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Antimicrobial Stewardship and Accountable Care Unit Five Minute Updates

28-Sep-2016

Accountable Care Unit Five Minute Update

What is an Accountable Care Unit? It is a system of care in which care team members are better connected with one another and are responsible to each other to ensure that patients receive the safest, highest quality care possible.

The Regina Qu’Appelle Health Region’s Accountable Care Unit (ACU) pilot project is a key strategy for the Region this year; one that aligns completely with our three goals of improving the quality and safety of our care; enhancing patient flow through our system and contributing to a sustainable future. The Region’s Senior Leadership Team believes that the pilot will successfully demonstrate that we can transform our care system for all our acute inpatient units. This pilot project is made possible through funding from the Ministry of Health and additional funding from the Region.

The six-month pilot ended on August 24th, 2016, so this project is now in a transition phase. The established structure and processes will continue until November 30th, 2016. From now until then, in addition to continuing all ACU processes, robust evaluation will be occurring as part of the research component of the project and analysis of outcomes will be presented to RQHR’s Senior Leadership Team to determine replication options.

On an ACU, shared routines are foundational to creating high performing teams. The daily routines being applied on 4A are: structured interdisciplinary bedside rounds (SIBR), team huddle, shift to shift bedside handover (now known as transfer of accountability) and debriefs. The debrief sessions are a 10-minute team discussion, focusing on unit-based metrics four days a week and on learning needs of the unit two days a week. These valuable debrief sessions enable staff engagement and feedback in real time and are a sign of the continuous improvement culture that has been created through their journey in implementing an ACU.

New patient whiteboards have now been installed in all patient rooms. The whiteboards are an integral tool that supports and facilitates communication between the care team, the patient and their family. To ensure boards are updated consistently, standards for use of the boards have been built, including communication related to the More 2 Eat Study. As with all the other changes that have been implemented so far, this process will be monitored, evaluated and adjusted as needed, based on feedback from the frontline staff.

Prior to many of the changes, the team spent a significant amount of time defining the Charge Nurse role, which aims to facilitate patient flow on the unit. One of the key roles of the Charge Nurse is that of Rounds Manager during SIBR. The Rounds Manager facilitates the flow of SIBR and ensures that the team stays on time, organizes and prepares the team nurses for SIBR, and updates Sunrise Clinical Manager software with the target date of discharge in real time for the team. The work surrounding the charge nurse role started in May and is ongoing.

With the departure of the Clinical Nurse Educator (CNE) and Clinical Resource Nurse (CRN), Manager Sheri Bray has taken on extra responsibilities to continue the education, implementation and evaluation of all the above processes. In August, the new CRN and CNE were hired and will start learning about the ACU and how it functions on 4A to gain a better understanding of their role in supporting the staff in this model of care.

Over the next couple of months, the team on 4A will continue to embed the new and existing processes on the unit and continue sustaining the improvements that have been observed. A process for SIBR certification is in development and aims to be in place by October 2016. This certification gives nurses and physicians a way to demonstrate excellence in transforming something complex into something routine-leading and co-ordinating an interdisciplinary team at the bedside. It also gives leaders, managers and educators a reliable way to affirm demonstrated competence.

Patients are saying:

‘The staff on 4A were amazing!!! Very attentive, always asking how I was. They made the stay very easy and explained things any time I had questions. I came up here after very hard circumstances and they made the stay enjoyable and provided the knowledge I needed to carry on with my treatments after leaving the hospital. I received amazing care and I am very thankful for that.’ - 4A Patient

‘The team rounds were great. We didn’t have to wonder where the doctor was. We were better informed on a regular basis than on any previous stay.’ - 4A Patient

Staff are saying:

‘After recently spending a day observing the Accountable Care Unit at the Pasqua Hospital, I wasn’t disappointed. There is clearly a high level of staff morale and engagement, as well as patient satisfaction. Relationships between the entire interdisciplinary team are collaborative and respectful. The communication and teamwork is fascinating. Its truly a magnet-like environment.’ - KOT Specialist, Medicine Service Line

Physicians are saying:

‘I came across Canada to work in the ACU simply because I can’t do ‘this’ anywhere else’ – 4A Hospitalist

For more information on the Accountable Care Unit pilot project, please visit our website: http://www.rqhealth.ca/clinical-support/accountable-care-unit