About productive hours per patient day?

pickledpepperRN · Feb 20, 2007

Actually, HPPD stands for hours per patient day.
What this means is the amount of hours permitted or allowed for a nurse to spend with a patient per day (24 hour period). Generally speaking, the HPPD is set by your unit's budget. A nurse manager and the staff nurses are required to work within the confines of these numbers as they render care for the patients. Here is a senario that might help you understand it ....
An HPPD is calculated by the census. So if your unit has a census of 25 patients, then that number is multipled by the unit's HPPD.
Census of 25 multipled by the HPPD of 7.00 equals = 175 hours. The 7.00 is the number that is given to you by upper management and the number that most nurse managers fight over with the CNO to increase.
This means that the nurse manager has 175 hours of nursing time to work with in relationship to staffing the unit. So, If I have 175 hours to work with .... all of my unit's staffing hours must come from this number .... for example:
Assuming a nurse to patient ratio of 1:6 on days and 1:7 on nights and that we are a general medical-surgical unit ... we would staff as follows for this 24 hour period:
Days Shift Staffing Hours
Nurse Managers Hours - 5.73
Charge Nurse 12 hours
(The CRN would take 2 patients)
4 Nurses all 12 hours
2 CNA - 1 for 12 hrs and 1 for 8 hrs
1 Secretary - 12 hours
Total Hours for Days = 92
Night Shift Staffing Hours
Charge Nurse 12 hours
(The CRN would take 5 patients)
3 Nurses all 12 hours
1 CNA for 12 hours
1 Secretary for 12 hours
Total Hours for Nights = 72
Total Hours Per Patient Day for this 24 hour period would be: 170 (rounded)
Sometimes, patient acuity is so high that the nurses can not handle 6 patients on days .... the nurse manager needs to be flexible to staff up if needed to accomodate the needs of the patients. This means that you might go over your allowable hours for the day. However, I usually staff by the pay period .... so, if I am off one day, I try to make it up the other days, if possible .... and always with the help of the nurses.
Hope this helps a little.

Using HPPD for staffing is unfair to nurse managers, direct care nursing staff, and patients.

Staffing needs to be based on the needs of each patient not some budget scheme.

I am sorry you have to deal with this system.

This is just my opinion backed up by experience and research.

BirdieRN, BSN, MSN · Sep 5, 2007

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 and evaluate our productivity. They then suggested lowering our productivity based on "national benchmarks" so I was wanting to compare the real world numbers. Gather my ammunition. ANy help would be appreciated.

Good Luck! Consultants commonly come in to bring down your WHPPD. :trout: It is very difficult to come accross that information on line. One company will sell it to you, and I did purchase it. While it's costly ($150) it does give excellent break downs regarding what facilities are utilizing for their WHPPD. The ability to be as efficient as possible is key, but the best consultants aid on how to get to that point, not just throwing down a number and walking away.

Good luck to you & your staff.

mothertucker · Sep 27, 2007

Wow RNPATL! Thanks for the detailed definition! That helps alot for a novice like myself! I appreciate you taking the time to "spell it out".

RNPATL, DNP, RN · Sep 27, 2007

Wow RNPATL! Thanks for the detailed definition! That helps alot for a novice like myself! I appreciate you taking the time to "spell it out".

Not a problem at all. I am glad we still have people that are willing to be nurse leaders in this day and age of numbers crunching and reimbursement issues. I think many hospital administrators have forgotten the reason we exist is because we care for sick patients. Oh well ....

Love your name by the way! :) Patrick

patwil73 · Oct 20, 2007

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

hunt95 · Sep 25, 2010

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.

kayern · Sep 25, 2010

Check NDNQI for HPPDs.

catlover314 · Oct 18, 2010

@ hunt 95: My organization also includes the items you name in productive time.

RNCFJ · Dec 7, 2010

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?

shull · Feb 6, 2011

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??

RNPATL, DNP, RN · Feb 6, 2011

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! :yeah:

RNPATL, DNP, RN · Feb 6, 2011

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.