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AcuityPlus™Inpatient Coordinator Guide

Version 8.1

Client Support

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Copyright © 2012 QUADRAMED CORPORATION

AcuityPlus™Inpatient Coordinator GuideTable of Contents

Version 8.1

About This Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvWhat’s New in 8.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi

Chapter 1 Introduction

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 2 Implementation

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Implementation Timetable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Implementation Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Committee/Role Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Nursing Project Coordinator/Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Desired Qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Time Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Coordinator Activities Post System Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


ii QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY

Steering Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Desired Qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Time Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Patient Classification Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Desired Qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Time Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

First Line Manager (Unit Manager/Coordinator) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Desired Qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Time Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Project Sponsor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Data Entry/Clerical Support Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Desired Qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Time Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Network Services Analyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Hardware and Systems Engineer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Technical Installation Analyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Chapter 3 Inpatient Methodology

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Patient Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Research and Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Pre-Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Alpha Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Beta Testing (Phase I) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Beta Testing (Phase II) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Inpatient Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20QuadraMed’s Approach to Patient Acuity and Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Patient Classification and Indicators Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Table of Contents

QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY iii

Workload Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Relative Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Workload Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Acuity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

AcuityPlus Inpatient Methodology Patient Classification Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33AcuityPlus Inpatient Methodology Acuity and Point Range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Sample Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Calculating Classification Workload and Acuity- Example 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

AcuityPlus Inpatient Activity Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41ADT Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 Hr + Activity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Other Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 Hr + Activity Classification Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41AcuityPlus Inpatient 1 Hr + Activities Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431 HOUR+ ACTIVITIES WORKLOAD SCENARIOS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48ANSWER KEY – PROCEDURE WORKLOAD SCENARIO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Calculating Activity Workload and Overall Acuity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Example 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Example 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50Example 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Workload Measurement Key Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Calculation Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Chapter 4 Patient Classification

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53About Patient Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Who Should Be Classified? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54What Timeframe Should Be Used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54Classification Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54Classification by Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Sample Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Cascading Profile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Classifying Patients Located on a Different Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57


iv QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY

Guidelines for Patient Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58Manual or Automatic ADT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58Patient Classification Import Interface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Classification Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60Patient Classification Inpatient Indicator Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Patient Classification Indicator Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Chapter 5 Complexity of Care Methodology

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Complexity Research and Development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Complexity of Care Pre-Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Complexity of Care Testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Participating Institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Complexity of Care Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Complexity Score . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Complexity of Care Skill Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Chapter 6 Staffing Data

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87Guidelines for Collection of Staffing Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Data Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Actual Staffing Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Recording Partial Shifts and Overtime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Orientees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Scheduled/Actual Staffing Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

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Chapter 7 System Control

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Census. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94Data Input Via On-Line Use of AcuityPlus Software. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94Data Input Via Patient Classification Import . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Acuity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Expected Acuity Range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Patient Classification Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Reliability Scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97Reliability Testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Guidelines for Monitoring Patient Classification Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Patient Classification Monitoring Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Unit Monitoring Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104Hospital Monitoring Summary (Acuity Reliability) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105Indicator Agreement Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106Hospital Indicator Agreement Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Inpatient Inter-Rater Reliability Test A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Answer Key for Test A: Multiple Classification by Shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112Answer Key for Test A: One Time Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Inpatient Inter-Rater Reliability Test B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116Answer Key for Test B: Multiple Classification by Shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120Answer Key for Test B: One Time Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122Acuity Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124Actual Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124Paid to Actual Staff Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Complete Column A – Paid Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125Complete Column B – Actual Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Complete Columns C and D – Variance and Percent Variance . . . . . . . . . . . . . . . . . . . . . . . . . 126

Paid to Actual Staff Analysis Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127Paid to Actual Staff Analysis Worksheet Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128Patient Classification: Framework for Data Validity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129


vi QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY

Chapter 8 Staff Education

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131Staffing Education Outline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132Inpatient Indicator Application Exercise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135Inpatient Indicator Application Exercise Answer Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146Answers to Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148Patient Classification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148Workload Index and Acuity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150Staffing Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Chapter 9 Staffing Parameters

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153Staffing Translation Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154Unit Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155Staff Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156Target Hours Per Workload Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157Shift Distribution Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Skill Mix Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159System Staffing Framework Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160Staffing Framework Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160Factors to Consider When Establishing Productivity Targets . . . . . . . . . . . . . . . . . . . . . . . . . . . 161Nursing Activities Included in THPWI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161Target Hours Per Workload Index Analysis Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162Shift Distribution by Patient Type Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163Skill Distribution by Patient Type by Shift Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163Developing Shift Distribution and Skill Mix Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164Shift Distribution and Skill Mix Worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167Testing Goal Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168

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Sample Recommended Staffing Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174Data Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174Shift Distribution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174Skill Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175

Calculating Recommended Staffing Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176Staffing Targets for Non-Direct Care Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

Chapter 10 System Features

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179Staff Assignments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179Sample assignments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181Block assignment (assignments by room order) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181Assignment by Workload/Complexity of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182

Staffing Assignment Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182Outcomes module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182Outcome Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184Outcome Data Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185Staffing Ratio Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191Calculating Staffing Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192Staffing Ratio Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195


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Chapter 11 Transparent Classification

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197Benefits of Transparent Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197Mapping Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198Monitoring Patient Classification Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200

Chapter 12 Review

Review of Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203Review of Concepts: Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204

Chapter 13 Management Reports

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205Reports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208Daily Assignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208Activity Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210Activity Recommended Hours by Hour of Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212Activity Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214

Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215Activity Workload Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217

Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219Actual and Recommended HPWI Trend Graph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220

Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222Actual Staffing by Hour of Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223Actual and Scheduled Staffing by Shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225Acuity/Complexity Trend Graph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228

Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230ADT Activity - Projected and Actual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231Budget, Recommended and Actual Productivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231

Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232Census Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240

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Classification Accuracy by Classifying Nurse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242

Complexity and Acuity Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

Daily Shift Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247Daily Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251Default Classification Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256

Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257Default Classification Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258

Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259Do Not Classify Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260

Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261Executive Patient Care Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262

Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263Hospital Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267Hospital Summary in Dollars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270Indicator Detail by Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274Indicator Specific . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276Indicator Usage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278Inpatient Activity Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281LOS and Average Daily Patient Turnover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284Minimum Direct Staff Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286Monitoring Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289Monitoring Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291Monitoring Trend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293Multiple Classifications and Edit Classifications Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296Multiple Classifications and Edit Classifications Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298Multiple Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299Over/Under Use of Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300Patient Activity by Hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301Patient Classification Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304Recommended Direct Care Staff with HPWI Target and Min/Max Ranges . . . . . . . . . . . . . . . . . . . . . 306Recommended to Actual Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308RN: WI Staff Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310Rolling Indicators Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313Rolling Indicators Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314


x QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY

Staffing Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315Staffing by Hour by Day of Week . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316Staffing by MIS Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318Staffing Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320Staffing Percentages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322Staffing Ratios. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324

Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324Staffing Recommendation Comparisons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327Staffing Variance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330Treatment Area Workload . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335Unclassified Patient Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337Unclassified Patient Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339Unit Monthly Trend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340Unit Performance Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344Unit Period Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346Unit Period Detail by Shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353Unit Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356WI Measurement Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358Workload Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363Workload Analysis by DOW by Hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365Workload by Hour of Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368

Chapter 14 Budget Management

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372Implications for Managers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374Budgeting Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375Unit Labor Resource Budget Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377Unit Labor Resource Budget Worksheet Example:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379Calculating a Replacement Factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381Sample Replacement Factor Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383

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Appendix A Variable Staffing Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . 385

Appendix B Workload Fluctuation Analysis

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387Historical Workload Fluctuation Analysis Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391Historical Workload Fluctuation Analysis Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392

Appendix C Activity Logs

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393Activity Log Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395Sample Activity Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396Sample Activity Log Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397Activity Log Summary Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398

Appendix D Worksheets

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399Scheduled/Actual Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400Patient Classification Monitoring Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401Unit Monitoring Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402Hospital Monitoring Summary (Acuity Reliability) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403Paid to Actual Staff Analysis Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404Target Hours Per Workload Index Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405Shift Distribution by Patient Type. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406Skill Distribution by Patient Type by Shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406Shift Distribution and Skill Mix Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407Testing Shift and Skill Distribution Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409Unit Labor Resource Budget Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415


xii QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY

Appendix E System Parameters – System Setup Guidelines

Job Skills and Titles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418Job Skill/Job Title Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418Job Skill/Job Title Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418Day Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419Shift Definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419Shift Definition Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420Shift Definition Worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420Shift Distribution and Skill Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421Shift and Skill Distribution Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421

Shift Distribution: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421Skill Distribution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421

Shift and Skill Distribution Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423Shift Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423Skill Distribution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423

Staffing Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424Staffing Parameters Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424Staffing Parameters Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426Job Title Parameters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427Job Title Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428Staffing by Census . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429Staffing By Census Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429Staffing By Census Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429Midnight Census . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429Treatment Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429Treatment Area Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430Treatment Area Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430Weekly Schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430Weekly Schedule Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430Weekly Schedule Workload Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431

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Appendix F Determination of Classification Time

Use of the Data Retrieval Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433Data Retrieval Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434Compile Data and Complete the Data Summary Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435Data Summary Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436

Appendix G Educational Sheets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451


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QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY xv

About This Guide

This AcuityPlus™ PFS/WM Inpatient Coordinator Guide provides information on the AcuityPlus Inpatient methodology for your Hospital’s System Coordinator.

Audience and AssumptionsThe information in this guide is prepared with the following assumptions:

You know how to work in the Microsoft® Windows® environment.

You are a system administrator for AcuityPlus.

How to Use This GuideThis guide contains the following sections. Review this book before beginning to use AcuityPlus and thereafter use it as a reference when needed.

Introduction on page 1 Contains an overview of the Inpatient methodology.

Implementation on page 3 Provides information on implementing AcuityPlus with the Inpatient methodology.

Inpatient Methodology on page 17 Describes the Inpatient methodology in detail.

Patient Classification on page 53 Contains information on patient classification, including definitions of the indicators used in the Inpatient methodology.

Complexity of Care Methodology on page 77

Provides information on the Complexity of Care methodology.

Staffing Data on page 87 Explains how staffing data is used in AcuityPlus.

System Control on page 93 Describes the controls to use to ensure reliable workload data.

Staff Education on page 131 Provides an outline for staff inservices.

Staffing Parameters on page 153 Contains information for setting up system parameters for AcuityPlus.

System Features on page 179 Provides information on the Outcomes module.

Review on page 203 Provides information on the Staffing Ratio module.


xvi QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY

Related DocumentationThe following manuals are also available:

Coordinator Guides – Provide information for each available methodology.

AcuityPlus™ Automatic Report Calculation Guide – Explains how to use the Automatic Report Calculation program.

AcuityPlus™ Interface Guide – Provides information on how to use the interfaces with AcuityPlus.

AcuityPlus™ User Guide – Provides information for the system administrator on how to set up the AcuityPlus program and information for the end-user on how to use AcuityPlus.

AcuityPlus™ New Installation Guide – Explains how to perform a new installation of AcuityPlus.

AcuityPlus™ Update Installation Guide – Explains how to perform an update to an existing installation of AcuityPlus.

AcuityPlus™ IT Guide – Provides information for your IT department to maintain, test, and troubleshoot AcuityPlus.

System Requirements documents – Details the system requirements for AcuityPlus.

AcuityPlus™ Technical Architecture – Explains the technical architecture of AcuityPlus.

Management Reports on page 205 Describes the AcuityPlus reports.

Budget Management on page 371 Explains how to create budgeting data to use in AcuityPlus.

Variable Staffing Calculations on page 385

Describes how to calculate staffing adjustments.

Workload Fluctuation Analysis on page 387

Describes how to analyze unit workload fluctuation.

Activity Logs on page 393 Explains how to use activity logs for data collection.

Worksheets on page 399 Contains worksheets to use during the implementation and maintenance of AcuityPlus.

System Parameters – System Setup Guidelines on page 417

Contains worksheets to help you set up AcuityPlus.

Determination of Classification Time on page 433

Describes how to perform a classification study.

Educational Sheets on page 439 Contains documents you can use for education.

About This Guide

QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY xvii

Conventions

Fonts and TypefacesThis guide uses fonts and typefaces to connect what you read in this book to what you see on the screen or what you need to type when using the system. Of particular importance are the following:

Special Symbols

bold sans serif For text that appears in windows or dialog boxes (e.g., the Close and OK buttons, the File menu) and for file names (e.g., c:\control.ini, /etc/hosts) that appear within the text of paragraphs.

SMALL CAPITALS For keyboard key names, such as ENTER or TAB.

monospaced font

Used for listing the contents of files and code samples.

bold monospaced font

Identifies actual characters you should type. For example:

… type exit at the prompt …

means you should type the characters e, x, i, and t

Bold-italic Indicates that you should replace the text with the actual value appropriate for your system. For example:

… locate the file d:\directory\control.ini …

means you should replace d: and directory with the actual drive and path of the file in question, when performing the task; for example, c:\windows\control.ini

This arrow is used to show a series of selections (menu options, tabs, links, etc.). For example:

… select File New Folder …

means you should pull down the File menu and select New and then Folder.

The book symbol identifies a cross-reference to related information.

The caution symbol indicates that you should carefully read and follow any directions associated with it to prevent serious errors or data loss.

The note symbol identifies a helpful tip or technique, or additional information about the current topic.


xviii QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY

Contacting Client SupportIf you have any questions about your QUADRAMED® software, refer to the particular software’s user guide or online help. If you cannot find the answer, contact our Support Analysts. Client Support is available Monday through Friday, 8:00 AM–5:00 PM Eastern Time, except holidays:

Client Support

Preparing to CallWhen you contact Client Support, you should be at your computer and have the appropriate product documentation at hand. Be prepared to give the following information:

The version number of QUADRAMED product or application you are using.

The type of hardware you are using.

The exact wording of any messages that appear on your screen.

A description of what happened and what you were doing when the problem occurred.

A description of how you tried to solve the problem.

If possible, a screen print demonstrating where the problem or issue occurs. This helps the Support Analyst with the resolution process.

Trademarks and CopyrightsQUADRAMED CORPORATION - Proprietary StatementThis material constitutes proprietary and trade secret information of the QUADRAMED CORPORATION and shall not be disclosed to any third party, nor used by the recipient except under the terms and conditions prescribed by the QUADRAMED CORPORATION.

The trademarks, service marks, and logos of QUADRAMED CORPORATION and others used herein are the property of QUADRAMED or their respective owners.

Self-Service Support: https://customersupport.quadramed.comPhone: 877.823.7263

Fax: 877.238.2776Web Portal: http://www.quadramed.com/customer_service

Self-Service Support:�https://customersupport.quadramed.comPhone:�877.823.7263Fax:�877.238.2776Web Portal:�http://www.quadramed.com/customer_service

Self-Service Support:�https://customersupport.quadramed.comPhone:�877.823.7263Fax:�877.238.2776Web Portal:�http://www.quadramed.com/customer_service

About This Guide

QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY xix

QUADRAMED CORPORATION Copyright StatementThis material is also protected by Federal Copyright Law and is not to be copied or reproduced in any form, using any medium, without the prior written authorization of the QUADRAMED CORPORATION. However, the QUADRAMED CORPORATION allows the printing of the Adobe Acrobat PDF files for the purposes of client training and reference.

Contents copyright © 2012 QUADRAMED CORPORATION. All rights reserved.

