Accountable care units can help streamline communication and reduce length of stay

Learning objective

At the completion of this educational activity, the learner will be able to:

• Identify the potential advantages and challenges involved with establishing a hospitalist accountable care unit

Opening the lines of communication between clinicians and specialists to make care more efficient can be a sizable challenge.

At many facilities, hospitalists shuttle from floor to floor to see patients, each time trying to track down the nurse and other professionals working on each case. Information is typically transferred through an inefficient system of pages and phone calls?sometimes taking hours at a time to deliver crucial pieces of information.

Enter the accountable care unit?a new way of configuring care systems that can help to uncoil tangled communication wires between clinicians and support staff to provide care that is more efficient and streamlined.

In this model, hospitalists work with patients in a specified geographical area of the hospital in conjunction with interdisciplinary teams.

Having patients in one area helps make care more efficient, and as one hospital system in New Mexico learned, can also reduce length of stay and increase cost-efficiency.

A push toward regionalization

Regionalization of hospitalist patients is becoming more common today, because of the benefits it’s been shown to bring, says Stefani Daniels, RN, MSNA, ACM, CMAC, founder and managing partner of Phoenix Medical Management in Pompano Beach, Florida. Those benefits include:

• Improved teamwork, care coordination, and communication
• Fewer readmissions
• Improved resource management to lower cost of care
• Improvements in patient satisfaction
• Reduction in inefficiencies

"I’m pushing accountable care units at all my hospital clients," says Daniels. But while the will is there in many cases to make the change, it’s not always an easy conversion.

Sometimes these initiatives face pushback from physicians concerned about personnel or scheduling issues.

Other challenges include:

• The lack of diagnostic diversity that results from having set teams on a unit
• The challenge of deciding whether teams should be flexible or static
• Hammering out logistical issues, such as how patients should be triaged and how beds are managed

Despite the challenges these initiatives can face, Presbyterian Medical Group in Albuquerque, New Mexico successfully implemented a unit-based model with multidisciplinary rounds about six years ago, says David J. Yu, MD, MBA, FACP, SFHM, medical director of adult inpatient medicine service for Presbyterian Healthcare Services.

The initiative was prompted by a desire to improve inefficiencies and streamline care. "We basically needed to improve patient flow and communication," says Yu. "But we also realized it was a very large process because it involved almost every department, including case managers, physical therapy, nursing, and ancillary services."

To overcome that daunting multi-departmental challenge, officials enlisted the hospital’s Lean Six Sigma group to help coordinate the project.

Presbyterian sought to trade its outmoded care model for something more efficient; one that would improve communication and eliminate delays related to breakdowns in this area.

The changes began as a unit-based project with multidisciplinary whiteboard rounds, a daily meeting that included the hospitalist, nursing staff, care coordination, physical therapy, and other specialists. They discuss the treatment plan and the goals related to the patient care both for that day and the hospitalization for each patient, he says.

The success of that pilot program led officials to implement the same unit-based model in eight of the medical floors at the hospital.

The payoff for the organization has not only been a huge boost in the efficiency of communication, but reduced length of stay for patients. "We’ve seen significant improvements in the average length of stay. This is not because we’ve reduced therapeutic time, but because we’ve reduced inefficiencies," says Yu. Lag time created by communication gaps has been tightened up, allowing patients to move through the system more quickly and efficiently.

To ensure that these new efficiencies weren’t resulting in quality reductions, Yu says the organization also tracked readmissions, which remained steady, confirming that faster discharges weren’t compromising patient care.

Overcoming obstacles

Presbyterian has managed to overcome many hurdles that can make this model a challenge. Although these changes have been successful, they have not necessarily been quick.

"I think in many cases people are just interested in a quick fix," says Yu. This process has been anything but. More than half a decade in, Yu says the program is still a work in progress and the team is continually looking to make improvements.

The initiative took time because it addressed the underlying structure of the organization and didn’t just make surface changes that can’t be sustained.

"I like to use the analogy of painting a wall. The painting is the easiest part. What takes time is all the prep work getting the surface ready," he says.

Most organizations just want the paint on the wall?they aren’t willing to address work needed to fix the underlying structure. "This really is a foundational project that takes months and years to develop and mature," he says.

This project not only solved many communication problems at the organization, but it also helped to ready the facility for the new era in healthcare ahead?one where revenue is driven by quality, not volume.

Organizations that want to thrive in this new model will need to rethink antiquated processes and systems going forward, he says. Those that don’t may not survive in this model.

Steps to success

For an initiative like this one to be successful, it has to be well designed and have support?both in commitment and in terms of dollars?from upper management.

"A lack of resources is another reason why a lot of these projects fail," says Yu. "The hospital doesn’t want to fund it. If only one department is very excited about the project, it won’t work."

The model involves a major change that requires support from multiple disciplines. "Without the support of leadership it’s not going to succeed," he says.

You also have to give hospital staff members a reason to support it, which may be the biggest challenge.

"It has to successfully answer the question, ‘What’s in it for me?’ " says Yu.

If the changes are onerous and provide little benefit to the people they affect, there’s little incentive for anyone to support it.

"Understand your worker and your project," he says. And overcoming barriers may involve system and even contract changes, he says.

If you can get that support, you can make changes that will improve communication and consequently care at your organization?and help ready it for the changing healthcare landscape of the future.

HCPro.com – Case Management Monthly