Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and Quality Outcomes at Northwest Hospital
Our Journey to Shared Accountability Implementation process and outcomes of the ACU model Move to culture of Shared Accountability and Outcomes Lessons Learned Next Steps
Our Journey to Shared Accountability Implementation process and outcomes of the ACU model Move to culture of Shared Accountability and Outcomes Lessons Learned Next Steps
Quest to be the Best Northwest Hospital will rank among the state s BEST in Quality and Patient Satisfaction.
2001 Institute of Medicine report: High Quality Healthcare in US Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care.
Healthcare Silos Pharmacy Inpatient Care Skilled Nursing Facilities Emergency Department Outpatient Services Office Based Provider
Hospital Care Silos Nursing Attending Provider Resource Teams Consultant Services Case Management Ancillary Service Teams
Asynchronous Care RN with Patient at 8AM 9 10 11 12 1 2 3 8 7 6 5 4
Asynchronous Care Provider with Patient at 12pm 9 10 11 12 1 2 3 8 7 6 5 4
Asynchronous Care Care Manager/SW with Patient at 2pm 9 10 11 12 1 2 3 8 4 7 6 5
Team Based Patient Care Nursing Attending Provider Case Management Ancillary Support Team Consultant Services Resource Team
Accountable Care Unit Model
Accountable Care Unit Model Unit level Provider and Nursing Co-leadership Unit based teams Unit level performance reporting Interdisciplinary bedside rounds
ACU Pilot Unit at Northwest Insert Picture of team here
Number of Days Benefits of ACU Pilot: Improved Communication 5.0 5.0 Length of Stay (LOS) 4.0 4.09 3.0 3.46 2.0 Start of Rounds 1.0 Avg 2015 March 2015 April 2015
Benefits of ACU Pilot: Improved Accountability 90 80 70 60 50 40 30 20 10 0 4D Indwelling Catheter Days 2014-2015 76 84 80 82 74 77 43 48 47 Start of Rounds Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Foley Days Linear (Foley Days)
Benefit of ACU Pilot: Improved Patient Experience 4D Scores 80.0% 70.0% 60.0% 50.0% 50.0% 46.2% 50.0% 75.0% 61.5% 71.4% 75.0% 40.0% 30.0% 20.0% 25.0% 30.0% 10.0% 0.0% 0.0% Start of Rounds Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 4D Scores Linear (4D Scores)
Score Benefits of ACU Pilot: Improved Team Satisfaction 5.0 Internal Stakeholder survey pre and post ACU model initiation 4.0 4.42 4.58 4.56 4.56 Goal 4.5 3.0 3.64 3.87 3.79 3.75 2.0 1.0 Quality PI reps Care Management Providers
Score Unexpected Benefit of ACU Pilot 5.0 4.0 3.0 3.47 Goal 4.5 4.58 3.87 3.79 4.56 4.56 Question: 3.75 I have appropriate 2.0 2.54 staffing to provide the best quality care to my patients. 1.0 Perception of Staffing Resources
ACU Co-Leadership Teams ED Med/ Surg OBS PCU Med/ Surg ICU/ IMC Med/ Surg
Structured Interdisciplinary Bedside Rounds
Our Journey to Shared Accountability Implementation process and outcomes of the ACU model Move to culture of Shared Accountability and Outcomes Lessons Learned Next Steps
Patient Safety and Quality Checklist
ACU Team Members Provider Partner Nurse Manager Nursing team Zoned Hospitalist Quality, Infection Prevention, Care Management Educators
Unit Resource Team Quality Infection Prevention Educators/CNS
ACU Co-Leadership Team Meetings Handoff Communication Telemetry Protocol Family Communication CLABSI C diff Challenging Patient/Families Falls CAUTI
ACU Co-Leadership Team Meetings Med /Surg ED Med/ Surg OBS IMC/ ICU PCU Med/ Surg
Benefits of Shared Accountability: Improved Hospital Acquired Infection Rates
Benefits of Shared Accountability: Decrease in Patient Falls
Benefits of Shared Accountability: Increased Event Reporting
System Based Patient Care Nursing Attending Provider Case Management Ancillary Support Team Consultant Services Resource Team
Shared Accountability Approach: MHAC
Shared Accountability: Readmissions and Mortality MHAC Readmissions Mortality Others
Our Journey to Shared Accountability Implementation process and outcomes of the ACU model Move to culture of Shared Accountability and Outcomes Lessons Learned Next Steps
Critical to Success: Time Investment ACU Timeline Nov 2014 March 2017
Critical to Success: Leadership Support Med/ Surg ED Med/ Surg OBS IMC/ ICU PCU Med/ Surg
Critical to Success: Development Med /Surg ED Med /Surg ICU Med /Surg OBS PCU
What we would have done differently had we known. Communication plan around ACU and Shared Accountability Visibility of ACU Co-Leadership in cross departmental settings Implement Ground Rules of Rounds earlier in ACU development Better incorporation of night teams into ACU structure Build the ACU framework into onboarding of all new team-members
Our Journey to Shared Accountability Implementation process and outcomes of the ACU model Move to culture of Shared Accountability and Outcomes Lessons Learned Next Steps
The Journey Continues Private Attendings and Consultants into Model Challenging Conversations with Patients and families
We are the Accountable Care Units of Northwest Hospital
We are the Accountable Care Units of Northwest Hospital
We are the Accountable Care Units of Northwest Hospital