patient acuity system

EHOLISTIC-

You really did not specify how large the unit was.....25....50 beds? How did you figure staf ratio/acuity as "normal"? I am currently working with the Keane System in attempting to set up a patientacuity/staff ratio program that would fit our needs in a small rural hospital in southeastern ohio.

I can see this is a hot topic!! LOL No one really answered your questions, and I'm not sure I can either, but I'll try.

Diane

Our unit could use something more concrete too! Same problem, acuity is increasing but there is nothing concrete to hang your staffing criteria on. Having a more concrete 'mathmatical' process would help all concerned (admin. & HR for hiring practices, current unit staff, staffing co-ordinator and charge nurses for day to day operations, etc.) to see our actual need.

Patient Acuity System:

# of patient rooms occupied divided by # of nurses on shift= # of patients per nurse

acuity???what acuity???

we used an acuity system. you check a box next to the service that will be needed for the next shift. the nurses that work the floor were not included in setting it up and deciding options.

half of the stuff we had to do was not included in the choices(like transporting pt off the unit for xray where you could be gone for 30 min to an hour/sometimes two staff needed to reposition patient). or when a staff member has to leave the floor with a patient for a procedure and be gone for hours or all day.

i worked off site from the hospital so we had no support staff. there was nothing to indicate starting heplocks(it was done by the iv team at main hospital),changing picc/central line dressings(also iv team), and so many more things. plus how can you anticipate what will happen on the next shift???!!!

i checked every box possible every day. we would get "talked to" for checking too many boxes. like i checked lab draws every day because they drew labs on the next shift. they would complain if the pt didn't get that done--but i'm anticipating the doc to come in and he might order it. most pts got labs almost daily.

i checked shower--we were only supposed to do it on shower day(qod)--but who is to say if that pt has an incontinent episode or his family comes in and demands a shower at that time.

i just tried to anticipate any and all things that might happen to help with our staffing because it was bad. and we were offsite--we had to call 911 for a code!!

i floated to the main hospital and did their grasp--i was shocked to find out they got more points for their dressing changes than we did. burn care did the dressing changes over there. we did our own(including wound vac and complicated burns etc...). they also had alot more options to choose from than we did. i notified our manager and the person in charge of grasp at our hospital but nothing changed.

i don't know why i bothered--it was still like moonrose said--#of patients=# of nurses and or cnas.

i think our staffing dropped the last time from 6.3(without counting unit sec and manager) to 5.7 counting unit sec, manager, and assistant manager.

it is just ridiculous. i better stop now but you get the idea. please don't do this to your staff!!

Does anyone use a patient acuity system? My nurses feel like the acuity of their patients have increased so much that the normal ratio they are used to now feels unsafe to them... with battleing with the patient flow from the er when we have open beds, its hard to tell the nurses they have to yet take another patient to stop from posting the pt in boarding status in the er. help!!!!

Hello,

Not a manager, but have done research in the past on this. There is a software product by Quadramed called "AcuityPlus", which was used on an MICU I worked for.

http://www.quadramed.com/care_management/

There are some tools which can be used to judge acuity and amount of time nurses need to spend with a patient.

The TISS-28 (Therapeutic Intervention Scoring System), developed in 1996, produces a prediction of the number of minutes of nursing care required on an 8 hour shift for a particular patient. The TISS-28 is based on required interventions, such as suctioning, dressing changes, medications, and parenteral or enteral nutrition (Lefering, Zart, & Neugebauer, 2000).

The NEMS (Nine equivalents of nursing manpower use score) scale, developed in 1997, is based on the TISS-28, but has reduced the number of items in the instrument from 28 to 9 (Miranda, Moreno, & Iapichino, 1997).

Then there is the Apache II system for determining acuity and mortality. This is an online calculator:

http://www.sfar.org/scores2/apache22.html

Unfortunately, you could probably produce very compelling data for lowering your ratios, but it will probably be ignored, as most hospitals are looking at the bottom line now.

My hospital has raised their ratio to 6:1 (a Magnet hospital who advertised their low patient:nurse ratios), and these 6 patients are total care, heparin and cardizem drips, traches, blood hanging, etc etc etc. It's a shame, because most of us feel unsafe now.

Good luck,

Oldiebutgoodie

I've posted before regarding needing something concrete, so I can see we are all in the same boat. I've develped some spreadsheets I use for personal uses, that all me to show a more clear picture as to what the staffing vs. census/acuity is. Of course, it means nothing to non-clinical persons who are controlling the situation (HR, CEO, etc) but it at least shows you are actively keeping an eye on things as well as those non-clinical persons who are giving you the grief don't have a CLUE of all the realities and possibilities.

It may be timing consuming to enter your data, but if you'll send me your e-mail, I'll be happy to send it to you. The spreadsheet is in Excel just as a heads up.

My e-mail is [email protected]

napochi, llc. healthcare company has developed an acuity based patient care software.

www.napochi.com for software demo.

I took a look at their site and found an interesting video on their interactive assignment board: http://www.napochi.us/index.php?option=com_content&view=article&id=21&Itemid=61

Has anyone else seen this system?

I think the problem is acuity is only scored in a critical care setting. When the hospital looks at it, med surg is med surg. Those are medically managed patients who shouldn't be so acute. If they are more acute, they will be on a telemetry floor. If too acute for telemetry, they will go to a PCU or ICU. SO I think most actue care hospitals determine acuity as to what unit they are on. If these patients are more acute than what your unit usually handles, perhaps they need an upgrade in status to a different unit?

MOMRN0913,

I am a manager of the staffing office and we use an evalysis tool. I am currently looking to learn more about others and have seen several systems in conference settings. I like the Evalysis tool because it is not a sum of task. Yes, and ICU patient is more ill than PCU is more ill than TELE is more ill than MED/SURG....but...in all areas there is a norm of what is usual that you design based on your unit specific population and it incorporates the social and complex medical management of a patient. It incorporates what the patient needs and support and defense of budget. We are in Southern California and have mandated ratios but we also have an acuity requirement to determine if the need for more staff arises. It is not subjective but does have to be learned to use correctly.

I'm the nurse manager of a child psych unit and we use an acuity system that staff designed, so it's not just for critical care. We get more staff for 1:1 kids, kids who are a special 3 day intensive issue work program, etc.

Administration has been trying to get rid of the acuity system but I won't budge. It's the reason we haven't have a sentinel event to date. If it's removed, I will not be staying in my current position. Ethically, I wouldn't be able to sleep at night.

this sounds interesting - are you able to share your method?