Accountable Care Unit: Better care, better patient outcomes
A new model of care being trialed in a Saskatoon hospital is injecting some adrenalin into an overtaxed health system. The Accountable Care Unit at St. Paul’s Hospital was launched in April. It’s only been a few months, but care providers there are already sensing positive changes.
“It’s a very different system than what we used to have,” says Dr. Anne Pausjenssen, who is the physician lead for the trial. “It’s far more efficient. I love this new model of care.”
Early indicators suggest there is a lot to love about the new system. Its main strength is the team approach. Accountable Care requires all care providers to participate in Structured Interdisciplinary Bedside Rounds (SIBR) at the patient’s bed. Physicians, nurses, pharmacists, dietitians, social workers, physical and occupational therapists and Client Patient Access Services (CPAS) all work together on the same unit to provide care centred around the patient.
The team meets with the patient and their family daily. “We are talking and listening to the patient every day about what their concerns are and what their goals are for their health care. As a team we hear what they feel they need that day and we can then make sure we are working towards getting there,” says Pausjenssen.
There is evidence that a trust relationship is being built between patients and care providers. Melissa Babcock is the nurse manager for the internal medicine unit on the seventh floor at St. Paul’s. Pausjenssen says one of the reasons their unit in the Saskatoon Health Region was chosen to try out the new care model is because of Babcock’s consistent record of careful attention to improving care.
Babcock has heard from some patients that they like the new care model. “One patient told me, ‘It actually makes me a better patient because I’m not worried about what’s happening next or what the plan is’.” Another patient who has been in and out of the hospital with a chronic illness said, “For the first time in 10 years I’m not having anxiety during this admission.” Understanding what the plan was impacted both her physical and mental health.
Babcock has also seen members of the care team coming out of bedside rounds with big smiles on their faces. “They’re saying, ‘I love this! I know what’s going on and I feel like I’m part of the team’.” Staff satisfaction surveys have seen an increase in satisfaction with the new model.
The model was first trialed by the Regina Qu’Appelle Health Region at the Pasqua Hospital. Pausjenssen says a recent meeting with members of that region suggests there may be potential personnel savings with higher nurse satisfaction, less turnover of nurses, less sick time and less overtime. A news release from the province reported reduced lengths of hospital stays and reduced rates of readmission.
A big difference is, physicians no longer dash from floor to floor looking for their patients, they stay in their designated unit all
day. In the past, Pausjenssen could have had patients on up to eight different units. “I would start my day not really knowing where my sickest patient was within the hospital and being anxious about whether I was getting to the sickest patient soon enough. But now all my patients are on one floor.”
The model also provides a built-in mechanism to address patient safety. “Every day we are reviewing a safety checklist,” says Pausjenssen. Risks associated with blood clots, blood sugar, potential for infection and ulcers are being tracked and Pausjenssen says there is potential to make huge gains in improving patient care.
Having a pharmacist on the team is also new. Being assigned to a single unit means there is more time for pharmacists to review patients’ medications during their stay and during discharge to ensure they are on track. That care will soon extend to weekends. Physical therapy will also soon be available seven days a week, both of which are big changes, Pausjenssen says.
Measuring patient outcomes at a unit level rather than a hospital or system level is motivating to care providers. “It’s like getting your own report card, and I want to get an A+,” says Pausjenssen. In fact, the new model has made her want to work in a hospital again. “It allows for a really standard day and it makes the unit feel more calm because there’s structure.”
Saskatchewan is the first province to test the Accountable Care model, but Pausjenssen says other provinces are considering it as well. She believes the move to a single health authority in Saskatchewan is finally breaking down barriers between different health units. “We’re actually able to celebrate and replicate what another district is doing well. In the past there used to be a sense of competition and now we’re sharing strategies for how to improve patient care within the province. I don’t think that would have happened without this move to a single health authority.”
Working together as a team has increased the level of trust and respect team members have for one another. “It works out better for the patient and for everyone. It’s better care,” says Pausjenssen.
“We’re really excited about it,” says Babcock. “There’s so many positive things with this model of care!”