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Patient activity, Staffing, Productivity



  1. Urbanowicz, Janet A. RN, BSN, MSA


Patient care using patient volume rather than acuity has been a long-standing problem in a cardiac catheterization laboratory in a central New Jersey Medical Center. The current pattern of staffing results in some of the nursing staff becoming unproductive from a patient care perspective. This recently has become a concern of the Vice President of Nursing who has the unpopular task of consolidating nursing positions.


There is a very effective acuity measurement system, the Medicus Acuity System, in place for the various inpatient areas. This system also exists in the Emergency Department and is called EMERGE. The system collects and objectively weighs information regarding severity of patient needs or acuity. These data are collected daily and provide unit managers with information regarding hours of direct nursing care on their particular units. The information over time shows trends in direct care hours and allows these managers to target the average patient population. The system gives insight into units that require more and less nursing hours by hour of the day, day of the week, and month of the year. This makes overall housewide use of nursing personnel more patient-care appropriate and more financially sound, for example, in the summer months when acuity is shown to be higher. In today's managed care environment this author believes the practice of staffing units based on bed occupancy is now regarded as antiquated, inefficient, and impractical. This study investigated a modified version of the EMERGE tool and its ability to capture patient acuity as it relates to staffing in the cardiovascular laboratory (CVL).


During the 5 days of data collection, 87 patients were cared for in the CVL. The modified EMERGE cards were completed on 54 of the 87 patients that week. This represented 62% of that total patient population. Each day data for 60% or more of the patients were entered into the study. The interrater reliability of the data collected was better than 98% each day with overall accuracy being 99.5%. This interrater reliability was based on the findings by the expert panel, who compared two or three (approximately 10%) of the actual nurses' notes to the matching EMERGE cards each day.


More than 80% of the 54 patients were classified as Type 3, well above the Type 1 standard patient acuity category for the EMERGE system. Telemetry units with a majority of EMERGE Type 3 patients would require between 50 to 100 minutes of care per visit and would have a significant nursing workload. These units are where the CVL draws most of their patient population.


In summary, this study reflects a growing trend in healthcare that requires justification of staffing through the productivity of workers. Acuity tools provide tangible and objective data about daily workload and productivity by measuring patient's needs. As managed care forces hospitals to cut staff, acuity tools will become more important for evaluating productivity and retaining staff, especially nurses.