Payers reimburse observation patients and outpatients in a bed by the number of minutes the patient is in a bed. When the minutes accumulate to equal 24 hours, the area is given credit for 1 patient day.
For example, if a care unit has three patients who each stay 8 hours, this is equivalent to 1 patient day volume. Inpatients are paid by a daily bed rate; the inpatient day of discharge typically isn't reimbursed.
It's important to be aware of this because there are staffing strategies that can be used to improve performance. Arranging nursing assignments in a way that allows two nursing assignments to be combined as one after discharges is a way to match nursing hours to the number of hours that patients are in a bed. Many institutions are implementing daily multidisciplinary rounding, which supports discharge education and planning on admission, and facilitates the early dismissal of patients on the day of discharge.
Multidisciplinary rounding allows for improved caregiver communication, patient care, and discharge experience. Early discharge decreases labor costs by flexing down staff after dismissal. Another advantage to early discharge is that it opens up beds, allowing for the smooth flow of patients through the building. Managing patient throughput is essential to ensuring a constant readiness to serve. Staffing acuity systems and grids are tools that can be used to improve consistency in staffing decisions; however, remember that staffing tools shouldn't supersede critical thinking.
If quality care can be delivered with fewer resources than the grid shows, then staffing down is appropriate. Does the acuity rating accurately reflect the time it takes to care for a patient? It's important to realize that a staffing grid calculator typically looks at those hours in direct patient care.
Unless specifically added into the calculations, there are hidden hours that won't show up on this tool. Depending on your institution's definition of productive versus nonproductive hours, these hidden hours may include early clock-ins; late clock-outs; and manager, meeting, and training hours.
Using a typical nursing unit as an example:. The initial shift calculator showed the HPPD at After adding in the hidden hours, the true HPPD are Although many of these hidden hours may be necessary to support unit functions, you need to be ever vigilant of the number of these hours and look for opportunities to minimize them.
Training and orientation of new staff can be a huge drain on budgeted productive hours, making it important to support staff engagement and decrease staff turnover. Drilling down to find the number of early clock-ins and late clock-outs allows you to identify the reason for these overages and initiate strategies to decrease them. The previous example of end-of-shift late clock-outs may seem like a small number of hours related to the total number of productive hours used in a day, but early and late clock-outs combined with other overages quickly add up and can be the difference between meeting or not meeting financial targets.
In the example, we showed 2 hours of late clock-outs. Two hours of daily late clock-outs over a month is 60 hours, or an additional five hour staffing shifts. Strategies to decrease late clock-outs may include giving staff members the same assignment as the previous day, allowing for faster report; looking for opportunities to standardize shift report, allowing for streamlining of information; evaluating the level of effective communication between licensed and unlicensed staff, ensuring a team plan with the same priorities for the day; having the charge nurse identify RNs who've fallen behind on documentation before the end of the shift and take over patient care, allowing the RNs to complete their documentation and leave on time; and mitigating change-of-shift admissions and transfers by streamlining the discharge process.
Even the busiest units can have an occasional low census day; overstaffing just a few days a month can have a negative impact on overall productivity. Low volume takes away economies of scale and can make staffing assignments more difficult to manage. A detailed, written, low staffing plan is a key to ensuring efficiency. Points to consider in a low census plan include identifying the census point at which the charge nurse or manager is in assignment, developing a plan to consolidate patients to the same geographic area to improve nursing workflow, creating guidelines for voluntary and mandated canceling of extra staff, and promoting the expectation that all staff members are clocked out within 30 minutes of the given low census time and they aren't held over to relieve for lunches or potential patients that may never arrive.
There are clear data showing that process variation increases waste, and the processes used to determine appropriate numbers of staff are no exception. To ensure quality care and efficiency, all staff members who are responsible for making daily assignments need to have a thorough orientation that includes patient safety and regulatory concerns, how to determine correct staffing numbers, licensed to unlicensed staff ratios, when it's appropriate to staff down or up from the staffing acuity or grid tool, and how to access the chain of command.