Software and PDFs of guides and other documentation are available for download on the customer support website. CDs and printed material are available for purchase. See http://www.quadramed.com/customer_service for more information.

http://www.quadramed.com/customer_service


xx QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY

QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY xxi

What’s New in 8.1

The following changes are new with this version of AcuityPlus.

Updated Icons

Main Tool Bar

Patient Selection Scheduled Staffing

Actual Staffing Report Selection

Staffing Notes Change Password

Security Parameters System Parameters

Audit Trail Staffing Forecaster

Outcomes Report Generator Assignments


xxii QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY

Patient Selection Screen

New FeaturesAssignment Module

Find a Patient View Location History

Classify Selected Patients Edit Classification(s)

Classification History View Classifications

Delete Classifications Do Not Classify

Classify Selected Patients by Profile

New 1 Hr + Activity

Edit 1 Hr + Activity 1 Hr + Activity History

View 1 Hr + Activity Delete 1 Hr + Activity

Monitor Selected Patients Monitor History

Delete Monitor Help

What’s New in 8.1

QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY xxiii

Patient Selection ScreenOutcomes classification column.

The following Event classifications have been renamed to Activity classifications.

ADT Events to ADT Activities (see page 41)

Procedures to 1 Hr + Activities (see page 41)

Other Workload to Other Activities (see page 41)

1 Hr + Activity classification without an out time will appear red in the Activity column.

Ability to sort by Who Classified.

ReportsThe following Procedure Reports have been renamed:

Event Detail to Activity Detail. (see page 210)

Event Recommended Hours by Hours of Day to Activity Recommended Hours by Hours of Day. (see page 212)

Event Summary to Activity Summary. (see page 214)

Event Workload Analysis to Activity Workload Analysis. (see page 217)

Inpatient Event Analysis to Inpatient Activity Analysis. (see page 281)

New Reports:

ADT Activity - Projected and Actual (see page 231)

Multiple Graphs (see page 299)

Updated Reports:

Daily Staffing (see page 251)

Patient Classification Detail (see page 304)

Recommended to Actual Staff (see page 308)

Staffing Analysis (see page 315)

Staffing by Hour by Day of Week (see page 316)

Treatment Area Workload (see page 335)


xxiv QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY

Date range entered for first report will default to following reports.

Security ParametersValid days will be set to 120 days as a default if the field is blank.

The system will no longer have a password never expires feature.

Password hint feature has been added.

A temporary password can be set for any employee.

The SQL script window can be enabled for use by one designated user.

System ParametersNew Unit Recommended Staffing Overview table

New option - Use Projected ADT Workload

Transparent ClassificationAudit Transparent Mapping

View Chart Items

QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY 1

Chapter 1 Introduction

OverviewOne of the most difficult, yet critical challenges facing nursing leaders is that of staff appropriation. This represents one of the most costly components of hospital operations and has direct bearing on the quality of patient care.

For the past several years, healthcare workers have faced increased demands to maximize efficiency and exceed patient expectations related to customer service. These pressures co-exist in a health care environment with limited financial resources, changes in availability of professional nurses, and patients who are increasingly more acutely ill. Thus, allocation of these limited financial resources receives much scrutiny in health care organizations.

The QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System provides nursing leaders with the following:

Information for management decisions on resource allocation.

Ability to assess and measure productivity.

Ability to create patient care assignments based on patient workload and complexity of care.

Information for human resource budget development and management.

Ability to track patient population trends.

Ability to model resource needs for new or revised services.

Ability to benchmark with other health care facilities.

Ability to evaluate patient outcomes against staffing variables (requires the add-on Outcomes module).

The AcuityPlus Workload Measurement System consists of a research based patient classification methodology and a unique staffing framework.


2 QUADRAMED CORPORATION - CONFIDENTIAL AND PROPRIETARY

Patient Classification – Involves the use of an objective, validated methodology that measures patient care needs. The workload of a unit is a combination of the number of patients classified and the acuity of those patients. This current version of the Inpatient methodology includes the capture of admission, discharge, transfer (ADT), and certain procedural activity, incorporating it into the overall workload and acuity. This concept of workload provides a common denominator. That is, it allows comparability between units within the same organization, as well as between units in different healthcare facilities.

Staffing Framework – Provides a mechanism to incorporate considerations that are unique to a given patient care unit. Each institution selects customized staffing targets that should reflect the manner in which that institution chooses to meet the needs of its patients. Staffing targets include the targeted hours of care and the manner in which these hours are distributed by shift and personnel category. For example, a patient who has a myocardial infarction would be classified as having similar needs for care despite the unit or hospital to which he/she is admitted. However, the ways in which the needs of the patient are met may differ greatly from one institution to the next. There are several factors that could have an impact on those decisions. They include, but are not limited to, the following:

Available resources

Staffing patterns

Skill mix

Patient care philosophy

Physician-driven protocol



ObjectivesUpon completion of this chapter, you will be able to:

Describe key activities that occur throughout the implementation of the AcuityPlus system.

Identify responsibilities that the Nursing Project Coordinator is expected to perform during and after the implementation of the AcuityPlus system.

Explain the role of the Steering Committee during and after implementation of the AcuityPlus system.

Describe monitoring activities that are performed by Patient Classification Committee members during and after implementation of the AcuityPlus system.

OverviewWhen a clinical department decides to implement a workload measurement system, it is critical to the success of the implementation that a clear sense of mission accompanies that decision, and that there is defined and dedicated ownership of the system. Without this commitment, the system’s capabilities are not maximized. Commitment and ownership are essential to assure reliable information that can be used to facilitate management in making decisions regarding valuable resources. When implementing a workload measurement system, the management group should identify the specific objectives they have for the system as one of their first tasks. The objectives should then form the basis of the discussions surrounding the entire implementation phase. The following areas should be addressed during the implementation:

All key personnel who will be involved with the system should be included in the implementation plan.

As system components are implemented, their use should be incorporated into the management processes.

The management reporting function should be integrated into other staffing management processes so that the information becomes a valuable data source as soon as possible.

Using these guidelines can help you maximize the value of the workload measurement system.



Implementation Timetable MONTH KEY ACTIVITIES

Month 1 Data gathering

Committee selection

Attend Methodology Education Workshop

Attend Software Training

Preparation of computer and environment

Visit 1Overview(s) and introduction to system

Committee meetings

Unit tours

Patient Classification Committee/Patient Care Manager indicator education

Month 2/3 Software installation and establish interfaces

Month 3/4 Staff education

Assure accuracy of system file information

Begin patient classification

Begin collection of actual staffing data

Initiate data collection for patient specific and unit specific elements for Outcome data

Initiate system controls

Month 4/5 Visit 2Initial workload/system control data review

Establish initial acuities

Management report interpretation

Initiate use of staff assignments based on workload and complexity of care

Introduction to target setting concepts

Other issues (data capture, workload)

Review process for creating outcomes reports and graphs

Month 5/6 Visit 3Establish initial staffing targets

Review outcomes data

Workload issues/initiate special studies (if appropriate)

Month 7 Visit 4Finalize staffing parameters

Data utilization

Database comparisons

Review outcomes data and graphs

Month 8 Visit 5 (Optional)Final report presentation(s)



Implementation SummaryApproximately Eight Month Process

Individualized Project Plan

On/Off Site Professional Consultation

Unlimited Phone Support

Active Client Participation

Designated Coordinator

Committee Directed

Staff Involvement

Education

Methodology Workshop

Software Education Seminar

Client Support Coverage

Toll Free Hotline: 877-823-7263

Weekdays: 8:00 AM – 5:00 PM EST



Committee/Role Descriptions

Nursing Project Coordinator/ManagerThe AcuityPlus Project Manager is a professional nurse responsible for the installation, implementation and on-going maintenance of the system in the organization. The Project Manager acts as a liaison between the QUADRAMED Consultant, hospital Department of Nursing/Patient Care Services, and Information Services Division. Major activities include:

Staff and management education.

Coordinating and conducting meetings.

Software system setup and maintenance of system parameters.

Data preparation, analysis, interpretation, reporting, and utilization for patient care management decisions.

Testing software and interface functionality post-installation and for all upgrades.

Desired QualificationsCurrent responsibility in a line/staff position reporting to the Vice President of Nursing/Patient Care Services.

Previous experience as a project manager.

Working knowledge and involvement in the institution’s nursing and administrative organization.

Experience in providing educational programs.

Working knowledge of system theory and analytical techniques.

Excellent interpersonal and communication skills.

Budgetary skills and responsibilities.

Able to function as a liaison with IS department.

Knowledgeable in use of Excel spreadsheet.



Time RequirementsDuring the preparatory and implementation phases of the system, the position requires a full-time commitment. Following implementation, the position requires the time necessary to maintain system integrity and the hospital’s goals for utilization of the AcuityPlus data. The actual time requirement is dependent on the size/complexity of the organization, the use of the system, and the availability/level of independence of support personnel.

ResponsibilitiesCompile and send requested information/materials to the QUADRAMED Consultant.

Establish working committees in collaboration with the Vice President of Nursing/Patient Care and the QUADRAMED Consultant.

Attend the Methodology Education and Software training sessions.

Identify and develop a communication system for decision-making, reporting, and system maintenance throughout the project and thereafter.

Review, revise, and confirm the proposed implementation schedule with all involved parties.

Demonstrate a working knowledge of the AcuityPlus Inpatient methodology, workload measurement concepts, and the software application.

Develop hospital policies and procedures to facilitate the classification process, the collection of staffing data, and the distribution of system reports.

Establish and maintain a procedure for maintaining user security in the software, this includes adding new users and inactivating staff that no longer have a need for access to the system.

Conduct/facilitate inservices necessary to educate all nursing staff responsible for classification activity.

Plan and conduct regularly scheduled meetings with the Unit Managers and Patient Classification Committee to provide education related to the Inpatient methodology, system control mechanisms, and data interpretation.

Integrate education for the system into the nursing department orientation program for new staff nurses.

Develop, monitor and report system control mechanisms for assuring accuracy of system inputs.

Implement corrective measures to resolve problems identified through system control activities and analysis.

Monitor clerical personnel responsible for the documentation of required information, such as staffing information and computer outputs.



Develop skill in data analysis toward establishment of staffing allocation parameters.

Demonstrate competency in report analysis and interpretation.

Establish and maintain report-editing system to assure accuracy and completeness prior to distribution.

Develop feedback system for report analysis with documented action plans.

Collaborate with the QUADRAMED Consultant to provide interim status reports to appropriate administrative personnel.

Demonstrate ability to articulate system inputs, controls, outputs, and results to nursing and hospital staff.

Develop trend analysis reports as appropriate.

Assist Patient Care Managers and others in interpretation and use of data for decision-making (staffing operations, budget preparation, etc.).

Work collaboratively with the Steering Committee and Patient Care Managers to assure appropriate system use and integration.

Work with the Information Systems Project Manager to facilitate software installation and related interfaces, as appropriate.

Participate in the testing of interface data transfer as necessary.


AcuityPlus™Inpatient Coordinator Guide Chapter 2 Implementation

Coordinator Activities Post System Implementation

DAILYPER (USER-DEFINED) REPORTING PERIOD

MONTHLY QUARTERLY SEMI-ANNUALLY ANNUALLY

Assure patient classification occurs on all classifying units

Review daily acuity measures

Assure that each classifying unit has been monitored at least once during the period

Review period-to-date information as appropriate

Independently monitor 25% of the classifying units

Review management reports with Patient Care Administrators as appropriate

Chair Patient Classification Committee (PCC) meeting

Complete and submit to the Steering Committee system control reports, such as:

Midnight to LOS Adjusted or Classification Census Analysis (if applicable)

Paid to Actual Staff Analysis

Classification Monitoring

Review acuities and recommend revisions to Steering Committee

Review staffing target parameters and recommend revisions to Steering Committee

Complete inter-rater reliability testing of PCC

Identify causative factors of variances on system control reports. Plan, implement, and evaluate corrective actions

Review/revise report distribution

If appropriate, perform Workload Fluctuation Analysis on identified units and submit to Steering Committee

Review/revise budget parameters to reflect any changes

Assure that staff educational needs are met regarding patient classification

Assure availability to the Patient Care Administration to assist with any AcuityPlus system concerns

Compare hospital and unit data to National and Regional Database

Update the FY (fiscal year) parameters in the software

Review/revise system parameters for each unit



Steering CommitteeThe Steering Committee is composed of administrative personnel accountable for the implementation, use, and integration of the QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System within their hospital’s organization. This committee is responsible for all decisions related to the AcuityPlus system.

Desired QualificationsAdministrative responsibility, minimally at the middle manager level, with involvement in nursing departmental policy and procedure formulation/revision.

Working knowledge and accountability in the hospital’s nursing and administrative organizations.

Ability to impact organizational change through channels of communication.

Demonstrates strong decision making and analytical skills.

Fiscal responsibility for patient care staffing decisions.

Time RequirementsDuring the implementation of the QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System, the Steering Committee should meet on an average of twice per month for approximately two to three hours. Upon completion of the implementation, the committee should meet at least quarterly to assure continued appropriate use of the system.

ResponsibilitiesDemonstrate a working knowledge of the key concepts of the Inpatient methodology.

Develop operational understanding of the patient classification process, including guidelines and indicator functions.

Demonstrate knowledge and understanding of the management reports and ability to interpret and analyze output information.

Demonstrate understanding of system control mechanisms through the assessment of the reliability of workload data across units.

Collectively make all decisions necessary to implement the system and to support continued use, including the establishment of appropriate staffing targets.

Work collaboratively with Patient Care Managers to use system data.

Determine and oversee implementation of system integration into nursing department operations.



Patient Classification CommitteeThe Patient Classification Committee (PCC) ensures appropriate use of the patient classification indicators by the patient care staff. The PCC supports the Project Manager by acting as a liaison between the staff on the patient care units and administration.

Desired QualificationsCurrent clinical responsibility as a staff nurse.

Working knowledge of the hospital’s organization.

Strong communication and interpersonal skills.

Time RequirementsDuring the AcuityPlus system implementation, the PCC meetings are held an average of twice per month, each meeting being approximately one to two hours. Additionally, the performance of monitoring activities requires two to four hours each week during implementation and bi-weekly post-implementation.

ResponsibilitiesDemonstrate a working knowledge of the system methodology.

Develop and maintain proficiency in the application of the patient classification indicators.

Monitor patient classification as scheduled by randomly selecting patients on units other than their own on a weekly basis during system implementation and bi-weekly post-implementation.

Communicate patient classification monitoring results verbally to the involved unit staff at the time of the monitoring and in writing to the Project Manager.

Channel staff concerns/questions/comments to appropriate personnel for resolution.

Act as resource person for staff on own unit.

Complete inter-rater reliability testing during implementation and quarterly thereafter.

Attend/support patient classification orientation sessions.



First Line Manager (Unit Manager/Coordinator)The First Line Manager is responsible for assuring the integration and ongoing appropriate use of the AcuityPlus system in the patient care unit. In addition, the First Line Manager may be required to participate on selected organizational committees structured to oversee the data reliability of the system.

