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Working together on the Accountable Care Unit

The Accountable Care Unit (ACU model) has been under way at Emory for the past three years, and both physicians and nurses give the model high marks.

Photo by Jack Kearse

The old model of patient care: nurses and doctors, for the most part, worked independently of each other. The new model at Emory Healthcare: nurses and doctors spend their entire shift in the same unit, working side by side, and together, are responsible for the unit's patient outcomes. Welcome to the accountable care unit (ACU).

ACUs have a set team of nurses and physicians that are managed jointly by a nurse and physician. The unit is responsible for its clinical, service, and cost outcomes.

For example, one clinical measurement, the rate of pressure ulcers, traditionally fell to nurses to manage and improve. On an ACU both nurses and physicians work together to prevent or manage patients' symptoms and reduce the rate for the unit.

The ACU model has been under way at Emory for the past three years, and both physicians and nurses give the model high marks. "Employee engagement was blown out of the water," says RN Bryan Castle, unit director for 6G at Emory University Hospital. "It's the first time in surveys that I've seen that 100% of the nurses felt like they had a collegial relationship with the physicians they work with on the unit."

"We have real work relationships now," says hospitalist Jason Stein. "Everyone knows everyone and something about each other. We've had a lot of people observe our unit, and they often remark how quiet it is. Phones and pagers are used less—there's much more face-to-face. There's a certain calm and order." Stein and Castle have teamed up with Susan Shapiro, system director of research and evidence-based practice in the nursing school, to advance the ACU model. Shapiro recently secured a three-year, $1.5 million grant from the Health Resources and Services Administration to evaluate the ACU model, train more staff nurses to lead unit-based teams, and develop a tool kit for other health systems on how to implement an ACU.

Currently there are three ACUs at Emory University Hospital, one at Emory University Hospital Midtown, and one at Emory John's Creek Hospital. Seven more are planned.

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