Forum Focus – Unit Base Care Model

When a Lean Six Sigma report showed a high number of inpatients, a high percentage of people leaving the Emergency Department without being seen, and a high average length of stay (LOS), those running the Adult Inpatient Medicine Service (AIMS) at 453-bed Presbyterian Hospital (part of Presbyterian Healthcare Services) in downtown Albuquerque, N.M., knew something had to change. Thus was born the Unit Base Care Model (UBCM).

The UBCM geographically isolates hospitalists and incorporates these units into a multidisciplinary team with daily rounding involving all team members. Although other organizations have implemented the UBCM concept, Presbyterian took it to the next level by incorporating communication as a standard of work. Each morning begins by having daily “whiteboard rounds” where the hospitalist, nurses, physical therapist, and care coordinators for each unit meet at the whiteboard (which lists the patients on the floor and their pertinent care issues) and discuss each patient’s treatment and discharge plan. This structured environment has fostered a new culture of communication and interaction that has been transformational and it shows in their results.

Average LOS for the AIMS dropped from 5.06 days prior to the UBCM to 4.61 days in 2011, and 4.52 year to date for 2012 without increasing the readmission rate. By lowering average LOS, Presbyterian has been able to backfill beds, thus increasing discharges from 12,503 in 2010 to 14,411 in 2011. As well, Emergency Department congestion has been improved and no Emergency Department diverts have been recorded in the last 15 months.

To learn more about the UBCM, contact David Yu, MD, MBA, FACP, SFHM, Medical Director of the AIMS at Presbyterian Medical Group, dyu3@phs.org.

David Yu, MD, MBA, FACP, SFHM

Personnel from the UBCM meet to discuss plans for that day's patients.

Daily "whiteboard" rounding at the UBCM.

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