Desired QualificationsCurrent responsibility as First Line Manager (Unit Manager, Unit Director, Clinical Manager).Working knowledge of system theory and analytical techniques.Familiarity with budgeting concepts; ability to develop and control unit nursing resource budget.

Time RequirementsThe time commitment for the First Line Manager involves small time allotments on a daily basis for the review of classification data and subsequent daily workload summary reports, as well as bi-weekly analysis and trending reports. During system implementation, attendance is required at scheduled meetings held approximately twice per month to review various system components and analyze system controls and output information. Following implementation, meetings should continue on a monthly basis. Committee meetings should be two - three hours in length.

ResponsibilitiesDemonstrate a working knowledge of the system methodology.Ability to articulate the system inputs, outputs, and results to the patient care staff.Develop and maintain proficiency in using the patient classification tool.Assure accuracy of daily patient classifications through a review within specified time limits.Review daily and periodic reports for compliance and reliability.Review feedback received from the Patient Classification Committee. Take action as appropriate.Communicate questions/concerns to the Project Manager.Facilitate patient classification monitoring by:

Contributing unit-specific appropriate indicator applications.

Discussing indicators regularly at unit staff meetings.Ensuring staff availability to perform monitoring activities and interact with unit-based monitors.

Identify and resolve unit problems involving patient classification monitoring.Work collaboratively with Steering Committee members to assure appropriate system use.Implement and maintain AcuityPlus system integration within current information systems.



Project SponsorThe Project Sponsor is the primary executive-level supporter of the project. Generally, the Project Sponsor is the Vice President of Patient Care and is responsible for providing the organizational support required for a successful implementation. This support includes monitoring the progress of the implementation process, working with all involved parties to assure the availability of resources for project completion, and facilitating the resolution of any issues identified during the process.

Data Entry/Clerical Support PersonnelUnder the supervision of the Project Manager, the Data Entry Support personnel are responsible for providing clerical and secretarial assistance with the AcuityPlus system, including data entry, printing, and distributing reports.

Desired QualificationsHigh school graduate.

Light typing and filing skills.

Able to operate office equipment (prior computer experience preferred).

Working knowledge of medical terminology.

Strong communication and problem-solving skills.

Time RequirementsPosition time requirements for a 200–300 bed hospital are approximately one to two hours bi-weekly to complete data entry and generate reports. The time requirements vary depending on the mode of data entry (manual versus automated via interfaces). It should be noted that some data entry may need to occur seven days per week as well as holidays.

ResponsibilitiesProvide secretarial and clerical assistance to the Project Manager, such as taking meeting minutes and preparing reports for distribution.

Arrange for duplication of necessary materials.



Network Services AnalystThe Network Services Analyst is responsible for the connectivity and network maintenance of workstations, servers and printers required for the AcuityPlus system multi-user product. The Network Services Analyst is also responsible for interface connectivity to and from other systems. If an organization has separate database professionals, some of the DBA responsibilities can be reassigned.

ResponsibilitiesEnsure the server hardware meets the AcuityPlus hardware requirements.

Configure server for the product installation and network configuration.

Provide TCP/IP DNS or name resolution services.

Configure workstation TCP/IP connectivity.

Troubleshoot network connectivity issues.

Provide interface connectivity to other vendor systems.

Provide remote access to the database server for QUADRAMED support and maintenance.

Assist QUADRAMED staff during the on-site database and product installation (DBA).

Integrate the SQL Server database into existing backup and maintenance procedures (DBA).

Communicate issues/problems that have been identified and are unresolved to the QUADRAMED Advanced Technology Solutions (formerly Hardware & Systems) Analyst.

Hardware and Systems EngineerThe Desktop Services Analyst is responsible for installing the client portion of the QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System on the workstations.

ResponsibilitiesEnsure the workstation hardware meets the AcuityPlus system hardware requirements.

Install and deploy AcuityPlus system application.

Setup ODBC for the AcuityPlus system data source.

Troubleshoot workstation errors or issues.

Manage the AcuityPlus system application through internal help desk policies.

Communicate issues/problems that have been identified and are unresolved to the QUADRAMED Advanced Technology Solutions (formerly Hardware & Systems) Analyst.



Technical Installation AnalystThe Interface Analyst is responsible for the proper exchange of data between the AcuityPlus system and other hospital information systems. Depending on the number and type of interfaces purchased, more than one interface resource may be necessary.

ResponsibilitiesReview interface specifications.

Provide QUADRAMED with sample interface file data.

Test and validate the interfaced data.




Describe the process of workload measurement.

Discuss the relationship between workload index, acuity, and census.

Discuss the development of the patient classification methodology.

Describe the purpose of patient classification indicators.

Describe the activity components of workload measurement.

Patient ClassificationPatient classification refers to the process whereby patients are categorized according to an assessment of their relative needs for care. This process provides the basis for determining workload on a patient care unit. QUADRAMED’s patient classification system rejects traditional thought, which proposes that workload can be defined through census counts or assignment of standard times to specific activities/tasks. Instead, it is based upon assessment of patients’ needs for care. This approach has proven highly effective in dealing with the variability of patient care needs.

Research and DevelopmentThe patient classification tool is based on research initially begun in 1971 by Medicus® Systems with Rush-Presbyterian-St. Luke’s Medical Center in Chicago. Since that time, the methodology has been refined and integrated into a resource management system, including the PFS/WM Inpatient methodology that was completed in 2000 and the AcuityPlus Inpatient methodology update completed in 2007. The QUADRAMED patient classification instrument is valid in all inpatient care areas: Medical/Surgical and all sub-specialties, Critical Care, Pediatrics, OB,



Nursery, Rehabilitation, and Skilled Nursing. It also addresses the needs of short-stay patients on inpatient units due to its ability to measure workload in less than 24-hour increments. Mental Health and Substance Abuse specialties utilize a separate methodology that was revalidated in 1992.

Several steps are taken to develop and update a methodology, including pre-testing, alpha testing, and beta testing. The process to update from the PFS/WM Inpatient methodology to the AcuityPlus Inpatient methodology is summarized here.

Pre-TestingPre-testing activities included a literature search, client surveys and focus groups, conducted between January 2005 and February 2006.

In June 2005 QUADRAMED consultants collected data on 2,072 patients from 52 units at the Clarian Health Partners facilities in Indianapolis, IN.

Alpha TestingDuring alpha testing, clinical experts from 19 facilities classified 3,494 patients from 86 units using an initial set of indicators. The indicators were further refined, and initial methodology modeling was begun. Clinical sites during this phase of development included:

Albany Medical Center Albany, NY

Aurora Healthcare Hartford, WI

Boston Medical Center Boston, MA

Calgary Health Region Calgary, AB

Charleston Area Medical Center Charleston, WV

Cleveland Clinic Cleveland, OH

London Health Sciences Centre London, ONT

Massachusetts General Hospital Boston, MA

Mayo Clinic Rochester, MN

Medical Center of Central Georgia Macon, GA

Mission Hospitals Asheville, NC

Newton-Wellesley Hospital Newton, MA

Pitt County Memorial Hospital Greenville, NC

Riverside Regional Newport News, VA

Roper St. Francis Healthcare Charleston, SC

Sharp Healthcare San Diego, CA

St. Luke’s Hospital Jacksonville, FL

Western Pennsylvania Hospital Pittsburgh, PA

Wake Forest University Baptist Medical Center Winston-Salem, NC



Beta Testing (Phase I)The first phase of beta testing occurred in February and March 2007 when QUADRAMED Nurse Consultants classified 2,091 patients on 48 units at the Clarian Health Partners facilities. Validity testing and indicator refinement occurred during this phase of development.

Beta Testing (Phase II)During this final stage of beta testing, validity, reliability, and transportability testing was completed. Clinical experts collected data on 1,037 patients from 61 patient care units at the following sites:

The updated Inpatient methodology, including a procedural component, was completed in September 2007.

Albany Medical Center Albany, NY

Calgary Health Region Calgary, AB

Cleveland Clinic Cleveland, OH

London Health Sciences Centre London, ONT

Massachusetts General Hospital Boston, MA

Mayo Clinic Rochester, MN

Medical Center of Central Georgia Macon, GA

Mission Hospitals Asheville, NC

Roper Saint Francis Healthcare Charleston, SC

Sharp Healthcare San Diego, CA

St. John Healthcare Warren, MI

Western Pennsylvania Hospital Pittsburgh, PA

Wake Forest University Baptist Medical Center Winston-Salem, NC



Inpatient MethodologyThis classification instrument is a factor evaluation tool in which weighted critical indicators are utilized to objectively categorize patients. As a result of patient classification, patients are placed into one of six groups. The groups are defined by a range of care hours required per 24 hours.

There are two approaches to the classification of patients. One is a process-oriented approach, and the other is a task-oriented approach. QUADRAMED methodologies are based on the process-oriented approach. The process-oriented approach focuses on the patient’s need for care, rather than the tasks completed by a caregiver. Systems that focus on the patient’s need for care were developed in response to nurses’ concerns about task-oriented approaches. In the process-oriented approach, patient needs are assessed according to the level of physical and psycho-emotional dependence the patients exhibit. This assessment results in the classification of the patient into a level of care that represents their care requirements. The approach is based on the nursing process model, which views patient care as a continuous process. In this approach, workload and related staffing requirements are more directly related to the assessed levels of physical and psycho-emotional dependence of patients than the tasks performed for patients. The focus on patient need as a measure of workload was better suited to perceptions of how care is delivered. An additional advantage to the process-oriented approach is the ability to benchmark data. When this approach is used in the classification of patients, data is comparable both within the organization and across organizations.

The task-oriented approach views the delivery of care as a collection of discrete tasks, performed sequentially, which together constitute patient care. This is not representative of the basic nursing philosophy that views the delivery of patient care as a continuous process requiring ongoing assessment, planning, intervention, and evaluation. The task-oriented approach defines a specific standard time for each task performed. The standard times do not differentiate the level of care associated with variances in the physical and psycho-emotional support required by individual patients. The task-oriented approach is impacted by any changes in procedures or equipment that result in a new or different task or completion time required for the task. Additionally, when a system is based on tasks performed by caregivers, comparative data does not provide an intensity measure that is based on the needs of the patients.

The development of critical indicators resulted from intensive factor and regression analysis. These statistical approaches determined the degree to which each indicator could be predictive of patient care requirements, that is, which indicators had the strongest statistical relationship to the categorization process. Indicators eliminated during testing were those that did not have the ability to effectively discriminate care requirements (e.g., to determine patient categories). For example, certain indicators may have been redundant, did not add to what was already known about a patient, or were not useful in differentiating one patient from another (indicator equally applicable across all patient types).

Type I II III IV V VI

Hrs/24 0-4 4-7 7-10 10-14 14-20 20+



The results of this analysis also provided the basis for developing weights for each indicator. The regression coefficients became the weights used in the patient classification process. It is critical to understand that the indicator weight has no correlation with the amount of time associated with that particular patient need, but represents its ability to place patients in the appropriate category. It was an important feature of the final patient classification tool that the indicator weights reflect the ability of each indicator, when combined with other indicators, to predict the overall care requirements or category of each patient.



QuadraMed’s Approach to Patient Acuity and StaffingA patient has the same needs regardless of location.

Each unit/hospital has its own unique mix of patients, acuity, and complexity.

Each hospital environment is uniquely different from other hospitals.

There is a measurable relationship between staffing, costs, and quality.



Patient Classification and Indicators OverviewPatient classification is a process in which critical indicators and specific activity events are used to objectively categorize patients into resource consumption categories.

Classification process:

A daily or more frequent assessment of patient care needs

Critical indicators:

Describe patient need for care

Statistically weighted based on ability to predict overall care requirement

Sum of weights places patients into one of six categories

Activity Events:

Incorporate activity time/duration into the workload measure

ADT activity: defines the average minutes of care associated with an admission, discharge, transfer-in, and/or transfer-out

1 Hr + Activity: pre-defined requiring unit-based staff involvement for 1-hour or greater

Other: workload associated with non-registered patients

Six categories:

Predictive of relative requirements for care



Workload Measurement

Relative ValuesThe conversion of patient classification information into a measure of workload is accomplished by translating patient classification categories into “units” of workload. This is accomplished by assigning relative workload values (acuities) to each category.

Based on the relative values of patient types, one could say that the staff member caring for a Type V patient in the ICU and the staff caring for 3.1 Type II patients on a general care unit have about the same amount of workload. Although reference is not made to relative values as a part of patient classification on a regular basis, understanding the meaning of these values is critical to system control. Staff is more comfortable using the tool if:

They recognize the relationships among patient categories;

They understand that the goal of the system is to assure that patients are placed in the correct categories; and

They know if patients are not categorized correctly, it has a significant measurable impact on workload (either positively or negatively).

It is often helpful to use relative values and hours of care ranges when verifying accuracy in patient typing. If a caregiver feels strongly that a particular indicator should be marked, you may determine whether this results in an appropriate change in patient type. For example, if a Type II patient increases to a Type III, you should question whether the patient requires approximately 3-4 hours of additional care.

PATIENT TYPE ACUITY MEANING

I 0.7 Average Type I patient care requirement is 0.7 times that of a Type II patient.

II 1.0 Standard patient with a care requirement equal to 1.0 unit of workload.

III 1.5 Average Type III patient care requirement is 1.5 times that of the Type II patient.

IV 2.3 Average Type IV patient care requirement is 2.3 times that of the Type II patient.

V 3.1 Average Type V patient care requirement is 3.1 times that of the Type II patient.

VI 4.6 Average Type VI patient care requirement is 4.6 times that of the Type II patient.



Workload IndexThe workload index is the total workload represented by a group of patients and is based on the number of patients in each classification category. Workload index is calculated in the AcuityPlus software based on the patient length of stay and the shift distribution defined in the system parameters. The unit workload is a sum of the workload for each patient category. The AcuityPlus system calculates the workload index as follows:

Workload Index*

= ((Total length of stay for Type I patients on 1st shift / shift length) x shift distribution goal for 1st shift) x relative value 0.7

+ ((Total length of stay for Type I patients on 2nd shift / shift length) x shift distribution goal for 2nd shift) x relative value 0.7

+ ((Total length of stay for Type I patients on 3rd shift / shift length) x shift distribution goal for 3rd shift) x relative value 0.7

+ ((Total length of stay for Type II patients on 1st shift / shift length) x shift distribution goal for 1st shift) x relative value 1.0

+ ((Total length of stay for Type II patients on 2nd shift / shift length) x shift distribution goal for 2nd shift) x relative value 1.0

+ ((Total length of stay for Type II patients on 3rd shift / shift length) x shift distribution goal for 3rd shift) x relative value 1.0

+ ((Total length of stay for Type III patients on 1st shift / shift length) x shift distribution goal for 1st shift) x relative value 1.5

+ ((Total length of stay for Type III patients on 2nd shift / shift length) x shift distribution goal for 2nd shift) x relative value 1.5

+ ((Total length of stay for Type III patients on 3rd shift / shift length) x shift distribution goal for 3rd shift) x relative value 1.5

+ ((Total length of stay for Type IV patients on 1st shift / shift length) x shift distribution goal for 1st shift) x relative value 2.3

+ ((Total length of stay for Type IV patients on 2nd shift / shift length) x shift distribution goal for 2nd shift) x relative value 2.3

+ ((Total length of stay for Type IV patients on 3rd shift / shift length) x shift distribution goal for 3rd shift) x relative value 2.3

+ ((Total length of stay for Type V patients on 1st shift / shift length) x shift distribution goal for 1st shift) x relative value 3.1

+ ((Total length of stay for Type V patients on 2nd shift / shift length) x shift distribution goal for 2nd shift) x relative value 3.1

+ ((Total length of stay for Type V patients on 3rd shift / shift length) x shift distribution goal for 3rd shift) x relative value 3.1



or

* The workload index calculation is based on the number of primary shifts defined for the unit, for example this could be 2, 3, or 4 shifts within a 24 hour period.

