Patient acuity measurement

lee1 · Apr 10, 2005

Hi all, do you have a system in place in your hospital, etc for the measurement of patient acuity?? How often, what does it look like??

My state regs state that the hospitals MUST have a system in place and the hospitals must use it. BUT, do they really? Not from what we can tell, it is mostly about census and those state regs that do apply to units like ICUs. cardiac telemtry, open heart, NICU. Med/surg is out in the wind of course. The acuity system seems to not really capture all of what we do. Does your??

RNKPCE · Apr 10, 2005

I agree acuity systems are a joke. But they shouldn't be. Basically they staff by # of patients or mandated state ratios.

Our current acuity system does nothing to tell you how many nurses is required so I don't see how it can even meet the legal reason.

We use to have a system where all the data was calculated and by some formula it came up with number of staff needed. I don't know why they gave it up. It seemed to serve a purpose more than the current one does.

Long Term Care Columnist / Guide · Apr 10, 2005

We used to staff by patient acuity, then after the Cardinal consultants blew through, we went to staffing by the numbers alone. We were supposed to be creative with assignments, distributing the heavy-care patients evenly among the staff, instead of assigning a nurse and aide to a contiguous group of rooms/beds. Well, THAT never really happened.......most of our staff has been there for years, and old dogs just don't learn new tricks very quickly, so what we often ended up with was 4-5 patients in a block of rooms, rather than 6. The problem was, there were always at least 3 heavy-care patients among them---folks who needed to be fed, who were incontinent, who needed close observation or Q 2 hr turns, etc.

Unfortunately, the CNA staff had been slashed to the bone, so we had little or no help managing them. Both staff and patients/families began to complain, and so now we've got a sort of mixed system........we STILL don't have enough CNA staff after 3 PM, and that needs to change because even with only 4 pts, if you've got one or two heavy cares and no aide, you're running all the time. But we're getting there........we've hired several new CNAs for day shift, and management is revamping the staffing grid so there are NO cuts from 7 AM-11 PM (unless, of course, we D/C 10 patients and don't get any admissions).

IMO, any staffing model that DOESN'T include patient acuity is worthless, because if you have 3 patients who need total care, it's harder than if you have 6 who are alert & oriented and can go to the bathroom on their own or with minimal assist. (Me, I prefer the latter.......not only is the load easier to handle physically, but there's less chance of getting an admission. :) )

And whatever staffing model is used, DON'T put the unit secretary in charge of deciding who does the next admission.........ours go strictly by the numbers, and if a nurse has 4 pts. while everyone else has five, she gets the admit even if she got the last one, plus a fresh post-op, another pt. who keeps ripping out his IV and crawling out of bed, and still another who has to go to the bathroom every half an hour and needs 2-person assist :angryfire

flashpoint · Apr 10, 2005

IMO, any staffing model that DOESN'T include patient acuity is worthless, because if you have 3 patients who need total care, it's harder than if you have 6 who are alert & oriented and can go to the bathroom on their own or with minimal assist. (Me, I prefer the latter.......not only is the load easier to handle physically, but there's less chance of getting an admission. :) )
And whatever staffing model is used, DON'T put the unit secretary in charge of deciding who does the next admission.........ours go strictly by the numbers, and if a nurse has 4 pts. while everyone else has five, she gets the admit even if she got the last one, plus a fresh post-op, another pt. who keeps ripping out his IV and crawling out of bed, and still another who has to go to the bathroom every half an hour and needs 2-person assist :angryfire

LOL...too true, too true...:) We have a charge nurse who assigns strictly by numbers...one nurse could end up with three patients who are 99% self care and are only in for IV antibiotics, while another nurse has three total care, incontinent, confused and crawling out of bed, telemetry patients. She also give admits to who ever is lucky enough to be caught up...doesn't matter if the nurse who is caught up hasn't taken a break when the ones who are behind have gone to lunch and out to smoke or to the bathroom five times. I'm still not smart enough to intentionally be half an hour behind...

meownsmile, BSN, RN · Apr 10, 2005

Patient acuity is something that is only in play when inspectors/accrediting bodies come around. Any other time its by numbers. Sure they have the little program that tracks acuity and who is assigned to each patient so if someone comes in and asks they can say sure we watch acuity and staff as such. But it sure doesnt happen on most given days of the week.

lee1 · Apr 13, 2005

Soo, does anyone know what kind of acuity system your hospital uses???