Revolutionizing Patient-Centered Care: How Accountable Care Units and SIBR Rounds Are Transforming Hospitals

Introduction

In an era where patient satisfaction scores can significantly impact hospital reimbursements, the quest for truly patient-centered care has never been more critical. A recent study by the Beryl Institute found that 95% of patients consider the quality of their healthcare experience very important (Wolf, 2024). Enter Accountable Care Units (ACUs) and Structured Interdisciplinary Bedside Rounds (SIBR) – two innovative approaches that reshape how hospitals deliver patient-centered care. This blog post explores how ACUs and SIBR are revolutionizing hospital care, placing patients at the heart of every decision and interaction and are saving hospitals money at the same time.

Understanding Patient-Centered Care

Patient-centered care is an approach that prioritizes the patient's preferences, needs, and values in all clinical decisions. It emphasizes treating patients as partners in their care, rather than passive recipients. The Institute of Medicine and Committee on Quality of Health Care in America (2001) identifies patient-centered care as one of the six key elements of high-quality care. However, implementing this approach can be challenging in complex hospital environments with diverse teams and time constraints. ACUs and SIBR offer practical solutions to these challenges, enabling hospitals to deliver truly patient-centered care.

Accountable Care Units: A Foundation for Patient-Centered Care

Accountable Care Units (ACUs) are clinical microsystems designed to enhance teamwork, ownership, and accountability among healthcare providers. Key features of ACUs include geographically defined patient care areas, unit-based teams, nurse-physician co-leadership models, and unit-level data.

ACUs promote patient-centered care in several ways:

1. Improved communication: By creating cohesive, unit-based teams, ACUs facilitate better communication among healthcare providers, reducing errors and ensuring that patient needs are consistently addressed.

2. Enhanced care coordination: The geographical organization of ACUs allows for more efficient care coordination, ensuring that all aspects of a patient's care are seamlessly integrated.

3. Increased accountability: The co-leadership model and unit-level performance reporting foster a culture of accountability, where every team member is invested in patient outcomes.

For example, Emory University Hospital implemented ACUs and saw a 0.5-day reduction in average length of stay and a 10% increase in patient satisfaction scores within the first year (Stein et al., 2015).

SIBR Rounds: Putting Patients at the Center of Care Discussions

SIBR rounds are daily, systematic rounds conducted at the patient's bedside, involving the entire care team, including the patient and family members. SIBR typically follows a structured format and lasts 4-7 minutes per patient.

SIBR contributes to patient-centered care by:

1. Direct patient and family involvement: By conducting rounds at the bedside, patients and families become active participants in care discussions, able to ask questions and provide input in real-time.

2. Comprehensive care planning: The interdisciplinary nature of SIBR ensures that all aspects of patient care are addressed, from medical issues to psychosocial needs.

3. Improved patient education and engagement: Regular, structured interactions with the care team enhance patients' understanding of their condition and treatment plan, leading to better engagement and adherence.

A study published in the Journal of Hospital Medicine found that implementing SIBR led to a 10% reduction in the length of stay and a 10% increase in top-box rated patient satisfaction scores (Lopez et al., 2019).

The Synergy of ACUs and SIBR in Advancing Patient-Centered Care

When implemented together, ACUs and SIBR create a powerful synergy that amplifies their individual benefits. The stable team structure of ACUs provides the perfect foundation for effective SIBR, while SIBR reinforces the collaborative and patient-focused culture of ACUs.

This combination results in:

1. More efficient and effective care delivery

2. Higher levels of patient and family engagement

3. Improved communication and collaboration among healthcare providers

4. Better continuity of care

5. Enhanced patient safety and quality outcomes

Stein et al. (2015) in the Journal of Hospital Medicine found that hospitals implementing both ACUs and SIBR saw significant improvements in patient satisfaction, nurse-physician teamwork, and various quality metrics. These findings were further supported by additional research by Lopez et al. (2019), Schwartz et al. (2021), Loertscher et al. (2021), Gausvik et al. (2015), Cao et al. (2018), Basic et al. (2021).

Implementing ACUs and SIBR: Considerations for Hospital Leaders

For hospital leaders considering implementing ACUs and SIBR, key steps include:

1. Securing buy-in from all levels of the organization

2. Providing comprehensive training for staff

3. Adapting the models to fit your hospital's specific needs and culture

4. Establishing clear metrics for measuring success

Common challenges include resistance to change and initial time investments. These can be overcome through effective change management strategies and by emphasizing long-term benefits.

Resources like www.1unit.com offer valuable guidance, training programs, and implementation support for hospitals embarking on this journey.

Conclusion

Accountable Care Units and Structured Interdisciplinary Bedside Rounds represent a significant leap forward in delivering patient-centered care. By fostering teamwork, enhancing communication, and actively involving patients in their care, these approaches address many of the challenges hospitals face in putting patients first. As healthcare continues to evolve, hospital leaders who embrace these innovative models will be well-positioned to improve patient outcomes, increase satisfaction, and thrive in an increasingly competitive healthcare landscape. The time to act is now – your patients, staff, and hospital stand to benefit immensely from this patient-centered revolution.

References

Basic, D., Huynh, E. T., Gonzales, R. & Shanley, C. G. 2021. Twice-Weekly Structured Interdisciplinary Bedside Rounds and Falls among Older Adult Inpatients. Journal of the American Geriatrics Society, 69, 779-784.

Cao, V., Tan, L. D., Horn, F., Bland, D., Giri, P., Maken, K., Cho, N., Scott, L., Dinh, V. A., Hidalgo, D. & Nguyen, H. B. 2018. Patient-Centered Structured Interdisciplinary Bedside Rounds in the Medical ICU. Critical Care Medicine, 46, 85-92.

Gausvik, C., Lautar, A., Miller, L., Pallerla, H. & Schlaudecker, J. 2015. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of multidisciplinary healthcare, 8, 33.

Institute of Medicine & Committee on Quality of Health Care in America 2001. Crossing the Quality Chasm: A New Health System for the 21st Century, The National Academies Press.

Loertscher, L., Wang, L. & Sanders, S. S. 2021. The impact of an accountable care unit on mortality: an observational study. J Community Hosp Intern Med Perspect, 11, 554-557.

Lopez, M., Vaks, Y., Wilson, M., Mitchell, K., Lee, C., Ejike, J., Oei, G., Kaufman, D., Hambly, J. & Tinsley, C. 2019. Impacting Satisfaction, Learning, and Efficiency Through Structured Interdisciplinary Rounding in a Pediatric Intensive Care Unit: A Quality Improvement Project. Pediatric Quality & Safety, 4, e176.

Schwartz, J. I., Gonzalez-Colaso, R., Gan, G., Deng, Y., Kaplan, M. H., Vakos, P.-A., Kenyon, K., Ashman, A., Sofair, A. N. & Huot, S. J. 2021. Structured interdisciplinary bedside rounds improve interprofessional communication and workplace efficiency among residents and nurses on an inpatient internal medicine unit. Journal of Interprofessional Care, 38, 427-434.

Stein, J., Payne, C., Methvin, A., Bonsall, J. M., Chadwick, L., Clark, D., Castle, B. W., Tong, D. & Dressler, D. D. 2015. Reorganizing a hospital ward as an accountable care unit. Journal of Hospital Medicine, 10, 36-40.

Wolf, J. 2024. Consumer perspectives on patient experience 2024. Nashville, TN: The Beryl Institution.