Case Study

A Summary: Reorganizing a Hospital Ward as an Accountable Care Unit

Introduction

In response to the Institute of Medicine’s call for a redesign of the U.S. healthcare system, Emory University Hospital initiated a transformative project to reorganize one of its traditional hospital wards into an Accountable Care Unit (ACU). This innovative approach aimed to address the chasm between the quality of care provided and the superior healthcare standards deserved by patients. The initiative focused on establishing an effective clinical microsystem with enhanced unit-based teamwork, structured interdisciplinary bedside rounds (SIBR), performance reporting, and collaborative leadership between nurses and physicians.

The Challenge

Before the transformation, the hospital ward operated with fragmented care models that hindered effective team communication and coordination. Physicians and nurses worked in silos, creating inefficiencies and potential safety issues. The ward’s traditional structure resulted in nonspecific care plans and missed opportunities for timely intervention. To overcome these challenges, the ACU aimed to synchronize frontline professionals into cohesive unit-based teams that could routinely collaborate and progress shared care plans.

A Collaborative Solution

The ACU was meticulously designed with four key features:

  • – Unit-Based Teams: Teams of physicians were assigned specifically to the ACU to ensure close geographic and functional alignment with nursing staff. This setup facilitated mutual respect, cohesiveness, and efficient face-to-face problem-solving.
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  • – Structured Interdisciplinary Bedside Rounds (SIBR): SIBR was implemented to foster daily comprehensive communication at the patient’s bedside, involving nurses, physicians, and allied health professionals. This approach ensured that all care team members could exchange information effectively and articulate clear daily care plans.
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  • – Unit-Level Performance Reporting: To manage outcomes effectively, performance metrics such as mortality rates, infection rates, patient satisfaction, and length of stay were reported at the unit level. This allowed the team to directly see the impact of their work and foster continuous improvement.
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  • – Unit-Level Nurse and Physician Co-leadership: Leadership was structured to include both a nurse unit manager and a physician medical director, emphasizing a patient-centered approach and accountability for care outcomes.

Transformative Outcomes

The implementation of the ACU led to significant improvements in care delivery and team dynamics:

  • – Enhanced Team Collaboration: With unit-based teams and SIBR, the ACU facilitated better communication and collaboration among staff, which were essential for improving patient care and safety.
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  • – Improved Efficiency and Satisfaction: The structured rounds and clear communication protocols reduced misunderstandings and errors, leading to higher patient and staff satisfaction.
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  • – Positive Clinical Outcomes: The ACU experienced reductions in in-hospital mortality and length of stay, demonstrating the effectiveness of the new care model in delivering high-quality healthcare.


Conclusion

The reorganization of the hospital ward into an Accountable Care Unit at Emory University Hospital represents a pioneering model in healthcare delivery. By integrating structured communication practices, dedicated team alignment, and strong leadership, the ACU has set a benchmark for transforming traditional hospital wards into effective clinical microsystems. This case study exemplifies how deliberate design and committed leadership can significantly enhance the quality and efficiency of hospital care, fulfilling the promise of improved health outcomes and patient satisfaction.