Utilization of patient classification systems in Swedish hospitals and the degree of satisfaction among nursing staff

BACKGROUND

Although patient classification tools have been used in Sweden since the 1980s, few studies have examined how they are utilized and monitored.

AIM

This paper investigates the patient classification systems implemented in hospitals in the country as well as the level of satisfaction of nurses with the implemented instrument.

METHOD

A postal survey method was used in which a total of 128 questionnaires were sent to nurse managers. Twenty-three hospitals were identified with patient classification systems currently in operation.

RESULTS AND CONCLUSION

The Zebra and Beakta systems are the most commonly used instruments. Nurse managers appear to be satisfied with the patient classification systems in use on their wards as a whole except for their inability to measure the quality of care provided, the time spent to use the instruments and the fact that the administration do not estimate nursing staff requirements using the system.

Data warehouse approach to nursing management

AIM

This article describes a data warehouse approach when designing an information system to meet nursing management needs in acute hospital setting.

BACKGROUND

The rapidly changing health care environment has created new challenges for nursing leaders and requires appropriate, accurate and timely data for decision-making.

METHOD

Key aspects of current information needs were identified by a nursing expert group. A data warehouse-based Nursing Management Information System was produced and piloted in nine wards. A survey and interviews were conducted to evaluate the piloting.

RESULTS

Data from the patient administrative system together with nursing rostering data and measures for nursing care intensity brought new opportunities for nursing management.

CONCLUSIONS

A Nursing Management Information System is suggested to be built using data warehouse model. Successful implementation of a Nursing Management Information System requires systematic data quality checks. An information analyst is essential for interpreting and communicating nursing data to multi-professional management groups.

Nursing leadership succession planning in Veterans Health Administration: creating a useful database

An electronic database was developed for succession planning and placement of nursing leaders interested and ready, willing, and able to accept an assignment in a nursing leadership position. The tool is a 1-page form used to identify candidates for nursing leadership assignments. This tool has been deployed nationally, with access to the database restricted to nurse executives at every Veterans Health Administration facility for the purpose of entering the names of developed nurse leaders ready for a leadership assignment. The tool is easily accessed through the Veterans Health Administration Office of Nursing Service, and by limiting access to the nurse executive group, ensures candidates identified are qualified. Demographic information included on the survey tool includes the candidate's demographic information and other certifications/credentials. This completed information form is entered into a database from which a report can be generated, resulting in a listing of potential candidates to contact to supplement a local or Veterans Integrated Service Network wide position announcement. The data forms can be sorted by positions, areas of clinical or functional experience, training programs completed, and geographic preference. The forms can be edited or updated and/or added or deleted in the system as the need is identified. This tool allows facilities with limited internal candidates to have a resource with Department of Veterans Affairs prepared staff in which to seek additional candidates. It also provides a way for interested candidates to be considered for positions outside of their local geographic area.

Impact of Average Patient Acuity on Staffing of the Phase I PACU

The authors consider methods for determining staffing requirements for a Phase I PACU. Given that the total number of nursing hours per day is limited by budgetary constraints, PACU staffing can be adjusted to minimize the percentage of days that the PACU is full and cannot accept additional patients from the OR. Except for very small PACUs, the number of staffing options is so large that computer optimization methods must be used. In addition, patient acuity must be incorporated into the staffing plan. Methods are described for adjusting staffing requirements when some patient acuities differ from 1 nurse:2 patients, when patients transition from one acuity to another, and when acuity is not known for all patients.

A web-based programme for hospital and community student placements

A web-based clinical placement information project was implemented through a partnership between one university, an acute trust and one primary care trust. The collaborative project was developed as a result of the concern regarding a lack of parity of information and learning opportunities for students between individual placements in the area and in recognition that both higher education institutions and service providers are responsible for the quality of the learning opportunities provided for students. Student nurses are given a 10-14 week hospital or community placement in an area that can be up to 30 miles away from the university campus. Problems arise from this geographical separation and the diversity of placements in the area. The web site provides a resource of contact details and information of possible learning experiences for students, outlining the aims and objectives of the placements and services in the area.

Assessment of nursing management and utilization of nursing resources with the RAFAELA patient classification system - case study from the general wards of one central hospital

BACKGROUND

RAFAELA is a new Finnish PCS, which is used in several University Hospitals and Central Hospitals and has aroused considerable interest in hospitals in Europe.

AIMS AND OBJECTIVES

The aim of the research is firstly to assess the feasibility of the RAFAELA Patient Classification System (PCS) in nursing staff management and, secondly, whether it can be seen as the transferring of nursing resources between wards according to the information received from nursing care intensity classification.

