Background: In Canada, as in the US, hospital medicine has become an increasingly important staffing model innovation. Canadian hospitalists are typically Family Physicians and General Internists. In an attempt to advance its hospitalist staffing model into a care model innovation as well,  the Regina Qu’Appelle Health Region (RQHR) implemented Canada’s first Accountable Care Unit (ACU) with the support of the ACU solutions provider (1Unit LLC). An ACU has four specific design features: 1) unit-based physician teams; 2) structured interdisciplinary bedside rounds (SIBR); 3) unit-level performance reporting; and 4) unit-level nurse and physician co-leadership.

Purpose: RQHR sought to gauge the effect of its first ACU on the clinical, cost, and satisfaction outcomes. Outcome measures included: 1) length of stay; 2) rate of patient advocate complaints; and 3) staff-supervisor relations. Process measures included: 1) hospitalist time spent conducting SIBR ; 2) frequency of hospitalist forecasting Target Date of Discharge (TDD) during SIBR (as outlined in the SIBR communication protocol); 3) frequency of a documented  rationale for those patients not on VTE Prophylaxis (VTE-P) ; 4) frequency of malnutrition screening on admission, which was part of a concurrently running  More2Eat Study (M2E); and 5) frequency of  patient weight documented  in the chart (as per M2E).

Description: In the second half of 2015, the RQHR developed unit-based hospitalist teams on 4A, a medical-surgical unit at Pasqua Hospital in Regina, Saskatchewan. During this time, the RQHR also engaged the 1Unit to provide onsite ACU education for most unit staff, online SIBR training for nurses and hospitalists, and distance mentoring for the 4A leadership dyad. Data for the process and outcome measures were collected for the first six months of the ACU and compared to pre-intervention baseline (Figure 1). Hospitalists spent an average of 50.66 minutes per day conducting SIBR on an average of 14.21 patients per day. The TDD was verbalized 96.82% of the time during SIBR.  

Conclusions: During the first six months after ACU implementation, we observed large and significant improvements across a range of outcome and process measures that affect both patients and staff. With further consultation from 1Unit, the RQHR is now expanding the ACU care model to additional wards within Pasqua Hospital and developing a plan to implement more broadly within the region.