The workload index is also called a weighted census because it converts the actual census into an equivalent number of Type II patients. Several examples follow:

Example 1If there are:

25 patients, each with a 24-hour length of stay.

All patients are Type II patients.

3 shifts have been defined with 34% of the care needs on the 1st shift, 33% of care needs on the 2nd shift, and 33% of care needs on the 3rd shift.

The workload index would be:

(((25 x 8) / 8) x 0.34) x 1.0 + (((25 x 8) / 8) x 0.33) x 1.0 +(((25 x 8) / 8) x 0.33) x 1.0 = 8.5 + 8.25 + 8.25 = 25

+ ((Total length of stay for Type VI patients on 1st shift / shift length) x shift distribution goal for 1st shift) x relative value 4.6

+ ((Total length of stay for Type VI patients on 2nd shift / shift length) x shift distribution goal for 2nd shift) x relative value 4.6

+ ((Total length of stay for Type VI patients on 3rd shift / shift length) x shift distribution goal for 3rd shift) x relative value 4.6

Workload Index*

= Sum over all shifts ((Total Type I patients’ length of stay on each shift / specific shift length) x (specific shift distribution percentage) x 0.7)

+ Sum over all shifts ((Total Type II patients’ length of stay on each shift / specific shift length) x (specific shift distribution percentage) x 1.0)

+ Sum over all shifts ((Total Type III patients’ length of stay on each shift / specific shift length) x (specific shift distribution percentage) x 1.5)

+ Sum over all shifts ((Total Type IV patients’ length of stay on each shift / specific shift length) x (specific shift distribution percentage) x 2.3)

+ Sum over all shifts ((Total Type V patients’ length of stay on each shift / specific shift length) x (specific shift distribution percentage) x 3.1)

+ Sum over all shifts ((Total Type VI patients’ length of stay on each shift / specific shift length) x (specific shift distribution percentage) x 4.6)




25 patients, each with a 24-hour length of stay; (8 Type I, 9 Type II, 4 Type III and 4 Type IV patients).

3 shifts have been defined with 34% of the care needs on the 1st shift, 33% of care needs on the 2nd shift, and 33% of care needs on the 3rd shift.

The workload index would be:

Thus, these 25 patients generate the workload requirements equivalent to 29.81 Type II patients.

When entering data via the patient classification import interface, the patient length of stay is 24 hours. When using the AcuityPlus system with either an automated or manual ADT approach, the patient length of stay is the actual length of stay. In this approach to classification, workload identified for the patient starts at time of admission/transfer into a unit and ends at time of discharge/transfer out of a unit. This results in a very precise measure of the unit’s overall workload.

= (((8 x 8) / 8) x 0.34) x 0.7 + (((8 x 8) / 8) x 0.33) x 0.7 + (((8 x 8) / 8) x 0.33) x 0.7

+ (((9 x 8) / 8) x 0.34) x 1.0 + (((9 x 8) / 8) x 0.33) x 1.0 + (((9 x 8) / 8) x 0.33) x 1.0

+ (((4 x 8) / 8) x 0.34) x 1.5 + (((4 x 8) / 8) x 0.33) x 1.5 + (((4 x 8) / 8) x 0.33) x 1.5

+ (((4 x 8) / 8) x 0.34) x 2.3 + (((4 x 8) / 8) x 0.33) x 2.3 + (((4 x 8) / 8) x 0.33) x 2.3

= 1.90 + 1.85 + 1.85 (for Type I patients)

+ 3.06 + 2.97 + 2.97 (for Type II patients)

+ 2.04 + 1.98 + 1.98 (for Type III patients)

+ 3.13 + 3.04 + 3.04 (for Type IV patients)

= 29.81 units of workload




25 classified patients with varying lengths of stay:

PATIENT PATIENT TYPE LOS - DAYS LOS - EVES LOS - NGTS LOS - TOTAL

A I 8 8 8 24

B I 4 8 8 20

C I 8 4 - 12

D I 8 8 8 24

E I 8 8 8 24

F I 8 8 8 24

G I - 2 8 10

H I 6 8 8 22

I II 8 8 8 24

J II - 8 8 16

K II 8 8 8 24

L II 8 8 8 24

M II 2 8 8 18

N II 4 8 8 20

O II 8 8 8 24

P II 8 8 8 24

Q II 8 8 8 24

R III 8 8 8 24

S III 8 8 8 24

T III 8 8 8 24

U III 8 8 8 24

V IV 8 8 - 16

W IV 8 8 8 24

X IV 8 8 8 24

Y IV 8 8 8 24

542 Patient Hours



The primary shifts are days, evenings and nights with a distribution of:

The length of stay for each patient in each type category is summed by shift:

The workload index is calculated as follows:

These 25 patients are equal to 22.58 (542 patient hours / 24) equivalent 24-hour patients and generate the workload requirements equivalent to 27.24 Type 2 patients.

PATIENT TYPE DISTRIBUTION - DAYS DISTRIBUTION - EVENINGS DISTRIBUTION - NIGHTS

I 40% 33% 27%

II 40% 33% 27%

III 38% 33% 29%

IV 35% 35% 30%

V 34% 33% 33%

VI 34% 33% 33%

PATIENT TYPE TOTAL LOS ON DAYS TOTAL LOS ON EVES TOTAL LOS NGTS

I 50 54 56

II 54 72 72

III 32 32 32

IV 32 32 24

= ((50 / 8) x 0.40) x 0.7 + ((54 / 8) x 0.33) x 0.7 + ((56 / 8) x 0.27) x 0.7

+ ((54 / 8) x 0.40) x 1.0 + ((72 / 8) x 0.33) x 1.0 + ((72 / 8) x 0.27) x 1.0

+ ((32 / 8) x 0.38) x 1.5 + ((32 / 8) x 0.33) x 1.5 + ((32 / 8) x 0.29) x 1.5

+ ((32 / 8) x 0.35) x 2.3 + ((32 / 8) x 0.35) x 2.3 + ((24 / 8) x 0.30) x 2.3

= 1.75 +1.56 +1.32

+ 2.70 + 2.97 + 2.43

+ 2.28 + 1.98 + 1.74

+ 3.22 + 3.22 + 2.07

= 27.24 units of workload



In addition, the AcuityPlus application allows the user to classify patients multiple times in a 24-hour period. Each classification is considered unique, and workload is calculated based on the length of stay on each shift for each classification. Use of the length of stay in workload calculations provides a more precise representation of the unit’s workload in a 24-hour period. This also results in a census that reflects patient length of stay. For example, a 24-hour length of stay is equivalent to one (1.0) patient, and a 12-hour length of stay is equivalent to a half (0.5) patient.

The workload index is therefore the key to determining staffing, because it has translated a headcount into a measure of care requirements. It is the most important indicator of a patient care unit’s activity. If a unit’s workload varies by more than three or four units from one day to the next, it may translate into the equivalent of as much as one more or one less 8-hour shift required. When looking at resource allocation, workload index is the common denominator between units.

AcuityPatient specific acuity is defined as the relative workload value of one patient. Classification acuity is defined as the average mix of all patients on the unit. Classification acuity is calculated by dividing the Workload Index (Weighted Census) by the Length of Stay Adjusted Classification Census. The classification acuity for each example in the previous section is calculated as follows:

Example 1Workload Index of 25 / LOS Adjusted Census of 25 = Acuity of 1.00

The average workload of all patients is equal to the average type II patient.

Example 2Workload Index of 29.8 / LOS Adjusted Census of 25 = Acuity of 1.19

The “average patient” on this unit requires 1.19 times the care of the type II equivalent.

Example 3Workload Index of 27.24 / LOS Adjusted Census of 22.58 = Acuity of 1.21

The average patient on this unit requires 1.21 times the care of the type II equivalent.

The classification acuity of a unit is an excellent indicator of the general status of the unit. That is, for any unit in a specific clinical service, the mix of patients present is usually based on the typical diagnoses, treatment regimens, and care needs. Over time, a typical acuity can be expected based on the normal patient population. When the acuity is suddenly very different from what is normally expected, it is a signal that the patient mix is significantly different. For example, if a unit has an average census with an acuity lower than what is normally expected, the workload generated by the patients present will not require as many variable staff as usual. On the other hand, with the same average census but a significantly higher acuity than usual, the patients present will require more than the usual complement of variable staff.



AcuityPlus Inpatient Methodology Patient Classification Tool INDICATOR WEIGHTS

1. ADL - Self/Minimal Care 2

2. ADL - Partial Care 10

3. ADL - Complete Care 21

4. ADL – Rehabilitative 2

5. ADL Assistance – 2-3 Caregivers 8

6. ADL Assistance – 4 or more Caregivers 27

7. Communication Support 1

8. Cognitive Support 5

9. Behavior/Emotional Management 8

10. Behavior/Emotional Management – q 1 Hour 13

11. Safety Management – q 2 Hours 4

12. Safety Management – q 30 Minutes 8

13. Isolation Precautions (Transmission-Based) 6

14. Assessment – q 4 Hours 16

15. Assessment – q 2 Hours 18

16. Assessment – q 1 Hour 33

17. Assessment – q 30 Minutes 59

18. Medication Preparation - ≥ 20 Minutes 5

19. Wound/Injury Management 8

20. Wound/Injury Management - ≥ 30 Minutes 9

21. Healthcare Management Education - ≥ 1 Hour 0

22. 1 to 1 Physiological Intervention - ≥ 2 Hours 15


NCH/24 0-4 4-7 7-10 10-14 14-20 20+

Acuity 0.7 1.0 1.5 2.3 3.1 4.6

Point Range 0-17 18-36 37-56 57-79 80-104 105+



AcuityPlus Inpatient Methodology Acuity and Point Range

Workload Index =

Acuity = Workload Index (Weighted Census) / LOS Adjusted Census

Sample Calculations

Workload Index (WI) X HPWI = Recommended Staff Hours

Staff Hours / Workload Index = HPWI

Recommended Staff Hours / LOS Adjusted Census = HPPD


NCH/24 0-4 4-7 7-10 10-14 14-20 20+

Acuity 0.7 1.0 1.5 2.3 3.1 4.6

Point Range 0-17 18-36 37-56 57-79 80-104 105+

Sum over all shifts ((Total Type I patients’ length of stay on each shift / specific shift length) x (specific shift distribution percentage) x 0.7)

+ Sum over all shifts ((Total Type II patients’ length of stay on each shift / specific shift length) x (specific shift distribution percentage) x 1.0)

+ Sum over all shifts ((Total Type III patients’ length of stay on each shift / specific shift length) x (specific shift distribution percentage) x 1.5)

+ Sum over all shifts ((Total Type IV patients’ length of stay on each shift / specific shift length) x (specific shift distribution percentage) x 2.3)

+ Sum over all shifts ((Total Type V patients’ length of stay on each shift / specific shift length) x (specific shift distribution percentage) x 3.1)

+ Sum over all shifts ((Total Type VI patients’ length of stay on each shift / specific shift length) x (specific shift distribution percentage) x 4.6)

PATIENT TYPES LOS ADJUSTED CENSUSUNIT I II III IV V VI WI ACUITY HPWI STAFF HPPD

A 8 10 6 1 0 0 25.0 26.90 1.08 5.00 16.8 5.38

B 6.7 8.3 4.0 1 0 0 20.0 21.29 1.06 5.00 13.3 5.32

C 0 0 0 4 3 2 9.0 27.70 3.08 5.00 17.3 15.39

D 0 25 0 0 0 0 25.0 25.00 1.00 5.00 15.6 5.00


AcuityPlus™Inpatient Coordinator Guide Chapter 3 Inpatient Methodology

Calculating Classification Workload and Acuity- Example 1

TOTAL LOS / 24 HOURS/DAY = LOS ADJUSTED CENSUS

SHIFT LOS / SHIFT LENGTH X SHIFT DISTRIBUTION % X ACUITY = CLS

WI

Type I 192 / 24 = 8

Day 64 / 8 x 0.34 x 0.7 = 1.90

Eve 64 / 8 x 0.33 x 0.7 = 1.85

Ngt 64 / 8 x 0.33 x 0.7 = 1.85

Sum = 5.60

Type II 216 / 24 = 9

Day 72 / 8 x 0.34 x 1.0 = 3.06

Eve 72 / 8 x 0.33 x 1.0 = 2.97

Ngt 72 / 8 x 0.33 x 1.0 = 2.97

Sum = 9.00

Type III 96 / 24 = 4

Day 32 / 8 x 0.34 x 1.5 = 2.04

Eve 32 / 8 x 0.33 x 1.5 = 1.98

Ngt 32 / 8 x 0.33 x 1.5 = 1.98

Sum = 6.00

Type IV 96 / 24 = 4

Day 32 / 8 x 0.34 x 2.3 = 3.13

Eve 32 / 8 x 0.33 x 2.3 = 3.04



Therefore:

Ngt 32 / 8 x 0.33 x 2.3 = 3.04

Sum = 9.21

Type V 0 / 24 = 0 0 / 0 x x 3.1 = 0

Type VI 0 / 24 = 0 0 / 0 x x 4.6 = 0

LOS Adjusted Census = 25

Classification Workload = 29.81

Classification Workload / LOS Adjusted Census = Classification Acuity

29.8 / 25 = 1.19


SHIFT LOS / SHIFT LENGTH X SHIFT DISTRIBUTION % X ACUITY = CLS

WI



Example 2


SHIFT LOS / SHIFT

LENGTHX SHIFT

DISTRIBUTION % X ACUITY = CLS WI

Type I 160 / 24 = 6.67

Day 50 / 8 x 0.40 x 0.7 = 1.75

Eve 54 / 8 x 0.33 x 0.7 = 1.56

Ngt 56 / 8 x 0.27 x 0.7 = 1.32

Sum = 4.63

Type II 198 / 24 = 8.25

Day 54 / 8 x 0.40 x 1.0 = 2.70

Eve 72 / 8 x 0.33 x 1.0 = 2.97

Ngt 72 / 8 x 0.27 x 1.0 = 2.43

Sum = 8.10

Type III 96 / 24 = 4.00

Day 32 / 8 x 0.38 x 1.5 = 2.28

Eve 32 / 8 x 0.33 x 1.5 = 1.98

Ngt 32 / 8 x 0.29 x 1.5 = 1.74

Sum = 6.00

Type IV 88 / 24 = 3.67

Day 32 / 8 x 0.35 x 2.3 = 3.22

Eve 32 / 8 x 0.35 x 2.3 = 3.22

Ngt 24 / 8 x 0.30 x 2.3 = 2.07



Therefore:

Sum = 8.51

Type V 0 / 24 = 0 0 / 0 x x 3.1 = 0

Type VI 0 / 24 = 0 0 / 0 x x 4.6 = 0

LOS Adjusted Census = 22.59

Classification Workload = 27.24


27.24 / 22.58 = 1.21


SHIFT LOS / SHIFT

LENGTHX SHIFT




Example 3

TOTAL LOS / 24 HOURS/DAY

= LOS ADJUSTED CENSUS

SHIFT LOS / SHIFT

LENGTHX SHIFT


Type I / 24 =

Day / 8 x x 0.7 =

Eve / 8 x x 0.7 =

Ngt / 8 x x 0.7 =

Sum =

Type II / 24 =

Day / 8 x x 1.0 =

Eve / 8 x x 1.0 =

Ngt / 8 x x 1.0 =

Sum =

Type III / 24 =

Day / 8 x x 1.5 =

Eve / 8 x x 1.5 =

Ngt / 8 x x 1.5 =

Sum =

Type IV / 24 =

Day / 8 x x 2.3 =

Eve / 8 x x 2.3 =

Ngt / 8 x x 2.3 =



Therefore:

Sum =

Type V / 24 =

Day / 8 x x 3.1 =

Eve / 8 x x 3.1 =

Ngt / 8 x x 3.1 =

Sum =

Type VI / 24 =

Day / 8 x x 4.6 =

Eve / 8 x x 4.6 =

Ngt / 8 x x 4.6 =

Sum =

LOS Adjusted Census =

Classification Workload =


/ =

TOTAL LOS / 24 HOURS/DAY

= LOS ADJUSTED CENSUS

SHIFT LOS / SHIFT

LENGTHX SHIFT




AcuityPlus Inpatient Activity ClassificationOn an inpatient unit, the workload includes methodology workload and activity workload. The activity workload is comprised of three components. They include ADT events associated with the HL7 interface, activities requiring staff presence/performance for one hour or longer, and Other Activity Workload.

