Acuity-Adaptable Care Delivery Improve Renal Transplantation Outcomes: A Pilot Study

Thursday, 15 July 2010

Alma Degracia, MBA, RN, CCRN
Multi-Organ Transplant Unit, The Methodist Hospital, Houston, TX
Sandra Cesario, RNC, PhD
College of Nursing, Texas Woman's University - Houston, Houston, TX
Nena M. Bonuel, MSN, RN, CCRN, CNS, APRN-BC
Education Service Line, Michael E. DeBakey Veterans Affair Medical Center, Houston, TX

Learning Objective 1: 1. Explain the concept of Acuity-Adaptable care delivery

Learning Objective 2: 2. Discuss the impact of the Acuity-Adaptable care delivery on the renal transplantation patients.

Purpose: The purpose of the study is to determine if :
·         Patient cared for in the Acuity-Adaptable (A-A) patient Room will have decreased cost for their total care experience to patient cared for in a transitional process.
·         Patient cared for in the Acuity-Adaptable (A-A) patient room will have decreased length of stay in comparison to patients cared for in a transitional care process.
·         There will be no difference in patient’s satisfaction, nursing care, patient comfort, physiologic measures and nosocomial infection between those patients cared for in the acuity-Adaptable Patient room and those cared for in a transitional care process.
Methods: Pre and post was used in this study.

To actualize the acuity-adaptable patient room concept, four transplant rooms in the medical –surgical nursing unit were hardwired with cardiac monitor capable of hemodynamic monitoring and the room is also equipped with medical gases capable of supporting mechanical ventilation. An admission and discharge criteria was developed and implemented as a nursing unit policy. A CARE Pathway of the renal transplant patient was implemented based on evidence-based practices and through benchmarking with other academic centers. Competency of the nursing staff were addressed to include didactic training and competency focusing on critical care concepts, and education on the admission and discharge criteria. Senior leadership engagement was sought and was enthusiastic about the pilot.
Results: Renal transplant patient who were cared for in the A-A room have decreased LOS of 4 days compared to the transitional process which is 10 days.
The Direct Care Cost of patient in the A-A room was $21,489.00 compared to the renal transplant patient in the transitional care process to $26, 308.00.


Acuity-Adaptable care delivery hold promise in meeting the patient needs of the future.