Acuity-Adaptable Care Delivery Model for Inpatient Care
August 10, 2017 | Special HTA Reports
Patients admitted to a hospital are typically moved several times over the course of their stay to receive treatment in different treatment settings and care levels until discharge. (1) According to an Agency for Healthcare Research and Quality (AHRQ) report, “on average, 40 to 70 percent of patients on the typical inpatient nursing unit in the United States are transferred each day. " These intrahospital patient transfers require communication among many care providers and often result in patient flow issues, care delays, and lack of continuity in patient care. Other disadvantages of transferring patients described in the literature include increased risks for the following:(1-4)
Also, intrahospital transfers can be costly. Gallant and Lanning described three cost components to consider when evaluating the financial impact of patient transfers: direct cost, indirect cost, and holding cost:(2)
Hendrich and Nelson studied the impact of intrahospital transfers on hospital efficiency and reported only a 12% efficiency in the transfer process. (5)
To address the inefficiencies of multiple intrahospital patient transfers, some hospitals have implemented an acuity-adaptable care delivery model for homogenous patient populations (e.g., cardiac surgery, renal transplant, oncology). (6) The acuity-adaptable care delivery model is a strategy to keep a patient in the same hospital room from admission to discharge regardless of acuity level throughout the stay (i.e., intensive care, stepdown, acute care). Each private acuity-adaptable hospital room has the technology to support patients at all acuity levels, so room assignment is more flexible. The acuity-adaptable concept involves directing equipment, staff, and resources to the patient instead of transferring the patient to areas where specialized equipment and nursing expertise are located. During recovery, rather than transferring the patient to another unit as his/her acuity changes, the nursing care delivery steps down. (2,3,6-9) Model variations include a model with patient admission from ICU care level through discharge and a care model from a step-down care level through discharge. (3,6)
Acuity-adaptable rooms require more space than a regular hospital room to accommodate critical care equipment, additional staff, procedures, and family members. Ideally, nursing staff must be able to see the patient from the corridor. Thus, space for family and other visitors is usually on the opposite bedside from the doorway “to facilitate visual observation of the patient and more direct physical access to the patient in the case of emergencies. "(10)
According to a 2010 article on patient room design, key...