A Collaborative Initiative to Implement a New Patient Centered, Team Based Care Model Called Accountable Care Unit

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1 A Collaborative Initiative to Implement a New Patient Centered, Team Based Care Model Called Accountable Care Unit Carolyn Swinton, RN, MN, NEA-BC, FACHE Chief Nursing Officer, Palmetto Health Christina Payne, MD Hospital Medicine Physician and Senior Medical Director Accountable Care Unit, Palmetto Health Forrest Marie Fortier, RN, BSN, MSTD Director of Nursing Research and Program Development, Palmetto Health

2 Today s presenters do not have any relevant financial interests presenting a conflict of interest to disclose. Participants must attend the entire session(s) in order to earn contact hour credit. Continuing Nursing Education credit can be earned by completing the online session evaluation. The American Organization of Nurse Executives is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. AONE is authorized to award one hour of pre-approved ACHE Qualified Education credit (non-ache) for this program toward advancement, or recertification in the American College of Healthcare Executives.

3 By attending this presentation, the learner will Explain how collaborative partnerships between nursing, physicians, and other healthcare disciplines can be developed and strengthened through the implementation of the ACU model. Discuss how the triple aim of patient centeredness, quality, and cost are improved through the implementation of the innovative ACU Care Model Evaluate the effectiveness of the preparation of hospital staff as their role and practice setting changed through the implementation of the ACU Care Model

4 Accountable Care Units (ACUs ) and Structured Interdisciplinary Bedside Rounds (SIBR ) were created by Dr. Jason Stein at Emory University in Atlanta. Palmetto Health launched ACUs with the help of Centripital, Inc., a 501(c)(3) nonprofit founded by Dr. Stein with the mission to train hospital professionals to work together in high-functioning, patient-centered teams. Centripital has successfully implemented Accountable Care Units (ACUs) in more than 50 hospital units in 14 U.S. states and overseas since 2012.

5 Our Vision To be remembered by each patient as providing the care and compassion we want for our families and ourselves.

6 Triple Aim Focus Patient Centeredness Quality Cost

7 System Goal Implement Patient-Centered, Team Based Model of Care

8 Previous State: Asynchronous Care 10:10a 10:30a 11:00a

9 Accountable Care Unit (ACU): definition: a geographic inpatient area consistently responsible for the clinical, service, and cost outcomes it produces

10 ACU Components 1. Unit-based physician teams 2. Daily structured interdisciplinary bedside rounds (SIBR) 3. Unit level performance reports 4. Unit level nurse and physician leadership

11 Structured Interdisciplinary Bedside Rounds (SIBR) Shared Mental Model for Teamwork Confirms Plan for Discharge: a. Patient Came from (home, nursing home) b. Functional Status upon admission (bed bound, amb with walker) c. Discharge needs i. DME equipment or home health needs ii. PPD status d. Patients preferred pharmacy identified e. Identify PCP and ensure follow-up is scheduled prior to discharge f. Next site of care whiteboard SW Collaborative Cross-Checking Highlight Medication Safety Opportunities: a. DVT prophylaxis management b. Beers Meds c. Other as applicable i. Antibiotic stop or discontinued meds ii. Results (Drug Level, Culture) d. IV to oral switch recommendations Manage SIBR Rounds a. Ensure next bedside nurse ready for SIBR team b. Orient float nurses PharmD RN Patient Family PST Rounds Manager MD 1. Introduce a. Lead team into room, greet patient & family b. Say name of RN, Tech & SW, roles of team members c. Orient patient and family to roles of team members 2. Update hospital course a. Review active problems and response to treatment b. Discuss interval test results/consultant inputs c. Invite inputs from patient and family, then nurse 3. Update current status a. Patient s goal for the day b. Overnight events c. Vital signs & Pain management d. Mental Status e. Tele Status (if applicable) 4. Review Quality-Safety Checklist Central Line Foley Catheter Pressure Ulcer Stage and/or Prevention VTE Prophylaxis Hypo/Hyper- glycemia 5. Update current status: a. Fluid & food intake b. Urine & bowel output c. ADLs d. Fall precautions e. Define PST Goal for the Day Duration: 60 mins Quality-Safety Checklist 6. Invite inputs from allied health a. PharmD, & Social Worker 7. Synthesize plan using all inputs a. Propose Plan-for-the-Day & assign responsibilities b. Propose Plan-for Discharge Discharge needs & next site of care Anticipated day of discharge c. Acknowledge team member inputs and concerns d. Thank patients and family for their time < 15 seconds < 30 seconds 45 secs < 30 seconds < 45 seconds 2 mins < 30 seconds Interdisciplinary Plan of Care 2:30 mins < 30 seconds 4:30 mins

12

13 GO LIVE APRIL 2, 2014

14 Logistics Decision Matrix for Unit Selection Physician Partner Nursing Performance Ancillary Support Patient Placement LEAN Methodologies

15 Shared Mental Model SIBR Ground Rules All Patients Starts on Time Ends on Time All Team Members at the Bedside Starts when both MD and RN are in the Room Ends with a Plan All Orders Entered SIBR Scripts Rounds Manager MD Nurse Tech Pharmacy Case Management Other

16 Evaluate Change of Shift Team Huddle Bedside Report Change Management Change of Shift Huddle Implement Patient Assess Bedside Report SIBR Plan Nursing Diagnosis RNs LPNs SIBR Techs

17 Change of Shift Huddle Beginning of Each Shift Both Shifts All Staff Starts on Time Less than 5 Minutes Shared Mental Model Bedside Report At the Bedside Engages the Patient Pre-SIBR Complete Assessments Quality- Safety Checklist Advocate for the Patient Tell a Story

18 Training and Accountability Commitment to Each Other Our Patients The Process Covenants Leadership Team

19 Results Pre- SIBR 6-9 months Post SIBR Service (Patient Centeredness): HCAPHs Composites (greater than the 95 th percentile) 0 of 8 5 of 8 Quality: Harm Index (CLABSI, CAUTI) 11 2 Quality: Falls Quality: Hypoglycemic Events Finance (Value): Length of Stay Cost Avoidance per ACU = approximately $800k 1 st year

20 Process Logistics Shared Mental Model Training Accountability Evaluation Lean Methodologies Ground Rules Structured Scripts SIBR Certification Participant Reaction Team Adoption Covenants Leader Competency

21 Next Steps Development of a Composite Metric to Capture Value Improvement Telemetry Beers Meds Utilization Medical Device Utilization Addition of a Nurse Practitioner to ACU Team Focus on Medication Safety at Care Transitions Determine Value Based Purchasing Impact of ACU

22 Changing Our Culture Clinical Transformation Outcomes Driven Practice Evidenced Based Care Quality and Patient Safety Top of License and Certification

23 Changing Our Culture Operational Excellence Standard Work Accountability Strategic Partnerships

24 Excellence is to do a common thing in an uncommon way. Booker T. Washington

25 Please note that this Power Point presentation is an educational tool that is general in nature. It is not intended to be an exhaustive review of the subject matter or the opinion of Palmetto Health. Materials presented in this presentation should not be considered a substitute for actual statutory or regulatory language. Always refer to your legal counsel and the current edition of a referenced statute, code and/regulation for precise language.

26 Carolyn Swinton, RN, MN, NEA-BC, FACHE Christina Payne, MD Forrest Marie Fortier, RN, BSN, MSTD

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