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  1. Ramson, Kathy Paulik DNP, RN, NE-BC, CCRN
  2. Dudjak, Linda PhD, RN
  3. August-Brady, Michele PhD, RN
  4. Stoltzfus, Jill PhD
  5. Thomas, Paula DNP, RN


OBJECTIVE: This study examined the effects of an acuity-adaptable care model in a rural hospital setting on nurse satisfaction, patient satisfaction, patient safety, and quality indicators (events, falls, and medication errors), patient length of stay (LOS), and worked hours per patient-day (WHPPD).


BACKGROUND: Acuity-adaptable care models have been implemented as a nursing strategy to improve workflow through the elimination of unit-to-unit patient handoffs. However, to our knowledge, this model of care has not been studied in a rural hospital setting.


METHODS: A descriptive, comparative design with repeated measures was utilized for this study. A professional nurse survey was created to measure staff satisfaction; separate t tests for percentages were utilized to evaluate patient satisfaction and patient safety/quality indicators. Financial data were examined to perform the analysis of patient LOS and WHPPD.


RESULTS: The nurse satisfaction survey demonstrated a decrease in weekly floating and cancellations due to low census. There was a statistically significant improvement in patient satisfaction for overall rating and willingness to recommend the hospital. No significant difference was noted in patient quality indicators or LOS; however, there was a favorable trend for all events and medication errors. This study also found a decrease in WHPPD, with a corresponding salary expense reduction reported.


CONCLUSION: Acuity-adaptable units may be a viable strategy for rural facilities.