Impact of an Accountable Care Unit on mortality
Top Results
Overview
The implementation of an Accountable Care Unit (ACU care model) with Structured Interdisciplinary Bedside Rounds (SIBR) significantly improved unit mortality and the rate of unexpected deaths.
Objectives
To evaluate the impact of transitioning a medical unit to an Accountable Care Unit (ACU) on inpatient mortality rates.
Methods
The study used an observational pre-post design involving 12,158 consecutive inpatients with a mean age of 62.2 years. Conducted over six years, from August 26, 2013, to August 25, 2018, the intervention included:
Geographic localization of the unit.
Partnered nurse-physician unit leadership.
Daily Structured Interdisciplinary Bedside Rounds (SIBR) involving nurses, physicians, pharmacists, and care managers.
Results
Risk-Adjusted Mortality Reduction
Year 2: aOR = 0.58 (0.35-0.94)
Year 3: aOR = 0.64 (0.39-1.03)
Mortality returned to baseline in Years 4 and 5.
Unexpected Deaths
Zero in Year 3.
Sustained reduction below pre-implementation rates in Years 4 and 5 (~0.1% vs. 0.38%).
Conclusion
The geographic ACU with nurse-physician partnered leadership and daily SIBR effectively reduced mortality and unexpected deaths among inpatients, demonstrating the importance of structured team-based care models. However, maintaining these outcomes requires continuous focus and effort.