You should oversee daily staffing to identify coaching opportunities, including mentoring those who are in charge on the night and weekend shifts. On many units, the census goes down on the weekend and patient needs may decrease on the night shift, so it's imperative to take advantage of down staffing when the opportunity presents. Having a checks and balances process ensures efficient and consistent staffing between charge nurses.
Touch base with charge nurses throughout the day and evening to mentor, discuss staffing plans for the following shifts, and establish guidelines for the charge nurse to contact you if he or she believes that the plan needs to change or if there's a need to staff above the acuity or grid tool.
Waiting until after the shift to discuss the details of how the staffing decisions should have been implemented is too late. Are you on the staffing bubble or did you think you were getting a new patient who never arrived? Both situations have the potential for overstaffing. Proactive discussions with charge nurses regarding these situations, along with well thought-out staffing strategies, are essential to avoiding staffing pitfalls.
When on the staffing bubble and trying to determine to staff up or down, it's advisable to staff down initially, with the option of calling in additional help if needed. It's much easier to call in a staff member than send one home after he or she is in assignment.
To avoid the work of inappropriate transfers in and out of a unit, develop written guidelines that state the type of patients appropriate for the area and ensure that the charge nurse is involved in the transfer decision. When able, avoid calling in additional staff until the patient arrives on the unit.
It's often possible to absorb a new patient with current resources versus staffing up. The charge nurse may take a light assignment to get through a busy time, take over another RN's assignment so that he or she can take the admission, or give a strong clinician an additional patient with increased unlicensed or charge nurse support. Many hospitals have house supervisors who may be able to assist with care or they may know of another area of the hospital that can send a staff member for a few hours.
The consistent use of these lean staffing strategies can lead to an improvement in productivity. Productive SPPD are a result of multiplying productive hours worked by the average hourly rate. There are many variables that affect SPPD. If an area is well staffed, requiring very little premium pay, and has low orientation expense, the SPPD may be below target, whereas the HPPD may be at or above target related to low volume or high acuity.
To keep SPPD within target, staff to core so that there are enough staff members to meet the most frequently occurring census, which leads to decreased OT use, incentive pay, and use of agency or resource team nurses who receive a higher hourly rate.
Adequate core staffing is important to maintain quality and staff satisfaction, and keep costs down by ensuring staff members aren't working excessive hours above their FTE.
OT expense can be reduced by creating a balanced schedule, including weekends and holidays; maintaining a to ratio of full-time 0. Creating a balanced schedule includes a proper skill mix of licensed to unlicensed staff. Nurses should be working at the top of their license while unlicensed staff members provide care that doesn't require a license and can be done safely within their scope of practice.
Expand All Collapse All. Hospital Inpatient Quality Reporting Development. What are the Milestone Definitions? There are no links associated with the measure at this time. Returns all measures which contains either aspirin or cardiac. Returns all measures which contain aspirin and either cardiac or hospital. Info As Of. Total number of productive hours worked by nursing staff with direct patient care responsibilities for each hospital inpatient unit during the calendar month.
Denominator is the total number of patient days for each in patient unit during the calendar month. Denominator Exclusions. Patient days from some non reporting unit types, such as Emergency Department, peri operative unit, and obstetrics, are excluded. Despite the consistent evidence that better nurse staffing contributes significantly to improved patient outcomes, there is considerable variations in nursing care hours across and within different unit types.
Measure Developer. Development Stage. Measure Type. Meaningful Measure Area. Healthcare Priority. NQF Endorsement Status. NQF ID. Last NQF Update. Target Population Age. Target Population Age High. Target Population Age Low. Print this page Twitter Youtube LinkedIn. Home Nursing Hours per Patient Day. Is used in the inpatient setting wards , including haemodialysis, short stay, day surgery settings.
Measures and reports on the direct clinical care hours required and provided by nurses and midwives. The tool can also be used for: Predictive roster and shift planning Bottom up roster building for new or reconfigured services Tracking and reporting on variance across a roster period to help provide better roster management.
What other information is important to consider in delivering safe nursing and midwifery care? How were the benchmarks set? For Ward 4 it is 6.
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