METHODS

The material was received from the Central Hospital's 12 general wards between 2000 and 2001. The RAFAELA PCS consists of three different measures: a system measuring patient care intensity, a system recording daily nursing resources, and a system measuring the optimal nursing care intensity/nurse situation. The data were analysed in proportion to the labour costs of nursing work and, from that, we calculated the employer's loss (a situation below the optimal level) and savings (a situation above the optimal level) per ward as both costs and the number of nurses.

RESULTS

In 2000 the wards had on average 77 days below the optimal level and 106 days above it. In 2001 the wards had on average 71 days below the optimal level and 129 above it. Converting all these days to monetary and personnel resources the employer lost 307,745 or 9.84 nurses and saved 369,080 or 11.80 nurses in total in 2000. In 2001 the employer lost in total 242,143 or 7.58 nurses and saved 457,615 or 14.32 nurses. During the time period of the research nursing resources seemed not have been transferred between wards.

CONCLUSIONS

RAFAELA PCS is applicable to the allocation of nursing resources but its possibilities have not been entirely used in the researched hospital. The management of nursing work should actively use the information received in nursing care intensity classification and plan and implement the transferring of nursing resources in order to ensure the quality of patient care.

RELEVANCE TO CLINICAL PRACTICE

Information on which units resources should be allocated to is needed in the planning of staff resources of the whole hospital. More resources do not solve the managerial problem of the right allocation of resources. If resources are placed wrongly, the problems of daily staff management and cost control continue.

Nurse requirement planning: a computer-based model

RATIONALE

The paper considers the recent debate on mandating patient-nurse ratios in inpatient units of hospitals, and highlights the need for a comprehensive approach to requirement estimation, which can facilitate the implementation of mandated patient-nurse ratios in hospitals.

AIM

After considering the available methods for nurse requirement planning, this paper intends to discuss an alternative approach for estimating nurse requirement when certain patient-nurse ratios have been prescribed.

METHODS

Once the required information becomes available, the next task is to estimate unit-wise and overall nurse requirement. As the computational effort is quite considerable, the paper develops and elucidates a computer-assisted nurse requirement-planning model, which helps in systematizing and accelerating the estimation process.

RESULTS

The computer-based nurse requirement-planning model enables planners to respond objectively and promptly to requests for more nurses by nursing administrators (who perceive nurse shortages).

CONCLUSIONS

The paper demonstrates the unique advantage of this computer-based approach over conventional methods, especially when the planner wishes to pre-evaluate alternative decision options by simulating manpower implications under alternative scenarios.

Analyzing fluctuating unit census for timely staffing intervention

A computer information system, which can provide cost-saving measures useful in adequately allocating nursing staff in the face of decreasing patient stays, increasing patient admissions and discharges, and the unexpected transfers surrounding busy nursing units, is explored.

User-driven design of a computerized rounding and sign-out application

Clinical information systems depend on close integration to workflow for success. We describe a method for user-driven design that guided our development of a computerized rounding and sign-out system. The resulting system supported clinical workflow sufficiently well that it spontaneously attracted new users, required no training, and is currently used by 95% of the house staff at two academic medical centers.

Virtual scheduling. A 21st-century approach to staffing

Nursing professionals have been aware of the management challenges associated with hospital scheduling and staffing for years. However, today's changing work force, advances in technology, increased financial pressures, and regulatory oversight have put the scheduling process on health care's strategic agenda. Virtual staffing is the optimization of front-to-back hospital processes, integrating traditionally disparate systems to provide prospective and informed decisions about resource planning.

Interactive computer aided shift scheduling

This paper starts with a discussion of computer aided shift scheduling. After a brief review of earlier approaches, two conceptualizations of this field are introduced: First, shift scheduling as a field that ranges from extremely stable rosters at one pole to rather market-like approaches on the other pole. Unfortunately, already small alterations of a scheduling problem (e.g., the number of groups, the number of shifts) may call for rather different approaches and tools. Second, their environment shapes scheduling problems and scheduling has to be done within idiosyncratic organizational settings. This calls for the amalgamation of scheduling with other tasks (e.g., accounting) and for reflections whether better solutions might become possible by changes in the problem definition (e.g., other service levels, organizational changes). Therefore shift scheduling should be understood as a highly connected problem. Building upon these two conceptualizations, a few examples of software that ease scheduling in some areas of this field are given and future research questions are outlined.

Staffing and scheduling at your fingertips

Learn how staff-scheduling software can help you reach goals for data gathering and management, outcomes improvement, or cost savings goals, and how to select the best system for your organization.

Statistical method using operating room information system data to determine anesthetist weekend call requirements

We present a statistical method that uses data from surgical services information systems to determine the minimum number of anesthetists to be scheduled for weekend call in an operating room suite. The staffing coverage is predicted that provides for sufficient anesthetists to cover each hour of a 24-hour weekend period, while satisfying a specified risk for being understaffed. The statistical method incorporates shifts of varying start times and durations, as well as historical weekend operating room caseload data. By using this method to schedule weekend staff, an anesthesia group can assure as few anesthetists are on call as possible, and for as few hours as possible, while maintaining the level of risk of understaffing that the anesthesia group is willing to accept. An anesthesia group also can use the method to calculate its risk of being understaffed in the surgical suite based on its existing weekend staffing plan.

