Background: Transforming hospital operations to optimize patient experience begins with a collaborative care team. The geographic re-location of physicians into one unit with an entire care team, in addition to the implementation of Structured Interdisciplinary Bedside Rounds (SIBR), have been linked to multiple outcomes related to effective care team communication and collaboration, including patient safety and satisfaction.
Methods: This study sought to perform a quantitative and qualitative assessment of outcomes related to efficiency and effectiveness of care, patient satisfaction, and care team communication and collaboration through restructuring a General Medicine ward at a large hospital in the United Arab Emirates (UAE) into an Accountable Care Unit. Participating physicians were assigned to care units where they collaborated with care team members and participated in daily SIBR incorporating checklists, with oversight of the unit provided by a nurse and physician leadership dyad. Assessment tools comprised two surveys: Patient experience and physician and allied health surveys administered pre- and post-implementation. Quantitative assessment was performed by comparing pre- and post-implementation data including length of stay index, readmissions, and discharge cycle time from the quarter before and after the intervention. Resource utilization addressed by the daily checklists was measured by the daily orders for lab tests including CBC, CRP and Procalcitonin.
Results: Patient experience survey responses showed an improvement in all survey components relevant to the goals of the ACU. Physician and allied health survey response scores showed a steady improvement after the implementation of the ACU model, including related to care team communication and collaboration. Quantitative analysis of outcome metrics showed a significant decrease (1.09 days, p< 0.05) in average length of stay accompanied by a significant (0.276, p< 0.05) decrease in the LOS index, implying higher efficiency. In addition to observed improvements in readmission rates, and discharge rates and time. Additionally, a significant decrease (-3%, p< 0.05) in CBC orders was observed.
Conclusions: When piloted on a medical unit at a hospital in the United Arab Emirates, the Accountable Care Unit model supported collaborative care that led to favorable care outcomes and improved patient experience.