ADT ActivitiesADT activities include admission, discharge, transfer-in and transfer out. The minutes of care for each ADT event is defined at the unit level and can be reflected in staffing recommendations.

1 Hr + ActivityThere are nine defined activities which are assigned at the unit level. Each has a specific definition and requires unit-based staff involvement for one hour or greater. Recommended staffing includes the time associated with the duration of the activity.

Other ActivitiesWorkload in this category is associated with non-registered/non-admitted patients cared for on the unit, or off unit care provided by unit staff. Use of Other Workload is optional. For example:

Outpatients where care is provided by the unit staff but the patient is not registered via the ADT interface.

An oncology unit nurse administering chemotherapy on another unit.

1 Hr + Activity Classification GuidelinesSelection of an activity should occur when:

Unit-based staff are responsible for the performance of the activity, and

Other Activity time is translated into workload by dividing the total other activity time by the target hour per workload index. This time is included in recommended staffing. Other activity workload is not included in the overall acuity calculation as it is not associated with a specific patient and/or length of time.



The length of the activity is one hour or greater

The start and stop time must be entered for each activity.



AcuityPlus Inpatient 1 Hr + Activities Definitions1. 1:1 safety observation non-RN

Select for a patient who, due to risk to harm self or others, requires one-to-one continuous non-RN observation.

2. Off unit accompanied by RN

Select for a patient who requires dedicated one-to-one RN caregiver to accompany the patient off unit for one (1) hour or greater. Not applicable for a patient who requires 1 to 1 RN care.

APPROPRIATE APPLICATIONS INAPPROPRIATE APPLICATIONS

A patient who requires a unit-based sitter/safety companion at the bedside continuously for one hour or greater because of safety issues related to:

Avoidance of restraint application

Risk for falling due to confusion

Risk for pulling tubes and lines

Suicide Precautions

Flight risk related to pysch/legal hold issues

Traumatic Brain Injury with confusion

A patient who requires continuous safety observation by a unit-based sitter/safety companion for less than 1 hour.

A patient who requires continuous safety observation by a sitter/safety companion from a centralized hospital staffing pool, not charged to the unit, for one hour or greater.


A patient who does not require 1-to-1 RN care but requires a unit-based direct care RN to accompany a patient off of the unit for one hour or greater for a procedure, such as:

CT Scan

MRI

Angiogram

Cardiac catheterization

PET scan

A patient who does not require a unit-based direct care RN to accompany them off the unit.

A patient who requires 1-to-1 RN care and the RN caring for the patient accompanies the patient for an off unit test/procedure of 1 hour duration or greater.

A critically ill ICU patient on a ventilator with drips being titrated every 15 minutes requiring 1-to1 RN care and the RN caring for the patient accompanies the patient for a 2 hour angiogram.

An ICU patient who does not require 1-to-1 care and a unit-based direct care RN accompanies the patient for a CAT scan and is away from the unit for a total of 45 minutes.



3. Off unit accompanied by non-RN

Select for a patient who requires a dedicated one-to-one non-RN caregiver to accompany the patient off unit for one (1) hour or greater.

4. Patient/family education by RN

Select for a patient who requires individualized education of one (1) hour or greater continuous duration to address the knowledge and/or procedures that will be necessary for post-discharge healthcare management. A current plan with objectives for teaching/learning exists, and the patient is able to understand and respond to the education. May apply to the patient’s family, caregiver, or significant other.


A patient who requires a unit-based direct care non-RN staff member to accompany them for one hour or greater for:

CT Scan

Procedure in X-Ray

A patient who does not require a unit-based direct care non-RN staff member to accompany patient off unit.

A patient who requires 1:1 safety observation by a non-RN (sitter) who is accompanied by the sitter for a CT scan.


A patient with a chronic condition who requires continuous education by a unit-based direct care RN of 1 hour or greater to manage/control the disease process, such as:

Diabetes

Cardiac Disease

Multiple Sclerosis

Ulcerative Colitis

A patient who has had a surgical procedure which may require change/adaptation of day-to-day activities and routines that requires continuous education by a unit-based direct care RN of 1 hour or greater, such as:

A limb amputation

An ostomy

A patient who will be discharged requiring medical equipment to support their condition who requires continuous education by a unit-based direct care RN of 1 hour or greater, such as:

Ventilator

Apnea Monitor

Feeding Pump

V Pump

Oxygen Therapy

A patient who requires instruction regarding a hospital procedure regardless of duration.

A patient who requires information relating to devices and equipment used in their care while hospitalized regardless of duration.

Providing routine daily updates on condition, equipment and plan of care to patient, family or significant others regardless of duration.

A patient admitted with complications related to diabetes who requires continuous education by a diabetic nurse educator, who is not a part of the unit-based direct care staff, of 1 hour or greater to manage/control the disease process.

A patient who requires ostomy care education that is provided by a specialist who is not a part of the unit-based direct care staff.



5. Extensive wound management by RN

Select for a patient who requires continuous wound/injury site intervention by an RN for one (1) hour or greater.


A patient with a wound dehiscence or evisceration that requires a dressing change by a unit-based direct care RN of 1 hour or greater duration.

A patient with a wound requiring assessment and irrigation, debriding and/or packing by a unit-based direct care RN of 1 hour or greater duration.

A patient with a wound vac requiring a dressing and packing change by a unit-based direct care RN of 1 hour or greater duration.

A patient with a sheath removal that requires pressure at the wound site by a unit-based direct care RN of 1 hour or greater duration.

A patient with an extensive and complex wound requiring interventions by a unit-based direct care RN of 1 hour or greater duration. Interventions may include debriding, irrigating, tubbing and/or packing.

A patient whose extensive wounds require application of ointments/preparations by a unit-based direct care RN for 1 hour or greater duration.

A patient who requires sequential dressing changes by a unit-based direct care RN of 3 sites of 20 minutes duration each.

A patient with a wound vac that does not require the dressing/packing to be changed.

A patient with a wound vac that requires a 1 ½ hour dressing/packing change that will be performed by a wound team RN who is not a part of the unit-based direct care staff.

A patient with an extensive burn, dermatologic condition or wound/injury site that requires interventions less than 1 hour duration.

A patient who requires multiple sequential dressing changes but the cumulative time is less than 1 hour.

A patient who requires q 12 hour abdominal packing dressing changes of 15 minutes duration each.



6. Extensive wound management by non-RN

Select for a patient who requires continuous wound/injury site intervention by a non-RN for one (1) hour or greater.

7. Coordination of care by RN

Select for a patient who requires continuous intervention of one (1) hour or greater by an RN for coordination of services, such as: patient placement, transfer to another facility, home care arrangements, EMTALA transfers, or multiple medical, surgical, psychiatric and/or other specialty consults to facilitate a coordinated approach to care.


A patient with an extensive and complex wound requiring interventions by a unit-based direct care PCA/PCT of 1 hour or greater duration. Interventions may include debriding, irrigating, tubbing and/or packing.

A patient whose extensive wounds require application of ointments/preparations by a unit-based direct care PCA/PCT for 1 hour or greater duration.

A patient whose extensive burn debridement by an RN requires assistance of one hour or greater by a unit-based direct care LPN or PCA/PCT.

A patient who requires the assistance of a PCA/PCT for positioning while wound care is completed by an RN and the time spent is 1 hour or greater.

A patient with a wound that does not require the dressing/packing to be changed.

A patient with an extensive burn, dermatologic condition or wound/injury site that requires interventions less than 1 hour duration.

A patient who requires multiple sequential dressing changes but the cumulative time is less than 1 hour.

A patient with an extensive burn, dermatologic condition or wound/injury site that requires interventions of 1 hour duration or greater by an RN only.


A unit-based direct care RN actively spends one hour or greater to continuously coordinate:

Patient placement upon discharge

Transfer to another facility

Home care arrangements

EMTALA transfers

Multiple medical, surgical, psychiatric and/or other specialty consults/conferences to facilitate a coordinated approach to care/discharge

A patient who requires routine discharge interventions of any duration.

A patient who requires admission or discharge medication reconciliation of any duration.

A patient who is followed by multiple care teams, but the coordination by the RN is not continuous.

A social worker or case manager arranging for patient placement upon discharge.



8. 1:1 by RN

Select for a patient undergoing a bedside procedure who requires dedicated one-to-one care by an RN for one (1) hour or greater. Not applicable for a patient who requires 1 to 1 RN care.

9. 2:1 by RN

Select for a patient undergoing a bedside procedure who requires dedicated two-to-one care by RNs for 1 hour or greater.


A patient on a telemetry unit undergoing conscious sedation for a cardioversion who requires dedicated one-to-one care by a unit-based direct care RN for 1 hour.

A patient undergoing ECMO with a unit-based direct care RN continuously at the bedside, in addition to the RN providing routine care, to manage/monitor the ECMO technology for 24 hours.

A patient who does not require dedicated one-to-one care by a RN during a bedside procedure.

A patient on a telemetry unit undergoing conscious sedation for a cardioversion who requires dedicated care for 1 hour and the care is provided by a unit-based nurse educator.


A patient who requires dedicated two-to-one care by unit-based direct care RNs for one hour or greater duration for:

Physiological instability during and/or post cardiac resuscitation

Physiologic instability related to sepsis

Immediate post-operative stabilization in the ICU following open-heart or complex neurological surgery

A patient who does not require dedicated two-to-one care by unit-based direct care RNs beyond their basic care needs during a bedside procedure of one hour duration or greater

A patient who requires dedicated two-to-one care by unit-based direct care RNs at the bedside for 30 minutes to provide immediate post-operative stabilization after open-heart surgery

A patient who requires immediate post-operative stabilization by 2 RNs following open-heart of complex neurosurgery where one of the RNs will only be caring for patient for this shift with the other RN assisting for the first hour.



1 HOUR+ ACTIVITIES WORKLOAD SCENARIOS1. Today, RN Susan Jones assignment includes Mrs. Smith, a 60 year old female, who was

admitted to SICU today following a CABG x 2. Mrs. Smith is NPO, non-responsive and intubated on a ventilator. She has multiple invasive lines and IV drips. She has 2 chest tubes and a Foley catheter. Susan is assessing Mrs. Smith's cardiac, pulmonary and neurological status, intake/output, surgical dressing and IV drips per the unit's post open heart protocol. Because Mrs. Smith is unresponsive, her doctor has ordered a head CT scan today. To transport Mrs. Smith to and from her test, Susan asked the Respiratory Therapist and the unit CNA to assist her. Both Susan and the CNA were off the unit with the patient for over an hour.

Select the appropriate indicator(s) if any:

a. Off unit accompanied by RN

b. Off unit accompanied by non-RN

c. 1:1 by RN

d. 2:1 by RN

2. Marilyn Brown, RN, is assigned to care for Mrs. Green, a 45 year old female who had abdominal surgery 4 days ago. The wound was packed and the wound edges were left open. The wound requires an extensive sterile dressing change and wound packing today. As Marilyn collects the supplies, she asks the unit CNA to assist her with patient positioning while the wound care is being completed. The wound care will take over an hour to complete.


a. Extensive wound management by RN

b. Extensive wound management by non-RN

c. 1:1 by RN

d. 2:1 by RN

3. Mark Brown is a 50 year old male who had abdominal surgery several days ago. The wound became infected and re-opened. The wound requires an extensive sterile dressing change and wound packing. Mr. Brown is going home tomorrow and the nurse caring for Mr. Brown plans the dressing change knowing that she will also be providing home care education for the dressing change to Mr. Brown and his wife. The wound care and education will each take over an hour to complete.


a. Extensive wound management by RN

b. Extensive wound management by non-RN



c. Patient/family education by RN

d. 1:1 by RN

ANSWER KEY – PROCEDURE WORKLOAD SCENARIO

Calculating Activity Workload and Overall Acuity

Example 1

THPWI = 5.50

Activity Workload = 7/5.50 = 1.27


Classification Acuity = 29.81 / 25 = 1.19

Overall Acuity = 31.08 / 25 = 1.24

SCENARIO PROCEDURESMrs. Smith Off unit accompanied by RN

Off unit accompanied by non-RN

Mrs. Green

Extensive wound management by RN

Extensive wound management by non-RN

Mr. Brown

Extensive wound management by RN

Patient/family education by RN

ADT Time 3 hours+ 1 Hr + Activity Time 4 hours= Total Activity Time 7 hours

Classification Workload 29.81+ Activity Workload 1.27= Total Workload 31.08



Example 2

THPWI = 5.00

Activity Workload = 7/5.00 = 1.40



Overall Acuity = 31.21 / 25 = 1.25

Example 3

THPWI = 5.50

Activity Workload = 28 / 5.50 = 5.09



Overall Acuity = 34.90 / 25 = 1.40


Classification Workload 29.81+ 1 Hr + Activity Workload 1.40= Total Workload 31.21


Classification Workload 29.81+ 1 Hr + Activity Workload 5.09= Total Workload 34.90



Workload Measurement Key ConceptsWorkload Index – A census, weighted according to patient mix.

Acuity – Represents the average patient mix or the workload of an individual patient.

Actual Hours Per Workload Index – Productivity index that corrects for patient mix.

LOS Adjusted Census – Represents the equivalent number of 24-hour patients.