Determining staffing requirements for a second shift of anesthetists by graphical analysis of data from operating room information systems

Some operating room (OR) managers face the dilemma whereby all cases in a surgical suite are not completed during a regularly scheduled (e.g., 8-hour) day. If the anesthesia group at the surgical suite plans for its employed anesthetists to work a fixed number of hours each day, then more than 1 shift of anesthetists may be needed to care for the patients in the ORs. We developed a graphical statistical method that anesthetists and anesthesiologists can use to determine how many anesthesia providers are required on the second shift to minimize labor costs. The method uses data from surgical services information systems or hospital information systems to compensate for seasonality or seasonal variation in the number of ORs running at different times of the day. We also consider application of our method to scheduling surgical nurses with multiple overlapping shifts throughout the day.

Oh baby! A labor and delivery staffing system measures patient census and acuity

The unique characteristics of labor and delivery units make it difficult to plan clinically and fiscally justified staffing patterns. This article presents an effective technique to measure patient census, track patient acuity, and determine required and actual nursing care hours.

Self-scheduling with Microsoft Excel

Excessive time was being spent by the emergency department (ED) staff, head nurse, and unit secretary on a complex 6-week manual self-scheduling system. This issue, plus inevitable errors and staff dissatisfaction, resulted in a manager-lead initiative to automate elements of the scheduling process using Microsoft Excel. The implementation of this initiative included: common coding of all 8-hour and 12-hour shifts, with each 4-hour period represented by a cell; the creation of a 6-week master schedule using the "count-if" function of Excel based on current staffing guidelines; staff time-off requests then entered by the department secretary; the head nurse, with staff input, then fine-tuned the schedule to provide even unit coverage. Outcomes of these changes included an increase in staff satisfaction, time saved by the head nurse, and staff work time saved because there was less arguing about the schedule. Ultimately, the automated self-scheduling method was expanded to the entire 700-bed hospital.

A collaborative assessment of workload and patient care needs in four rehabilitation facilities

This article describes the process used by nurse executives at four freestanding rehabilitation facilities to implement and validate an interactive patient classification system. The research process involved defining critical indicators, measuring workloads by level of staff, and validating the number of care hours for the levels of patient classification. The database enabled the four consortium members to share their knowledge, resources, and costs of implementing a patient classification system, and it provides a benchmark of rehabilitation services. The study data are being used in making staffing decisions, preparing and defending budgets, and identifying the cost of care by disability classification.

Want simple, superior resource management?

Many nurse managers practice enterprise-wide resource management across networked departments and facilities. Here's help in understanding how automation can ease the process.

[Application of linear programming in optimizing nursing staff allocation in hospital]

After analysing the nurse work load of all departments in a certain hospital by comprehensive evaluation, the nursing staffs were allocated inappropriately was found. According to the work load of all departments, the optimal allocation of nursing staff was obtained with linear programming, so that the work load of all departments would be as identical as possible, and the disadvantages of differing in work load would be overcomed.

[Electronic data processing in nursing: specific needs related to rostering programs in nursing]

Electronic data processing is taking over in the nursing domain in German hospitals. This is due, not only to the fact that computer hard- and software are getting better and cheaper, but also due to the legal demands of the new health legislation. Neither nurse-managers nor the nurses themselves are adequately prepared for this technical innovation or its implications. The dominant influence of management-interests leads to the danger that criteria relevant to the content of nursing fail to be taken into account. Consequently the quality of care may suffer. The Ministry for environment, energy, youth, family and health has commissioned the Agnes Karll Institute for Nursing Research to identify software features specific for the requirement of nurses. The study focuses on rostering programs for nursing staff allocation, in relation to the workload and on conditions which have to be met to make software nurse-friendly. Selected, important results are reported.

A scheduling model for hospital residents

When medical students finish their school they must go through a horrendous apprenticeship known as hospital residency to be able to practice medicine. During residency, they work at least 16-hr a day, 5-days a week, with 2 or 3 nights on-call. These can turn into 36-hr shifts. This means that many patients are being treated by exhausted novices, who are therefore much more likely to make mistakes. It was one such mistake, leading to the death of a New York woman, which led to serious attempts to reforming working hours of residents. In this paper, we developed a decision model which attempts to schedule residents based on the requirements of the residency program as well as the desires of residents as to days-off, weekends, on-call nights, etc.

In-house medical personnel scheduler: a computerized on-call scheduling program

Creating an on-call schedule for health care professionals can be a time-consuming and thankless task. We have created a computer program to reduce the time consumed when creating and correcting a call schedule and to reduce complaints about perceived call inequalities.