title: Care redesign: a higher-quality, lower-cost model for acute care.
abstract: 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.
  
  
  CONCLUSIONS
  Innovative changes in nursing care delivery can maintain clinical quality and nurse and patient satisfaction while decreasing costs.
authors: Author Affiliations: Senior Vice President and Chief Nursing Officer (Dr Rudisill), Community Health Systems, Franklin; and Assistant Vice President Strategic Resource Group, Vice President Strategic Planning American Group (Ms Callis), HCA, Nashville, Tennessee; Professor (Dr Hardin), College of Nursing, East Carolina University, Greenville, North Carolina; and Professor Emeritus (Dr Dienemann), School of Nursing, UNC Charlotte and Nurse Researcher Carolinas Medical Center University, North Carolina; and Chief Nursing Executive (Dr Samuelson), Poplar Bluff Regional Medical Center, Missouri.
authors: Pamela T
authors: PT
authors: Rudisill
authors: Carlene
authors: C
authors: Callis
authors: Sonya R
authors: SR
authors: Hardin
authors: Jacqueline
authors: J
authors: Dienemann
authors: Melissa
authors: M
authors: Samuelson
mesh_terms: D003695:Delivery of Health Care; D004471:Economics, Nursing; D005069:Evaluation Studies as Topic; D007588:Job Satisfaction; D016294:Models, Nursing; D010348:Patient Care Team; D017060:Patient Satisfaction; D011787:Quality of Health Care; D012941:Social Responsibility