I think each team leader takes acuity into mind when making assignments and if one case manager has an overwhelming load due to a sudden surge in acuity of several patients, then a prn nurse or one of the other case managers who has a lighter load might be temporarily asked to visit some of their more stable patients in order to equalize things a bit. I think it would be hard to really use an acuity system when things change so rapidly from day to day.
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