Implementing an Accountable Care Unit in a Multicultural Hospital: A Quality Improvement Study from the United Arab Emirates

Abstract Objectives The patients on the general medicine units at our hospital in the United Arab Emirates are cared for by a group of multicultural clinicians. Diversity in training and practice backgrounds of these clinicians limits shared experiences and care paradigms vary. Our aim was to evaluate the feasibility of standardizing communication and care processes within a multicultural medical unit in the United Arab Emirates. Methods We sought to standardize workflows on our hospital’s medical units by implementing the Accountable Care Unit (ACU) model. The core elements of this model include: geographic co-location of teams, a nurse-physician leadership dyad, structured interdisciplinary rounds, and accountability of the unit teams for their own metrics. Adhering to the SQUIRE guidelines, we piloted iterative implementation of the ACU elements through multiple Plan-Do-Study-Act cycles on a medical unit. We measured length of stay (LOS), LOS index, discharge cycle time as well as patient and clinician experience. Results ACU implementation achieved high adherence to most intervention elements. Clinician surveys suggested favorable perceptions of interdisciplinary collaboration and discharge efficiency improved. Length of stay (7.17 days vs 6.08 days, P=0.02) and length of stay index (1.96 vs 1.69, P = 0.01) both decreased on the pilot ACU. Conclusion By implementing the ACU on one of our units, we introduced a culture of inter-professional, team-based care which facilitated more interaction between care team members with standardized processes associated with reductions in LOS and LOS index.