Background: Geographic Accountable Care Units (ACUs) have been in existence for years at our institution. The ACUs have demonstrated improved throughput, quality and patient experience metrics. Our hospitalists have embraced the ACU philosophy due to ease of rounding, interdisciplinary approach to patient care and its 7on/7off scheduling, which is not standard at our institution. Overall our care models have generally been very successful. However, in 2017 one of our oldest ACUs started showing worsening throughput metrics in the setting of staffing changes. At the same time the ACU Hospitalists, along with multiple disciplines voiced concerns about the effectiveness of interdisciplinary rounds (IDRs).
Purpose: To redesign our interdisciplinary rounds on a single accountable care unit in hopes of improving throughput metrics and increasing staff satisfaction in the rounds by using a PDSA cycle.
Description: Interdisciplinary Rounds (IDRs) were observed by Hospitalist, Social Work, and Nursing leadership. IDRs took place with representation from Social Work, Case Management, APPs, Nurse Managers, and the ACU Hospitalists. The nurses presented the patients, usually reading from the MD signout. Discussions were mainly an exchange of clinical information with little focus on discharge planning. Following observation, multidisciplinary meetings were held to gauge satisfaction and goals for IDRs. Subsequently we developed a more prescriptive IDR format and script for nursing presentation. ACU Hospitalists led multidisciplinary education and training on the new format and script.
Conclusions: Following the revamping of IDRs, dramatic improvements were noted in multiple throughput metrics (Percent discharges by 2 pm increased from 8% to 11%; ALOS decreased from 6.6 to 5.9 days; CMI adjusted LOS decreased from 5.4 to 4.7 days, Excess Days per case decreased from 1.8 to 1.2). These improvements have been sustained throughout 2018. These metrics demonstrate that a hospitalist led multidisciplinary PDSA approach to improving unit throughput in the area of interdisciplinary rounds can lead to sustained improvements.