Calculation Summary Classification Workload Index (WI) = Census x Acuity

Summing over all shifts ((total LOS on each shift by Patient Type / specific shift length) x (specific shift distribution percentage)) x relative value (acuity) for the category

Procedure Workload = Total Procedure Hours

THPWI

LOS Adjusted Census = Total LOS for all classified patients

24 hours

Unit Classification Acuity = Classification Workload Index

LOS Adjusted Census

Unit Overall Acuity = Total Workload

LOS Adjusted Census

Recommended Staff = Workload Index x THPWI

HPPD = HPWI x Acuity

BHPPD = # of Budgeted Staff x Shift Length

Budgeted Census

AHPPD = # of Actual Direct Staff Hours

MN or LOS Adjusted Census

AHPWI = # of Actual Direct Staff Hours

WI

RHPPD = # of Recommended Staff Hours


RHPWI = # of Recommended Staff Hours

WI




Determine the appropriate time of classification for own organization.

Discuss the patient classification process.

Discuss the indicators and their application.

Differentiate between classification and procedural indicators.

OverviewThe process of classification is done on-line via unit-based terminals or personal computers (PCs). Each day registered nurses assess patients’ care requirements and mark those indicators appropriate to the patient. Indicator definitions and guidelines are utilized to promote reliable application of the tool. The process of classification requires 30 seconds or less per patient. On-line classification may be imported and scored within the AcuityPlus system, or entered and processed on-line using the AcuityPlus software at individual PC workstations. Scoring involves the use of weights for each of the critical indicators. The sum of the indicator weights determines the given patient’s type.

About Patient ClassificationThe process of on-line classification involves classifying all patients on a nursing unit at least one time every 24 hours. The 24-hour day typically begins at 7 AM and ends at 7 AM the next day. All patients on the unit for any period of time during the 24-hour period are classified. This includes all admissions, transfers-in, transfers-out, and discharged patients. Classification of patients more


Point Ranges 0-17 18-36 37-56 57-79 80-104 105+



than one time per 24-hour period is an organizational decision. Some of the factors reviewed to make this decision are how rapidly patient conditions change, organizational patterns and state guidelines. This approach to classification provides data reflective of the census and workload on a unit across the 24 hours.

When a patient classification import approach is used to classify patients, the process of classification involves a “snapshot” of all patients on a patient care unit at a particular point in time. This approach to classification provides an average picture of the census and workload on a unit.

Specific guidelines for classification are developed by each organization. For details on classification with the different interfaces, see Manual or Automatic ADT on page 58 and Patient Classification Import Interface on page 59.

Who Should Be Classified?Who should be classified depends on the type of interface you are using:

AcuityPlus Automated or Manual ADT – It is important to classify all patients on a unit regardless of their length of stay. Therefore, all admissions, discharges and transfers should be classified each 24 hours.

Patient Classification Import – All patients on the unit at the time of classification are classified.

What Timeframe Should Be Used?Patients are classified based on their assessed needs for the defined 24-hour period, typically 7:00 AM to 7:00 AM.

The window of time for classification is hospital specific based on the general flow of patient activity within the hospital. The classification time is often dictated by the need for workload information to be available to make appropriate staffing decisions for the subsequent shifts. A study can be done to determine the appropriate time of the day when the projections yields the average patient workload. Studies have demonstrated this timeframe to frequently fall between 9:00 AM and 11:00 AM. When using a manual or automatic ADT function, it is necessary to classify all admissions/transfers-in occurring after the time of classification. Classification of those patients is based on their assessed needs from the time of admission/transfer-in until the following 7:00 AM or unit defined start of day.

Classification ProcessTo classify a patient, the nurse uses her/his knowledge of the patient’s current condition and any documentation regarding the patient needs at the time of classification. The list of indicators is reviewed to determine which are applicable to the patient.



Each indicator has a specific definition describing the patient’s need for care, assessment, and/or intervention. Many indicators are further defined with time parameters, that is, a frequency and/or duration of assessment/intervention. The ability to predict and differentiate patient care requirements is based on the defining characteristics of the critical indicators. Indicators should be applied only if their definition describes the patient’s status.

Finally, the classification process should allow for the selection of appropriate indicators that, in combination with other indicators, will identify the appropriate nursing care requirements of the patient. Indicators are therefore selected to differentiate one patient from another, and the intent of each indicator should be actively considered throughout the classification process to avoid misuse.

Classification by ProfileThe ability to classify a patient by profile is an optional feature in AcuityPlus. This feature is based on associating indicators with a patient profile. The description of the classification profile defines the type of patient to assign to the profile. Cascading profiles offer the option to add time frames to the application of the indicators. This means that one set of indicators can be selected and applied for 2 hours, then a different set of indicators can be selected for the next 4 hours, with a 3rd set of indicators selected and applicable to the remainder of the 24 hour period. The number of sets of indicators is not limited. Profiles can be used to provide a default classification for patients on the day of arrival (admission or transfer in) to the unit and on the day of discharge (departure) from the unit. Users have the option to overwrite the profile classification; this is done by classifying the patient using the indicators on the classification screen. Additionally, each profile can include a treatment area, which is automatically assigned to the classification. When classifying by profile, you can change the treatment area associated with the profile, if desired.

To establish profiles, follow these steps:

Define the patient populations that are similar in terms of care needs.

Review the indicators selected for the patient population.

Determine the treatment area for patient population, if desired.

If the data for the population of patients is the same, establish a profile for classification.

Both the default profiles and the patient profiles can be selected when classifying by profile.

Sample ProfilesDefault Profile Examples

Admission – This profile can be automatically assigned to all patients admitted to the unit. It can be overwritten by selecting the patient to classify and/or by assigning another profile. The profile could include the following indicators:



2. ADL - Partial Care

14. Assessment - q 4 Hours

Transfer – This profile can be automatically assigned to all patients transferred to the unit. It can be overwritten by selecting the patient to classify and/or by assigning another profile. The profile could include the following indicators:



19. Wound/Injury Management

Discharge – The discharge profile classification is designed for use with the transparent classification module. This profile classification can be used for all patients discharged that do not have a current classification. Thus if a patient is discharged and information is not included in the file download, the selected indicators will apply. An example of selected indicators would be:




Patient Profiles

Diabetic Ulcer – This profile might be used for patients with a diabetic ulcer. The profile could include the following indicators:




21. Healthcare Management Education - > 1 Hour

Pneumonia – This profile might be used for patients with pneumonia and no co-morbidities. The profile could include the following indicators:



Long Term Care – This profile may be used for all long term care patients with no immediate problems. The profile includes the following indicators:

3. ADL - Complete Care




Cascading ProfilePost operative patient - This profile could be used for patients on the day of surgery. The profile includes the following indicators and time frames:

For 3 Hours

3. ADL Complete

5. ADL Assistance 2-3

16. Physiological Assessment q 1 hour

19. Wound Management

For 4 Hours

2. ADL Partial

5. ADL Assistance 2-3

15. Physiological Assessment q 2 hours


For remainder of 24 hour period

2. ADL Partial

14. Physiological Assessment q 4 hours


Classifying Patients Located on a Different UnitThe AcuityPlus software has the functionality to re-direct workload; meaning assigning the workload to a unit where the patient is not physically located. To classify a patient and re-direct the workload:

Select the unit where the patient is located.

Select the patient.

Select the classification icon.

Select edit on the classification screen to open the edit classification box.

A Unit field is located on the Classification screen; this field defaults to the unit selected.



Using the drop-down arrow, select the unit you want the workload re-directed to.

You must enter both the classification time and the end time on the pop-up box prior to selecting the applicable indicators.

This feature is designed to allow for the classification of patients in a physical location different from the location of the care providers. With this feature, it is possible to classify the patient in multiple locations. An example is, the patient can be classified on the unit where the patient is located and can be classified to re-direct the workload to staff caring for the patient in a procedure room in a separate area. If the patient should be classified in only the re-directed unit, a Do Not Classify classification needs to be completed to prevent the appearance of unclassified time on the unit where the patient is physically located.

Guidelines for Patient Classification

Manual or Automatic ADTAll patients assigned to a bed, regardless of ADT status, are to be classified at least once per day based upon their assessed needs for the hospital defined classification period.

If classification is to occur only once per 24-hours, the classification should reflect the patient’s care requirements/assessed needs for the majority of the 24-hour period.

If patient classification is to occur more frequently (i.e. every shift and/or when a patient’s condition changes) each classification should reflect the assessed needs for the majority of the classification period.

All patients are classified during the hospital specified time frame. The window of time during which classification should occur is based upon the organization’s goals and objectives for data availability and benchmarking.

All new admissions/transfers into a unit must be classified at least once prior to the beginning of the next 24-hour time period (e.g. 0700 the next day). Classification is to be based upon the patient’s needs at the time of admission until the beginning of the next classification period.

A patient discharged/transferred out of a unit prior to the time of classification must be classified based upon the assessed needs from the beginning of the 24-hour period (e.g. 0700 the same day) until the time of discharge or transfer out or the next classification period. If any of the defined procedures are applicable to the patient, select the procedure and enter the procedure duration by indicating the start and stop times.



Patient Classification Import InterfacePatients are classified once per day based upon their assessed needs for the hospital defined 24-hour time period.

All patients are classified during the hospital specified timeframe. The window of time during which classification should occur is based upon the organization’s goals and objectives for data availability and benchmarking.

All patients assigned to beds, including admissions and transfers-in, should be classified.

Discharged patients that have not left the unit should be classified.

The total number of patients classified on each unit should not exceed the unit’s bed capacity.



Classification TerminologyThe appropriate and inappropriate applications included with the indicator definitions are only examples of situations in which the indicator may be applied to capture patient needs. These examples are not all inclusive. When reviewing the appropriate and inappropriate application examples, the actual indicator definition must be referenced for the intent of the indicator and the associated time frames for observation, assessment, and/or intervention.

When the following terminology is used in the indicators, these definitions apply:

Assessment – A process during which a professional care provider collects objective and subjective information to evaluate the patient’s physiological and/or psychological status and the need for interventions. The process requires professional judgment and therefore cannot be performed by a mechanical device. Examples of assessment include:

Determining the patient’s cardiovascular status through an analysis of vital signs, cardiac rhythm, and patient’s general appearance and verbalizations.

Evaluating the effectiveness of a pain medication via a patient’s response when questioned, appearance, and analysis of related signs and symptoms of pain.

Cueing – The process of providing verbal and/or visual guidance or direction to complete an activity.

Education – The process of providing information necessary to the knowledge required to manage outside of the hospital environment. The knowledge generally relates to a life style change for the patient/family member/significant other due to a physiological process/illness. This may include the use of equipment required for the life style change.

Instruction – The process of providing information related to the plan of care, activities, procedures, expectations, and/or equipment.

Intervention – The process of acting upon information obtained during an assessment and/or in accordance with the plan of care. In some instances, the plan may be that no action needs to occur at this time.

Observation – The recording or noting of an event or situation. Anyone or a mechanical device may perform an observation. Examples of an observation include:

Checking a patient or equipment to determine safety and/or functionality.

A telemetry monitor continuously recording cardiac rhythm.



Patient Classification Inpatient Indicator DefinitionsSelect one of indicators 1 – 3. Selection of one ADL indicator is required.

1. ADL – Self/Minimal Care– Select for a patient who independently performs activities of daily living (feeding, bathing, toileting, mobility, and dressing) or needs minimal assistance to manage the environment and/or medical/therapeutic devices.

2. ADL – Partial Care– Select for a patient who requires assistance in performing any activities of daily living.

3. ADL – Complete Care– Select for a patient who is dependent on staff for activities of daily living.

4. ADL – Rehabilitative– Select for a patient who requires assessment and intervention to restore/achieve the highest level of ADL attainable. Staff is working with the patient in a cognitive manner, helping the patient achieve a higher level of independence.

Select only one of indicators 5 – 6, if applicable.

5. ADL Assistance – 2-3 Caregivers– Select for a patient who requires two (2) or three (3) caregivers to complete any activity of daily living.

6. ADL Assistance – 4 or more Caregivers– Select for a patient who requires four (4) or more caregivers to complete any activity of daily living.

7. Communication Support– Select for a patient who requires additional care due to uncompensated vision, hearing, speech deficits, language barriers or limitations related to literacy. May apply if the additional care is provided to the patient’s family or significant other.

8. Cognitive Support– Select for a patient who, due to temporary or permanent limitations or alterations in cognitive functioning, requires an assessment and intervention to orient to person, place, time, or situation.

Select only one of indicators 9–10, if applicable.

9. Behavior/Emotional Management – Select for a patient who requires intervention to manage behavior or emotions to maintain/regain the ability to participate in the plan of care. May apply if the intervention is provided to the patient’s family or significant other.

10. Behavior/Emotional Management - q 1 Hour– Select for a patient who requires intervention to manage behavior or emotions to maintain/regain the ability to participate in the plan of care every one hour or more often for the majority of the classification period. May apply if the intervention is provided to the patient’s family or significant other.


11. Safety Management - q 2 Hours – Select for a patient who, due to risk to harm self or others, requires observation and/or intervention by a staff member every two (2) hours or more often for the majority of the classification period.



12. Safety Management - q 30 Minutes– Select for a patient who, due to risk to harm self or others, requires observation and/or intervention by a staff member every thirty (30) minutes or more often for the majority of the classification period.

13. Isolation Precautions (Transmission-Based)– Select for a patient who, due to known or suspected risk for transmissible infection or susceptibility to transmissible infection, requires additional precautions beyond Standard Precautions. This includes Airborne, Droplet, and/or Contact Precautions.


14. Assessment - q 4 Hours– Select for a patient who requires physiological assessment and/or intervention every four (4) hours or more often for the majority of the classification period.

15. Assessment - q 2 Hours– Select for a patient who requires physiological assessment and/or intervention every two (2) hours or more often for the majority of the classification period.

16. Assessment - q 1 Hour– Select for a patient who requires physiological assessment and/or intervention every one (1) hour or more often for the majority of the classification period.

17. Assessment - q 30 Minutes– Select for a patient who requires physiological assessment and/or intervention every thirty (30) minutes or more often for the majority of the classification period.

18. Medication Preparation ≥ 20 Minutes– Select for a patient who requires preparation of medication(s) or preparation to administer medication(s) requiring twenty (20) minutes or greater of continuous staff time.

Select only one of items 19–20, if applicable.

19. Wound/Injury Management– Select for a patient who requires an assessment and/or intervention of a wound/injury site.

20. Wound/Injury Management ≥ 30 Minutes– Select for a patient who requires continuous wound/injury site intervention for thirty (30) minutes or greater.

21. Healthcare Management Education ≥ 1 Hour– Select for a patient who requires individualized education of one (1) hour or greater cumulative duration to address the knowledge and/or procedures that will be necessary for post-discharge healthcare management. A current plan with objectives for teaching/learning exists, and the patient is able to understand and respond to the education. May apply to the patient’s family, caregiver, or significant other.

22. 1 to 1 Physiological Intervention ≥ 2 Hours– Select for a patient who, due to physiological instability, requires continuous 1:1 or greater (e.g., 2:1) RN assessment and/or intervention at the bedside for two (2) hours or greater.



