Reorganizing a hospital ward as an accountable care unit
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Overview
When Emory University Hospital reorganized a high-acuity 24-bed medical unit into an Accountable Care Unit, they significantly improved patient outcomes, reducing in-hospital mortality from 2.3% to 1.1% and shortening average length of stay from 5.0 to 4.5 days.
Objectives
To reorganize a traditional hospital ward into an Accountable Care Unit (ACU) to enhance clinical efficiency and effectiveness through improved teamwork and communication.
Methods
The ACU model was implemented using four key features: unit-based teams, structured interdisciplinary bedside rounds (SIBR), unit-level performance reporting, and nurse-physician co-leadership, evaluated over a four-year period at Emory University Hospital.
Results
Following the implementation of the ACU, the unit saw a significant reduction in in-hospital mortality from 2.3% to 1.1% and a decrease in average length of stay from 5.0 days to 4.5 days.
Subsequent analysis of the HCAHPS data for the ACU pilot unit showed increases in HCAHPS scores (reported directly to 1Unit after publication of the Journal of Hospital Medicine article):
Overall patient satisfaction score average increase of +2.9 percentage points
Overall use communication score average increase of +1.3 percentage points
Overall physician communication score average increase of +4.2 percentage points
Conclusion
The reorganization of the hospital ward into an ACU significantly improved patient outcomes and operational efficiency, demonstrating the value of structured team-based care models in high-acuity medical settings.
