title: Acuity adaptable patient care unit system shortens length of stay and improves outcomes in adult cardiac surgery: University of Wisconsin experience.
abstract: OBJECTIVE
  The Acuity Adaptable Patient Care (AAC) unit system allows all beds within a nursing unit to negate the need for transfer with changes in patient status. The unit is specialty specific to all levels of patient care. This system was implemented in March 2006 for cardiothoracic surgery at our institution. The purpose of this study was to evaluate the impact of the AAC system on the outcomes after adult cardiac surgery.
  
  
  METHODS
  We retrospectively reviewed 2930 consecutive patients who underwent major adult cardiac procedures between January 2003 and December 2010. The cohorts were divided into the pre-AAC group (January 2003 to February 2006, n = 1029) and the AAC group (March 2006 to December 2010, n = 1901). Patient demographics and postoperative outcomes were assessed.
  
  
  RESULTS
  The proportion of coronary artery bypass grafting was significantly lower (pre-AAC vs AAC: 43 vs 35%, P < 0.01), while those of aortic procedure (4 vs 11%, P < 0.01) and mechanical assist device insertion (3 vs 5%, P = 0.02) were higher in the AAC group. After the implementation of the AAC system, the incidence of all complications defined by the Society of Thoracic Surgeons (STS) database (49 vs 34%, P < 0.01), the median length of intensive care unit (ICU) stay (49 [interquartile range (IQR), 27-99] vs 26 [19-45] h, P < 0.01), that of hospital stay (6 [4-10] vs 5 [4-7] days, P < 0.01) and the readmission rate of ICU (5 vs 2% P < 0.01) were significantly decreased. Significant reductions in hospital mortality and the rate of hospital readmission <30 days were not observed.
  
  
  CONCLUSIONS
  The implementation of the AAC system has improved the outcomes after major cardiac procedures. The incidence of postoperative complications and length of stay have all decreased significantly without increasing readmission rate. AAC creates a system of fluid care with specialty-trained nursing and other ancillary support that expedites discharge and improves overall patient outcomes.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Shahzad A
authors.initials: SA
authors.lastname: Chindhy
authors.affiliation: St. Peter's Hospital, New York, NY, USA.
authors.forename: Niloo M
authors.initials: NM
authors.lastname: Edwards
authors.affiliation: Department of Biostatistics and Medical Informatics, Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Rajamanickam
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Entela B
authors.initials: EB
authors.lastname: Lushaj
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Lucian
authors.initials: L
authors.lastname: Lozonschi
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Nilto C
authors.initials: NC
authors.lastname: De Oliveira
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Takushi
authors.initials: T
authors.lastname: Kohmoto
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA osaki@surgery.wisc.edu.
authors.forename: Satoru
authors.initials: S
authors.lastname: Osaki
mesh_terms: D013504:Cardiovascular Surgical Procedures / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D010359:Patient Readmission / Q000706:statistics & numerical data; D013527:Perioperative Nursing; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D014922:Wisconsin / Q000453:epidemiology
keywords: Cardiac surgery; Patient care; Postoperative care