Patient Classification Indicator DefinitionsSelect one of indicators 1–3. Selection of one ADL indicator is required.

1. ADL – Self/Minimal CareSelect for a patient who independently performs activities of daily living (feeding, bathing, toileting, mobility, and dressing) or needs minimal assistance to manage the environment and/or medical/therapeutic devices.

2. ADL – Partial CareSelect for a patient who requires assistance in performing any activity of daily living.

3. ADL – Complete CareSelect for a patient who is dependent on staff for all activities of daily living. This may include patients who have reached their highest expected level of functioning/independence.


A patient who requires food containers to be opened and/or foods to be prepared (cut meat, butter toast).

A patient who requires assistance in preparing bath/shower.

A patient who requires assistance and/or supervision to perform any ADL.


A patient who needs assistance to get in/out of bed or to move in the bed.

A patient who requires cueing to perform any ADL.

A patient who requires assistance to bathe.

A patient who must be fed or who receives nutrition via a feeding tube.

A patient who needs assistance to ambulate.

A patient who is able to independently perform all ADLs.

A patient who is dependent on nursing to perform all ADLs.


A patient who requires total bathing and feeding and is dependent on nursing to move about.

Infants and toddlers.

A patient who is able to independently perform all ADLs.

A patient who requires assistance and/or supervision with some ADLs.

A patient who requires a complete bath and assistance with mobility, but is able to feed him/herself independently or with minimal assistance.



4. ADL – RehabilitativeSelect for a patient who requires staff assessment and intervention to restore/achieve the highest level of ADL attainable. Staff is working with the patient in a cognitive manner, helping the patient achieve a higher level of independence.

5. ADL Assistance– 2-3 CaregiversSelect for a patient who requires two (2) to three (3) caregivers to complete any activity of daily living.

6. ADL Assistance– 4 or more CaregiversSelect for a patient who requires four (4) or more caregivers to complete any activity of daily living.


A patient with a recent CVA who must be monitored during mealtime to follow swallow precautions.

A patient who is on a bladder/bowel training regime.

A brain-injured patient being retrained to perform ADLs via repetitive/rote activities.

An amputee learning to perform ADLs with a prosthesis.

A patient with a newly inserted total hip replacement being trained to manage mobility.

A patient who requires reminders to bathe but can complete ADLs independently.


Any patient who requires two to three staff to move in bed or transfer.

A patient who requires the assistance of two to three staff to ambulate.

Two caregivers completing a bath when the patient’s needs dictate the need for only one caregiver.

A one time transfer of a patient from stretcher to bed upon arrival from ED or OR.


Any patient who requires four or more staff to transfer from bed to cardiac chair.

A patient who requires the assistance of four or more staff to ambulate.

A patient who requires two to three staff to move in bed or transfer.

A patient who requires the assistance of two to three staff to ambulate.

A one time transfer of patient from stretcher to bed upon arrival from ED or OR that takes less than four staff.



7. Communication SupportSelect for a patient or significant other who requires additional care due to uncompensated vision, hearing, speech deficits, language barriers or limitations related to literacy. May apply if the additional care is provided to the patient’s family or significant other.

8. Cognitive SupportSelect for a patient who, due to temporary or permanent limitations or alterations in cognitive functioning, requires an assessment and intervention to orient to person, place, time, or situation.


A patient/significant other who does not speak the predominant language of the staff and interaction is required.

A patient who is hard of hearing and without a hearing aid.

A patient with a hearing aid that does not effectively correct a hearing problem.

A patient who is awake and alert but has an endotracheal tube or tracheostomy and is unable to speak.

A patient who is blind, deaf, or mute.

A patient with an expressive or receptive aphasia.

A patient who has undergone an extensive oral or EENT procedure which compromises the ability to communicate.

A patient who is illiterate and requires assistance completing/reading necessary forms or education materials.

A patient whose vision is corrected with contact lenses or eyeglasses.

A patient whose hearing is effectively corrected with a hearing aid.

A patient who can speak in spite of having a tracheostomy.

A patient with no barriers to communication.

A patient who is totally dependent for all care needs, (i.e. unconscious patient, infant, patient with severe dementia) and is unable to communicate their needs.


A patient with dementia requiring assessment and intervention to meet safety needs and/or to orient him/her to surroundings.

A confused or disoriented patient requiring assessment and intervention to orient to person, place, time, or situation.

A patient who is developmentally challenged and requires assessment and intervention to orient him/her to the surroundings/situation.

An autistic patient requiring assessment and intervention to orient her/him to the situation and surroundings.

A patient with confusion due to the effects of general anesthesia or sedation requiring orientation to person, place, time, or situation.

An unconscious patient.

Infants and toddlers.




9. Behavior/Emotional ManagementSelect for a patient who requires intervention to manage behavior or emotions to maintain/regain the ability to participate in the plan of care. May apply if the intervention is provided to the patient’s family or significant other.

10. Behavior/Emotional Management– q 1 HourSelect for a patient who requires intervention to manage behavior or emotions to maintain/regain the ability to participate in the plan of care every one (1) hour or more often for the majority of the classification period. May apply if the intervention is provided to the patient’s family or significant other.


A patient who is visibly upset and requires comforting and/or limit-setting.

A patient whose behavior requires that she/he is placed in soft or leather restraints to manage behavior.

A patient/significant other whose current behavior is disruptive to the unit environment.

A patient who is clinically depressed and requires repeated encouragement to complete ADL activities.

A patient or significant other who requires extensive interactive discussion to assist in decision-making related to DNR status or hospice referral.

A patient/significant other who is able to cope effectively with the patient’s current health situation.

A patient who actively participates in her/his care despite behavioral or emotional issues.


A patient with severe anxiety calling for assistance every 15 to 30 minutes for the majority of the classification period.

A patient with dementia calling out disruptively who requires intervention to manage behavior every one hour for the majority of the classification period.

A patient whose family member seeks out the patient’s RN for inappropriate requests every one hour for the majority of the classification period.

A patient with anxiety requiring reassurance every two hours.

A patient with dementia who is generally quiet and cooperative with care who has rare disruptive episodes.

A patient whose family member seeks out the patient’s RN for appropriate requests every one hour.




11. Safety Management - q 2 HoursSelect for a patient who, due to risk to harm self or others, requires observation and/or intervention by a staff member every two (2) hours or more often for the majority of the classification period.

12. Safety Management - q 30 MinutesSelect for a patient who, due to risk to harm self or others, requires observation and/or intervention by a staff member every thirty (30) minutes or more often for the majority of the classification period.


A patient who has been placed in soft restraints and requires visual observation every one to two hours for the majority of the classification period.

A patient whose age, mental status and/or behavior pose a risk to self or others if left unattended for indefinite periods and requires visual observation every one to two hours for the majority of the classification period.

A patient requiring one-to-one care for safety observation.

A patient who due to risk to harm self or others requires observation every 30 minutes or more often for the majority of the classification period.


A patient who has been placed in soft or leather restraints and requires visual observation every 30 minutes or more often for the majority of the classification period.

A patient whose age, mental status, and/or behavior pose a risk to self or others if left unattended for indefinite periods who requires observation every 30 minutes or more often for the majority of the classification period.

A patient requiring continuous observation by a staff member (sitter) for the majority of the classification period.

A patient who requires observations for safety every one to two hours for the majority of the classification period.

A patient in restraints who requires observation for safety every one to two hours for the majority of the classification period.

A patient who does not require continuous observation by a unit staff member but has a family-provided caregiver at the bedside.



13. Isolation Precautions (Transmission-Based)Select for a patient who, due to known or suspected risk for transmissible infection or susceptibility to transmissible infection, requires additional precautions beyond Standard Precautions. This includes Airborne, Droplet, and/or Contact Precautions.


A patient who, in addition to Standard Precautions, requires Airborne Precautions or the equivalent because of:

Pulmonary Tuberculosis

Measles

Chicken Pox

A patient who, in addition to Standard Precautions requires Droplet Precautions or the equivalent because of serious bacterial respiratory or viral infections spread by droplet transmission such as:

Meningitis

Pneumonia (haemophilus influenza)

Sepsis

Scarlet Fever

Mumps

Rubella

A patient who, in addition to Standard Precautions, requires Contact Precautions because of skin infections that are highly contagious or may occur on dry skin such as:

Impetigo

Herpes Simplex Virus (neonatal)

Major abscesses or cellulitis

Pediculosis

Scabies

VRE, MRSA, MRSE, C Diff, etc.

A patient who is immuno-compromised and at increased risk for bacterial, fungal, parasitic and viral infections from visitors, staff, other patients or the environment and requires precautions beyond Standard Precautions.

A patient who does not require any type of precautions beyond Standard Precautions.

A patient status post transplant on modified reverse precautions that are not beyond Standard Precautions.

Latex precautions.

Cytotoxic precautions.

Radiation precautions.




14. Assessment - q 4 HoursSelect for a patient who requires physiological assessment and/or intervention every four (4) hours or more often for the majority of the classification period.


A patient who requires assessment and/or intervention every four hours or more often for the majority of the classification period related to one or more of the following:

Fluid managementMedication managementPulmonary managementCardiovascular managementNeurological managementTechnology managementWound assessment

Fluid assessment and/or intervention related to:I&O q 3 to 4 hoursDrain output q 3 to 4 hoursPeritoneal dialysis q 3 to 4 hours

Medication assessment and/or intervention related to:

PCA response q 3 to 4 hoursSliding scale insulin with blood glucose q 3 to 4 hoursAdministration of medications every 3 to 4 hours

Pulmonary assessment and/or intervention related to:

Respiratory rate or O2 sat q 3 to 4 hrsSuctioning q 3 to 4 hoursRespiratory treatments q 3 to 4 hours

Cardiovascular assessment and/or intervention related to:

Pulse rate, heart rhythm, and/or BP q 3 to 4 hoursDoppler of pulses or flap q 3 to 4 hours

Neurological assessment and/or intervention related to:

Neuro checks q 3 to 4 hoursICP q 3 to 4 hours

Technology assessment and/or intervention related to:

VAD q 3 to 4 hoursBladder scanning q 3 to 4 hours

Wound assessment related to:Hematuria S/P TURP q 3 to 4 hoursCardiac Cath puncture site q 3 to 4 hrs

A patient who requires assessment and/or intervention less frequently than every four hours or more often for the majority of the classification period related to:


Fluid assessment and/or intervention related to:I&O q 6 to 12 hoursDrain output q 6 to 12 hoursPeritoneal dialysis interventions q 6 hours


Sliding scale insulin with blood glucose q 6 hoursHeparin drip with PTT q 6 to 24 hoursAdministration of medications q 6 to 24 hours


Respiratory rate or O2 sat q 6 to 8 hrsSuctioning q 6 to 8 hoursRespiratory treatments q 6 to 8 hours


Pulse rate, heart rhythm, and/or BP q 6 to 8 hoursDoppler of pulses or flap q 6 to 8 hours


Neuro checks q 6 to 8 hoursTechnology assessment and/or intervention related to:

VAD q 6 to 8 hoursBladder scanning q 6 to 8 hours

Wound assessment related to:Hematuria S/P TURP q 6 to 8 hoursCardiac Cath puncture site q 6 to 8 hrs



15. Assessment - q 2 HoursSelect for a patient who requires physiological assessment and/or intervention every two (2) hours or more often for the majority of the classification period.


A patient who requires assessment and/or intervention every two hours or more often for the majority of the classification period related to one or more of the following:


Fluid assessment and/or intervention related to:I&O q 2 hoursDrain output q 2 hours


PCA response q 2 hoursInsulin drip with blood glucose q 2 hoursAdministration of medications every 2 hours


Respiratory rate or O2 sat q 2 hourSuctioning q 2 hours


Pulse rate, heart rhythm, and/or BP q 2 hoursDoppler of pulses or flap q 2 hours


Neuro checks q 2 hoursICP q 2 hours


CRRT/CVVH q 2 hoursIABP q 2 hoursVAD q 2 hours

Wound assessment related to:Hematuria S/P TURP q 2 hoursCardiac Cath puncture site q 2 hrs

A patient who requires assessment and/or intervention less frequently than every two hours or more often for the majority of the classification period related to:


A patient who needs to be turned and repositioned or oral care every two hours to prevent skin breakdown or for comfort.

Fluid assessment and/or intervention related to:I&O q 1 hourDrain output q 1 hour


PCA response q 1 hourInsulin drip with blood glucose q 1 hourAdministration of medications every 1 hour


Respiratory rate or O2 sat q 1 hourSuctioning q 1 hour


Pulse rate, heart rhythm, and/or BP q 1 hourDoppler of pulses or flap q 1 hour


Neuro checks q 1 hourICP q 1 hour


CRRT/CVVH q 1 hourIABP q 1 hourVAD q 1 hour

Wound assessment related to:Hematuria S/P TURP q 1 hourCardiac Cath puncture site q 1hour



16. Assessment - q 1 HourSelect for a patient who requires physiological assessment and/or intervention every one (1) hour or more often for the majority of the classification period.


A patient who requires assessment and/or intervention every one hour or more often for the majority of the classification period related to one or more of the following:




Drip titration (Dopamine, Insulin, Propofol, Fentanyl, etc.) q 1 hourEpidural infusion q 1 hourAdministration of medications q 1 hour






Neuro check q 1 hourICP 1 hour



Wound assessment related to:Hematuria S/P TURP q 1 hourCardiac Cath puncture site q 1 hour

A patient who requires assessment and/or intervention less frequently than every one hour or more often for the majority of the classification period related to:


Fluid assessment and/or intervention related to:I&O q 30 minutesDrain output q 30 minutes


Drip titration (Dopamine, Insulin, Propofol, Fentanyl, etc.) q 15 to 30 minutesEpidural infusion assessment q 15 to 30 minutes


Respiratory rate or O2 sat q 15 to 30 minutesSuctioning q 15 to 30 minutes


Pulse rate, heart rhythm, and/or BP q 15 to 30 minutesDoppler of pulses or flap q 15 to 30 minutes


Neuro check q 15 to 30 minutesICP q 15 to 30 minutes


CRRT/CVVH q 15 to 30 minutesIABP q 15 to 30 minutesVAD q 15 to 30 minutes

Wound assessment related to:Hematuria S/P TURP q 15 to 30 minutesCardiac Cath puncture site q 15 to 30 minutes



17. Assessment - q 30 MinutesSelect for a patient who requires physiological assessment and/or intervention every thirty (30) minutes or more often for the majority of the classification period.


A patient who requires assessments and/or interventions every 30 minutes or more often for the majority of the classification period related to one or more of the following:


Fluid assessment and/or intervention related to:I&O q 30 minutesDrain output q 30 minutes


Drip titration (Dopamine, Insulin, Propofol, Fentanyl, etc.) q 15 to 30 minutesEpidural infusion q 15 to 30 minutes


Respiratory rate or O2 sat q 15 to 30 minutesSuctioning q 15 to 30 minutes


Pulse rate, heart rhythm, and/or BP q 15 to 30 minutesDoppler of pulses or flap q 15 to 30 minutes


Neuro check q 15 to 30 minutesICP q 15 to 30 minutes

Technology assessment and/or intervention related to;

CRRT/CVVH q 15 to 30 minutesIABP q 15 to 30 minutesVAD q 15 to 30 minutes

Wound assessment related to:Hematuria S/P TURP q 15 to 30 minCardiac Cath puncture site q 15 to 30 minutes

A patient who requires assessments and/or interventions less frequently than every one hour or more often for the majority of the classification period related to:




Drip titration (Dopamine, Insulin, Propofol, Fentanyl, etc.) q 1 hourEpidural infusion q 1 hour






Neuro check q 1 hourICP q 1 hour



Wound assessment related to:Hematuria S/P TURP q 1 hourCardiac Cath puncture site q 1 hour



18. Medication Preparation ≥ 20 MinutesSelect for a patient who requires preparation of medication(s) or preparation to administer medication(s) requiring twenty (20) minutes or greater of continuous staff time.


