Care Redesign: A Higher-Quality, Lower-Cost Model for Acute Care

OBJECTIVE:The aims of this study were to design, pilot, and evaluate a care team model of shared accountability on medical-surgical units. BACKGROUND:American healthcare systems must optimize professional nursing services and support staff due to economic constraints, evolving Federal regulations and increased nurse capabilities. METHODS:A redesigned model of RN-led teams with shared accountability was piloted on 3 medical/surgical units in sample hospitals for 6 months. Nursing staff were trained for all functions within their scope of practice and provided education and support for implementation. RESULTS:Clinical outcomes and patient experience scores improved with the exception of falls. Nurse satisfaction demonstrated statistically significant improvement. Cost outcomes resulted in reduced total salary dollars per day, and case mix–adjusted length of stay decreased by 0.38. CONCLUSION:Innovative changes in nursing care delivery can maintain clinical quality and nurse and patient satisfaction while decreasing costs.