Acute care transformation: Redesigning 7W

Shelley Sanders. M.D., and Laura Loertscher, M.D., 7W ACU co-medical directors
Collette Sajko, RN, nurse manager

Sept. 18, 2013

Providence St. Vincent Medical Center’s 7W Medicine is now functioning as one of the first Accountable Care Units, or ACUs, on the West Coast.

An ACU is essentially a “closed unit” similar to the intensive care unit or pediatrics floors. The goal is that all patients admitted to general medicine floor are cared for by one of two teams, which include house staff.

Accountable Care Units commit to patient-centered workflows and an organizational structure that includes:

Daily structured interdisciplinary bedside rounds, or SIBR (pronounced "cyber"). Instead of caregivers checking in on patients separately throughout the day, this model brings them all together – physician, bedside nurse, nurse care manager and unit charge nurse.

Every morning at a scheduled time the team rounds as a group, answering the patient’s or family member’s question and conferring on the patient’s status.

Geographic, unit-based teams. Team members, including physicians, care for patients solely on the 7W unit, making them consistently available as well as responsible for the clinical, service and cost outcomes of the unit. Because this project is a collaboration with the hospital’s internal medicine residency program, the two teams are led by internal medicine and hospitalist faculty, who work in rotation with residents, interns and medical students.

The model calls for more rigid scheduling, but it also prevents delays by making all care providers more accessible to the patient and to each other.

Shared accountability. Under the team-based approach, nurses and physicians work as partners and share decision-making. Coaching and feedback are not only encouraged, but expected. This kind of open communication is key to identifying clinical problems before they become critical.

The model is adapted from Emory University, which saw mortality drop by 53 percent after instituting ACUs. It was brought to Providence St. Vincent as part of the broader acute care transformation work led by Judy Tatman, chief nursing officer, Oregon Region.

To measure how well the model is working, the hospital will track the unit’s patient mortality, length of stay, hospital-associated infections, patient falls and patient satisfaction.
“The ACU finally brings together the goals of patient-centeredness, truly collaborative, team-based care and transparent ownership of clinical outcomes at the unit level,” says Steven Freer, M.D., Brill Professor and Chair, Department of Medicine, and medical director of hospital quality and patient safety. Dr. Freer served as the attending physician when the unit “went live” on Aug. 26.

“Achieving this has been challenging and we are still learning as we gain experience,” he adds. “But if the first two weeks are indicative, we think we have something.”

Early reviews from patients and staff have been positive as well. Instead of patients being overwhelmed by a large group of caregivers visiting their room, most have welcomed it. In fact, one patient returning from a morning test urged transportation to push his gurney faster through the hallway to his room. "I don't want to miss my team meeting!" he said.

Peter Gerber, RN, noted: "I have worked on 7W for seven years, and the last three days [under the new model] have been the best three days of my nursing career."

Providers are welcome to observe SIBR at 9:30 or 10:30 a.m. any day of the week on 7W. Contact Collette Sajko, RN, to arrange a visit.