News & Events
Updates on the ACU pilot and the Medical Surveillance Unit
Accountable Care Unit update
This month, we would like to continue to highlight an important metric that contributes to the pilot’s overall assessment: Patient length of stay (LOS).
Medical Surveillance Unit
In the spring of 2015, the Senior Leadership Team agreed to the creation of a medical intermediate care unit at the Pasqua Hospital in conjunction with
the amalgamation of the cardiac program at the Regina General Hospital. The Critical Care/Cardiosciences program then set out to review patient characteristics,
medical management and levels of nursing expertise to create a non-interventional cardiac monitoring unit which would provide enhanced patient care
to medically complex patients.
Over one year later, a compelling case is made with data, which has been collated at the unit level, highlighting the work of this team as well as the
positive patient and staff outcomes. The team has demonstrated improvement in all three areas of the Region’s focus in quality and safety, access and
patient flow and system sustainability.
Following the Cardiosciences program realignment at the RGH in October of 2014, the Medical Surveillance Unit (MSU) functioned as a general medicine unit with telemetry capabilities. In the fall of 2015, an agreement was reached related to the medical model of care which would see a Hospitalist run unit with support from General Internal Medicine physicians as consultants.
A unit leadership dyad relationship was formed with Dr. Kish Lyster and Marlee Cossette as physician and unit manager co-leads. Implementation plans were
developed through the creation of a MSU Transition Committee with oversight from Dr. David McCutcheon and Lori Garchinski. While formal work was ongoing
related to the Accountable Care Pilot on 4A, the frontline leadership team in MSU quietly adopted key concepts of the ACU model which included Structured
Interdisciplinary Bedside Rounding (SIBR), team huddles, geographic protection of beds, as well as bedside shift to shift nursing handover.
The incorporation of an Early Assessment and Response System (EARS) aided staff in managing more complex patient needs and provide a formal communication
mechanism between physician and nursing teams to highlight important changes in the patient’s clinical condition. An aggressive 13 week integrated
timeline was created to ensure the January 15, 2016 go live would be achieved. This timeline included creating our admission criteria, admission algorithms,
SIBR training and ground rules development, shift to shift at the bedside roll out plans, consent forms, work standards, team huddle guidelines, and
education days among other activities.
Prior to go live date in January, the co-leads realized the need for an evidenced-based method to evaluate and demonstrate the effectiveness of this new model of care. An Excel dashboard was developed by the Manager, Marlee Cossette, which captures unit based metrics on a daily basis. The dashboard has been designed in a manner in which its statistics simultaneously populate charts and graphs when unit staff, physicians and the manager enter data into the workbook. While we can demonstrate pre and post benchmarking within MSU, there is a need to review the outcomes as they compare to similar units nationally.
The dashboard of results captures 20 patient flow/demographic specific data points, 6 quality and safety metrics, 6 system sustainability metrics,
While there are many metrics that highlight the improvements in patient flow and quality of care, the success of the program can also be seen in both
the decrease in staff churn, overtime
This should not be underestimated in terms of staff morale and engagement. The current metrics clearly highlight the satisfaction of the staff working this model. When the leadership of MSU shared that there was a presentation occurring to SLT about the unit changes, 6 staff at a daily huddle volunteered to come on their own time to share their experiences and support for this model of care.
As work continues with frontline manager success, the time spent on data collection must transition to other resources so that the manager can be freed up to allow for other initiatives and work that she is accountable for. Formalizing the research component of daily metrics through other avenues will allow more robust measurements and mechanisms to feed the data back to staff and physicians in a timely manner.