Emory Healthcare reimagines patient care with accountable care units

By Pam Auchmutey | Emory Nursing | July 28, 2014

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Bryan Castle (center) leads a project to add several Accountable Care Units throughout Emory Healthcare. Castle codeveloped the ACU model with hospitalist Jason Stein. The nursing school’s Susan Shapiro helped secure funding to expand the ACU model.

Each weekday morning on the acute care unit at Emory University Hospital known as 6G, the conversation during patient rounds may go something like this:

Good morning, Mr. Blake. We’re back again for team rounds. I’m Jason Stein, your doctor, and you know your nurse today, Diaz. Also here with us is Jennifer from Social Services and Melissa, your pharmacist. As we’ve discussed, you have high blood pressure and diabetes and were admitted to the hospital because your kidneys were injured. We’ve been trying to understand why, and there are signs that your kidneys may be recovering. Your nausea is still troubling you, and we’re going to focus on that today. Is there anything else you would like to add?

As the discussion unfolds, the interdisciplinary team learns that Mr. Blake and his family are concerned about his discomfort and his medications. The team works with them to form a care plan that includes adjusting his medications and changing out his catheter to make him more comfortable.

Welcome to the Accountable Care Unit (ACU), a model of collaborative practice growing in use throughout Emory Healthcare.

Before the ACU was launched on 6G in 2010, nurses and doctors worked independently of each other, and physicians, on average, covered patients on eight different units. With the ACU, physicians—just like nursing staff—are dedicated to a primary unit that is jointly managed by a nurse and physician. Team members share responsibility for all clinical, service, and cost outcomes. Trainees from different disciplines also play a role in the unit.

Emory Healthcare now has five ACUs—three at Emory University Hospital, one at Emory University Hospital Midtown, and one at Emory Johns Creek Hospital. Seven more ACUs are scheduled to open during the next three years, funded by a $1.5 million cooperative award from the Health Resources and Services Administration to the School of Nursing and Emory Healthcare. Expansion will occur in two phases, with three ACUs in the first year and four more in years two and three.

A key objective of the award is to train more staff nurses to lead interdisciplinary unit-based teams. Training is now under way at Emory University Hospital Midtown for nurses, hospital and community physicians, and ancillary service providers. The cooperative agreement also provides for further evaluation of ACU effectiveness and development of a tool kit that other health care systems can use to establish ACUs.

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