# About productive hours per patient day? - page 5

by rrroyer 70,154 Views | 47 Comments

I'm the manager of a 20 bed ortho/neuro unit and a 29 bed medical/surgery unit. My questions is what are the productive hours per patient day alotted to various units/hospitals across the nation. We just had consultants come... Read More

1. 0
At our facility we staff according to an acuity based system. We do have recommended HPPD - Surgical 7.2, Medical 7.91, CCU 15.87, Neuro 8.67.

However these numbers are based on an average acuity - take for instance our medical floor. The average acuity is 1.34 (we get that from benchmark questions the nurses fill out on each patient each day)

So, based on the average acuity (1.34) and a census of 31 the floor should receive:

Days: RN 6 / PCA 5.3 (rounded to 5)
Eve: RN 5.8 (rounded to 6) / PCA 4.9 (rounded to 5)
Nights: RN 4.9 / PCA 3.7

This includes the charge nurse but not secreteries or managers.

However, last night we had an acuity of 1.53 so for a census of 31 they received:

Days: RN 7.14 (7) / PCA 5.67 (6) (we added 1 pca for their 2nd 1:1 to = 7 pca's)
Eve: RN 6.89 (7) / PCA 5.27 (5) (most likely will add a pca)
Nights: RN 5.9 (6) / PCA 4 (will probably add 1 pca)

We rarely if ever hit our HPPD, but the staffing ratio comes out of what we call THPWI (Total Hours Per Work Index). Basically if you multiply the census times the acuity times the THPWI you will get a number of hours to divide between each shift and RN's/PCA's (there is some other calculation in there but essentially that will get you very close)

Of course management is "reviewed" when the acuity is higher than the average, but as long as they can make a case for the high acuity it is ok.

Staffing is supposed to staff according to the numbers generated by the acuity program - however a matrix still comes into play. If the acuity comes back and each RN is taking 10 patients, they are given additional staff to get them down to acceptable shift staffing (D-6 / E-7 / N-8). Also the charge for each shift can request additional staff or (variance) but must justify it to their manager.

Hope this helps,

Pat
2. 0
What is considered "productive hours" at your organization? I am asking for as many responses as possible. My organizations include: orientation, education, sitters, and meeting time. Is this true for most places? We all know that those hours are not productive. Productive hours are for providing direct patient care. I would appreciate any information.
3. 1
Check NDNQI for HPPDs.
varnjosie likes this.
4. 0
@ hunt 95: My organization also includes the items you name in productive time.
Last edit by catlover314 on Oct 17, '10 : Reason: needed to address it to specific person
5. 0
Hi ,
I am trying to calculate HPPD backwards, in a sense. Suppose you go over the HPPD like instead of 6.00 HHPD you are 6.28. How do figure out hour many hours you went over?
6. 0
Thank you RNPTL, It helped me greatly to understand it and to explain it clearly to staff. Do you happen to know what the JCAHO standard is for an assessment for patients on med/surg? Is it in a 24 hour period an RN must do a full assessment on the patient and record it. Do you suggest it be done on the day shift early? I have heard many different things??
7. 0
Quote from shull
Thank you RNPTL, It helped me greatly to understand it and to explain it clearly to staff. Do you happen to know what the JCAHO standard is for an assessment for patients on med/surg? Is it in a 24 hour period an RN must do a full assessment on the patient and record it. Do you suggest it be done on the day shift early? I have heard many different things??
Great! I am glad to see that this thread is still helpful to nurse managers even today! As far as assessment is concerned, I have always gone with the premise that your policy should speak to how your hospital or unit assesses patients. For example, we know that the patient in an acute care environment must be assessed by a registered nurse every 24 hours. Defining a specific timeframe for this assessment is something I would avoid. If you are unable to meet your policy expectation for some reason, then you are out of compliance. Better to simply say that the patient is assessed every 24 hours by an RN.

Hope this helps!
8. 0
Quote from RNCFJ
Hi ,
I am trying to calculate HPPD backwards, in a sense. Suppose you go over the HPPD like instead of 6.00 HHPD you are 6.28. How do figure out hour many hours you went over?
Sorry for the delay in response. If you are interested in defining your variance to hours assigned, simply multiply the hours you ran for the 24 hour period by your total census. If you ran 6.28 hours and your census was 24 patients, this means you ran a total of 150.72 hours for the day. if you were budgeted to run 6.00 hours, that means you were over budget by 6.72 hours.

6.28 X 24 = 150.72

6.00 X 24 = 144.00

Variance to budget: 6.72 hours.

Hope this helps.