Providence St Vincent Medical Center

Setting: 29 bed medical unit

Timeframe: 5 years post Accountable Care Unit implementation with SIBR rounds.

Summary: A geographic ACU with nurse-physician partnered leadership and daily SIBR rounds can reduce total and unexpected mortality. Sustainment requires effort and can be complicated by organizational goals of replicating the model to other units. 

Compared to pre-implementation year, mortality, crude or risk adjusted, showed decline in Years 1, 2 and 3, reaching statistical significance in Year 2 (risk-adjusted odds ratio [aOR] = 0.58 [0.35–0.94]). Mortality rebounded to baseline over Years 4 and 5.

In fact, early success on the ACU led hospital executives to request our help in spreading the model, diluting our focus on the original unit.
risk adjusted mortality Odds Ratio for year 2
0.38 %
unexpected deaths by year 3