ACU model—namely, that creating unit teams required assigning attending physicians to a home unit, and that the structure led physicians and staff to follow a patient- and family-based approach to care-planning activities. Dr. Stein says the group behind the creation of the ACU model is in the process of submitting its data for publication.