“U-ACT” Unit Based Accountable Care Teams Improve Patient Outcomes
Brian Cosner, BSN, RN-C, Randy Bernat, RN, Ashley Zipp, BSN, RN
Penn State Hershey Medical Center, Hershey, PA
bcosner@hmc.psu.edu, rbernat@hmc.psu.edu, azipp@hmc.psu.edu
1. Identify barriers
2. Engage interprofessional
conversations to promote
compliance
1. Review adherence to
urinary retention
protocol and
standards of care
Hand Hygiene Compliance (July 2014 to June 2015)
Catheter Associated Urinary Tract Infections
100.00%
3
99.00%
Catheter Associated Urinary Tract Infections
per 1000 Catheter Days
Hand Hygiene
Discussion
U-ACT work on the unit demonstrated improved and sustained quality outcomes;
CAUTI
2.5
2. Review presence of
indwelling catheters
during
interprofessional
patient rounds
CLABSI
1. Review and discuss
patient needs for
device
2. Perform root cause
analysis on all
bloodstream infections
3. Monitor adherence to
CLABSI bundle
including indications
for central lines as
well as maintenance
of and discontinuation
Pressure Ulcers
1. Ensure participation
by all members of the
team assisting in
ambulation and
positioning
2. Promote RN/MD
communication to
provide appropriate
skin care
98.00%
97.00%
96.00%
Unit Data
Organization Data
95.00%
94.00%
2
1.5
Unit
NDNQI Mean
92.00%
Conclusions
Quality outcomes are every health
care worker’s responsibility. Unitbased Accountable Care Teams (UACTs) improve patient outcomes
through Nurse and Physician team
leadership and collaboration. The
efforts of U-ACT Nurse-Physician
led interdisciplinary teams
demonstrated results in achieving
quality and safety for patients.
0
2013 2013 2013 2014 2014 2014 2014 2015
Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1
Central Line Associated Bloodstream Infections
Unit Acquired Pressure Ulcers
1.2
1
0.8
0.6
Unit
NDNQI Mean
0.4
0.2
1.6
1.4
1.2
1
References
0.8
Unit
NDNQI Mean
0.6
0.4
2013 2013 2013 2014 2014 2014 2014 2015
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Squire, J., Linklater, S., Grimshaw, J., et al. (2014).
Understanding practice factors that influence
physician hand hygiene compliance. Infection Control
and Hospital Epidemiology, 35(12), 1511-1520. DOI:
10.1086/678597
How-to guide: Prevent catheter-associated urinary
tract infections. (2011). Cambridge, MA: Institute for
Healthcare Improvement. (Available at www.ihi.org).
0.2
0
0
U-ACTs create a grass roots
coalition, taking quality actions at
the bedside and on the unit.
Successes as well as failures are
shared with other U-ACT groups to
enhance the patient experience
across the organization.
Additionally, the importance of
physician and advanced practice
clinician involvement cannot be
overstated as key stakeholders to
ensure sustained success.
1
0.5
93.00%
Percent of patients with Hospital Acquired Pressure
Ulcers Stage II or above
U-ACT meetings are held weekly to
review patient safety and quality
issues in real time. Meetings create an
open forum for interprofessional
collaboration related to patient care
and the patient experience. Action
plans are created for identified areas
and results are reviewed.
Outcomes
Percent Compliance
Unit-Based Accountable Care Teams (U-ACT)
are a collaborative between Nurses and
Physicians that include Infection Control,
Patient Logistics, and Environmental Health
Services. Despite diversity within individual
unit teams, U-ACT groups share the common
goal of improving patient outcomes and
clinical quality indicators across the
organization. Nurse and Physician leadership
on each U-ACT group assures system wide
integration of best practices for achievement
of the highest level of quality and safety for
patients. Unit teams meet in their respective
services line and collaborate with other UACT teams to share best practices.
Team Meetings and Activities
Central Line Associated Blood Stream Infections per
1000 Central Line Days
Introduction
2013 2013 2013 2014 2014 2014 2014 2015
Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1
How-to guide: Prevent central line-associated
bloodstream infections (CLABSI). (2012). Cambridge,
MA: Institute for Healthcare Improvement. (Available
at www.ihi.org)