Portability and Success of a Clinical Microsystem Model in Improving Safety, Quality, and Cost at a Community Teaching Hospital

Jonathan Manheim, Elizabeth Harry and Kasia Mastalerz

Overview

In a study conducted at Presbyterian St. Luke’s Medical Center in Denver, CO, the implementation of an Accountable Care Unit (ACU) led to significant improvements in patient outcomes, safety, and cost savings.

$ 0 million
in direct cost savings over 21 months

Objectives

To assess the impact of implementing an Accountable Care Unit (ACU) on mortality, 30-day readmissions, length of stay (LOS), and cost per case in a community teaching hospital.

Methods

The study was conducted over 21 months on a 27-bed medical telemetry teaching unit. Data were collected 12 months pre- and 21 months post-ACU implementation. The control group consisted of matched cases from other hospitalist groups within the same hospital system. Outcomes measured included mortality, 30-day readmissions, LOS, and cost per case.

Results

Mortality:

• Decreased from 1.84% to 1.39% post-ACU implementation: a 24.5% reduction

• Control group saw an increase from 1.90% to 2.51%: a 32.1% increase

30-Day Readmissions:

• Decreased from 17.58% to 13.24% post-ACU implementation: a 247% reduction.

• Control group saw a decrease from 15.05% to 14.30%: a 5% reduction.

Length of Stay (LOS):

• Decreased from 4.49 days to 4.07 days post-ACU implementation: a 9.4% reduction.

• Control group saw an increase from 4.75 days to 4.79 days: a 0.8% increase.

Cost per Case:

• Decreased from $9,867 to $8,321 post-ACU implementation: a $1,546 reduction per case

• Resulting in cost savings of $2.4 million over 21 months.

Process Measures:

Foley Days: Reduced significantly post-ACU implementation: a 31.9% reduction.

Central Line Days: Reduced significantly post-ACU implementation: a 18.9% reduction.

Conclusion

The implementation of the Accountable Care Unit (ACU) at Presbyterian St. Luke’s Medical Center resulted in sustained, clinically significant improvements in mortality, 30-day readmissions, length of stay, and cost per case. These results highlight the effectiveness and portability of the ACU model in improving patient outcomes and operational efficiency. Future directions include expanding the ACU model to other hospital units and continuing to monitor data for sustained improvement.

Additional Data

The lead author of the results above shared his results with us in-person to clarify details of the control group. 

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