19. Wound/Injury ManagementSelect for a patient who requires an assessment and/or intervention of a wound/injury site.


A patient who requires 20 minutes or greater to obtain medications from Pyxis and preparation to administer via G tube.

A patient who requires 20 minutes or greater to confirm/verify chemotherapy administration orders.

A patient whose G tube medication preparation requires less than 20 minutes.

A patient whose verification of chemotherapy orders requires less than 20 minutes.


A patient with a surgical incision/site requiring assessment and/or intervention.

A patient with a newly created stoma site requiring assessment and/or intervention.

An infant requiring cord care and/or care of a circumcision site.

A patient requiring simple care of a pressure ulcer.

A patient who requires care of a tube insertion site (gastrostomy, suprapubic catheter, chest tube, tracheotomy).

A maternal patient requiring episiotomy and/or perineal care.

An antepartum patient requiring assessment of discharge related to PROM, placenta previa and/or placenta abruptio.

A patient whose central vascular line insertion site requires a sterile dressing change during the classification period.

A patient who has had a TUR and requires assessment of the CBI and urinary output for bleeding/clotting.

A patient with severe GI bleeding requiring assessment of any gastrointestinal discharges.

A patient with a wound vac that requires assessment of the site but does not require a dressing/packing change.

A patient who does not have a surgical incision or any break in skin integrity.

A patient requiring routine peripheral IV site care and monitoring.

A patient with a central line that requires assessment but does not require a dressing change.



20. Wound/Injury Management ≥ 30 MinutesSelect for a patient who requires continuous wound/injury site intervention for thirty (30) minutes or greater.


A patient with a wound dehiscence or evisceration that requires a dressing change of 30 minutes or greater duration.

A patient with a wound requiring assessment and irrigation, debriding and/or packing of 30 minutes or greater duration.

A patient with a wound vac requiring a dressing and packing change of 30 minutes or greater duration.

A patient with a sheath removal that requires pressure at the wound site for 30 minutes or greater duration.

A patient with an extensive and complex wound requiring interventions of 30 minutes or greater duration. Interventions may include debriding, irrigating, tubbing and/or packing.

A patient whose extensive wounds require application of ointments/preparations for 30 minutes or greater duration.

A patient who requires sequential dressing changes of 3 sites of 15 minutes duration each.

A patient with a wound vac that does not require the dressing/packing to be changed.

A patient with an extensive burn, dermatologic condition or wound/injury site that does not require interventions of 30 minutes or greater.

A patient who requires multiple sequential dressing changes but the cumulative time is less than 30 minutes.

A patient who requires q 12 hour abdominal packing dressing changes of 15 minutes duration each.



21. Healthcare Management Education ≥ 1 HourSelect for a patient who requires individualized education of one (1) hour or greater cumulative duration to address the knowledge and/or procedures that will be necessary for post-discharge healthcare management. A current plan with objectives for teaching/learning exists, and the patient is able to understand and respond to the education. May apply to the patient’s family, caregiver, or significant other.

22. 1 to 1 Physiological Intervention ≥ 2 HoursSelect for a patient who, due to physiological instability, requires continuous 1:1 or greater (e.g., 2:1) RN assessment and/or intervention at the bedside for two (2) hours or greater.


A patient with a chronic condition who requires continuous education of 1 hour or greater to manage/control the disease process, such as:

Diabetes

Cardiac Disease

Multiple Sclerosis

Ulcerative Colitis

A patient who has had a surgical procedure which may require change/adaptation of day-to-day activities and routines that requires continuous education of 1 hour or greater, such as:

A limb amputation

An ostomy

A patient who will be discharged requiring medical equipment to support their condition who requires continuous education of 1 hour or greater, such as:

Ventilator

Apnea Monitor

Feeding Pump

IV Pump

Oxygen Therapy

A patient who requires instruction regarding a hospital procedure regardless of duration.

A patient who requires information relating to devices and equipment used in their care while hospitalized regardless of duration.

Providing routine daily updates on condition, equipment and plan of care to patient, family or significant others regardless of duration.


A patient immediately post-op following a CABG and valve replacement who requires an RN continuously at the bedside for 2 ½ hours to establish physiological stability.

A patient in septic shock who is physiologically unstable and requires an RN continuously at the bedside for 3 hours.

A patient who is physiologically stable and requires continuous electronic monitoring of heart rate and rhythm, pulse ox and arterial BP.

A patient immediately post-op who requires an RN continuously at the bedside for 1 hour to establish physiological stability.



ObjectivesUpon completion of this chapter you will be able to:

Discuss the development of the complexity of care methodology.

Describe the complexity of care methodology.

Discuss complexity based skill distribution.

OverviewComplexity of care is a research based methodology that measures the patient’s need for skilled nursing care. The patient classification workload measurement determines the hours of care a patient requires to meet their needs, the complexity of care methodology augments the workload measurement system providing information on the type of care the patient requires. The complexity measure also provides another comparable metric of a patient population for hospitals to track and use for benchmarking.

Complexity Research and DevelopmentThe complexity of care research was initiated in 2000 with a pilot study at Children’s Memorial Hospital in Chicago, IL. This study evaluated the ability of the Inpatient Workload Measurement Methodology to predict the type of care required in a pediatric burn patient population. The positive results of the pilot study lead to further research to develop a module to compliment the workload measurement system across all inpatient populations. The research was initiated in February of 2003 and completed in February of 2004. The research process included complexity pre-testing and complexity testing.



Complexity of Care Pre-TestingPre-testing activities included a literature search and an analysis of workload measurement data in the QUADRAMED National Databases. The analysis of the databases included a review of 4,500 cases across 13 clinical specialty groups in the PFS/WM development database and a review of over 900,000 cases across 40 clinical specialties in the 2002 PFS National Benchmarking database. During this phase, the 30 PFS/WM patient care indicators were used as the framework for defining the components of patient care needs relating to the caregiver skill level.

Patient scenarios were developed to cover a broad range of clinical specialties and cover the common patient types and profiles found within the specialties. The patient scenarios were designed to be as concise as possible where the patient needs and links to specific PFS/WM indicators were clear. A stratified sample of clinical experts from our client institutions were sought to evaluate the patient scenarios. The sample of clinical experts included representation from hospitals of varied bed size, geographic region, and teaching affiliation.

Complexity of Care TestingThe testing phase included the review of 110 patient care scenarios by 236 clinical experts in 23 participating institutions. Clinical experts reviewed the patient scenarios to suggest the most appropriate caregiver mix to provide the care for the patient as described in the scenario. The caregiver categories reviewed in each scenario included RNs, LPNs/LVNs, Nursing Assistants/Unlicensed Assistant workers, and others. There were 2,368 scenario evaluations completed across 12 clinical areas:

MOTHER/BABY ONCOLOGY/HEMATOLOGY/BMT

NICU/INICU Telemetry/Step Down/Intermediate

Peds/PICU Critical Care

Med/Surg Burn/BICU

Orthopedics Rehabilitation

Neurology SNF/Sub-Acute/long Term



Participating Institutions

Complexity of Care MethodologyThe complexity methodology is a research-based, valid and transportable methodology that provides a complexity assessment of each patient as a by-product of patient classification. The PFS/WM indicators are weighted based on ability to predict the type (skill) of care a patient requires. The sum of the complexity weights places the patient into one of five complexity levels.

Brookhaven Memorial Hospital, NY Pitt County Memorial Hospital, NC

Charleston Area Medical Center, WV Rush North Shore Hospital, IL

Carteret General Hospital, NC Riverside Walter Reed Hospital, VA

London Health Sciences Centre, ONT Sutter Auburn Faith Hospital, CA

Loudoun Hospital Center, VA Santa Barbara Cottage Hospital, CA

Medical College of Georgia, GA Shands Teaching Hospital, FL

MetroHealth Medical Center, OH Sharp Healthcare, CA

Massachusetts General Hospital, MA St. Joseph’s Hospital, KY

Mission St. Joseph Hospital, NC St. Tammany Parish Hospital, LA

Miami Valley Hospital, OH University of North Carolina Healthcare, NC

Nebraska Health System, NE Washington Hospital, DC

North Country Hospital, VT



TYPE 1 2 3 4 5

PT RANGE 0-26 27-31 32-40 41-49 50+

COMPLEXITY SCORE 1.0 2.0 3.0 4.0 5.0

INDICATORCOMPLEXITY WEIGHT

ACUITY WEIGHT

ADL – Self/Minimal Care 14 2

ADL – Partial Care 16 10

ADL – Complete Care 22 21

ADL – Rehabilitative 0 2

ADL Assistance – 2-3 Caregivers 0 8

ADL Assistance – 4 or More Caregivers 0 27

Communication Support 0 1

Cognitive Support 1 5

Behavior/Emotional Management 1 8

Behavior/Emotional Management - q 1 Hour 5 13

Safety Management - q 2 Hours 0 4

Safety Management - q 30 Minutes 0 8

Isolation Precautions 6 6

Assessment - q 4 Hours 8 16


Assessment - q 1 Hour 22 33

Assessment - q 30 Minutes 30 59

Medication Preparation - > 20 Minutes 0 5

Wound/Injury Management 6 8

Wound/Injury Management - > 30 Minutes 8 9

Healthcare Management Education - > 1 Hour 5 0

1 to 1 Physiological Intervention > 2 Hours 7 15



Examples:

Patient 1 – Post OP

Patient 2 – Post CVA /Pneumonia

Patient 3 – Geriatric, awaiting placement

INDICATOR COMPLEXITY WEIGHT ACUITY WEIGHT

ADL Complete Care 22 21


Wound/Injury Management 6 8

Total Points 42 47

Complexity Type/ Patient Type 4 III


ADL Rehabilitative 0 2

ADL Assistance - 2-3 Caregivers 0 8


Total Points 8 26

Complexity Type/ Patient Type 1 II


ADL Complete Care 22 21

ADL Assistance - 2-3 Caregivers 0 8

Cognitive Support 1 5


Total Points 31 50

Complexity Type/ Patient Type 2 III



Patient 4 – Diabetic

Complexity ScoreThe complexity score represents the average complexity of patients on the unit. The average complexity score can be compared across time, across units within the organization, and across organizations. A consistent change in the complexity score indicates that the skill distributions need to be reviewed and revised as needed.

Calculation of complexity score:

Individual patient complexity score – Complexity Type x (LOS / 24)

Complexity score – Sum of individual patient complexity scores / LOS Adjusted Census


ADL Partial Care 16 10


Healthcare Management Education - > 1 Hour 5 0

Total Points 29 26

Complexity Type/ Patient Type 2 II



Example

Total Individual Patient Complexity Scores: 51.17Total LOS: 492 hoursLOS Adjusted Census: 492 / 24 = 20.5 Unit Complexity Score: 51.17 / 20.5 = 2.50

The average complexity type patient on the unit is between a type 2 and a type 3 patient.

Complexity of Care Skill DistributionThe complexity measure is used to determine the skill mix distribution of care providers. The Complexity and Acuity Analysis report provides information on the percentage of patients by acuity type and complexity type to provide a framework for establishing the skill mix distribution goals. The Complexity of Care - Staffing Recommendations Comparisons report provides a comparison of recommended staffing based on acuity based skill mix distribution and complexity based skill mix distribution. Upon system setup, you must decide if staffing is to be recommended based on acuity or complexity. An examples follows.

PATIENTCOMPLEXITY TYPE

LOS COMPLEXITY SCORE

PATIENTCOMPLEXITY TYPE

LOS COMPLEXITY SCORE

A. 1 24 1.00 M. 2 12 1.00

B. 1 24 1.00 N. 3 16 2.00

C. 2 20 1.67 O. 3 18 2.25

D. 3 18 2.25 P. 3 24 3.00

E. 2 10 0.83 Q. 3 24 3.00

F. 2 12 1.00 R. 2 24 2.00

G. 2 24 2.00 S. 2 24 2.00

H. 3 24 3.00 T. 2 24 2.00

I. 4 24 4.00 U. 4 24 4.00

J. 3 24 3.00 V. 4 24 4.00

K. 2 24 2.00 W. 2 16 1.33

L. 2 24 2.00 X 2 10 0.83



Example:

The workload is equivalent when based on acuity or complexity. The workload by complexity is calculated by summing the relative acuity value by patient acuity type for all patients within the complexity type. Thus the complexity based skill mix goal set is based on the distribution of workload by complexity. Following is a comparison of skill mix distributions based on acuity and complexity.

Acuity based skill distribution for the Day shift:

ACUITY BY COMPLEXITY CROSS TABACUITY >

Complexity T1 T2 T3 T4 T5 T6 Complexity Total

T1 1 1 2

T2 5 5 10

T3 1 6 1 8

T4 1 6 1 8

T5 1 3 4

Acuity Total 1 8 18 5 32

TYPE ACUITY BASED WORKLOAD COMPLEXITY BASED WORKLOAD

DAY EVE NIGHT TOTAL DAY EVE NIGHT TOTAL

I 0.315 0.21 0.175 0.7 0.715 0.55 0.435 1.7

II 3.20 2.72 2.08 8.0 4.625 4.325 3.55 12.5

III 9.45 9.45 8.10 27.0 4.24 4.295 3.765 12.3

IV 3.45 4.025 4.025 11.5 4.24 4.295 3.765 12.3

V 0 0 0 0 2.595 2.94 2.865 8.4

VI 0 0 0 0 - - - -

Total 16.415 16.405 14,380 47.2 16.415 16.406 14.380 47.2

DAYS I II III IV V VI

RN 62% 67% 72% 77% 82% 87%

LPN 20% 20% 15% 15% 10% 0%

NA 18% 13% 13% 8% 8% 13%



Recommended staffing based on THPWI of 5.5 and the following shift distribution:

RN: 8.11

LPN: 1.81

NA: 1.36

Total: 11.29

Complexity based skill distribution for the Day shift:

Recommended staffing based on THPWI of 5.5 and the same shift distribution as for the acuity based staffing recommendations.

RN: 8.14

LPN: 1.78

NA: 1.36

Total: 11.29

I II III IV V VI

Days 45% 40% 35% 30% 34% 34%

DAYS 1 2 3 4 5

RN 50% 65% 70% 78% 85%

LPN 25% 20% 15% 11%

NA 25% 15% 15% 11% 15%




Differentiate between direct and non-direct care providers.

Describe job skills and job titles and how they are used in the AcuityPlus system.

Describe the guidelines for collecting actual and scheduled staffing data.

OverviewThe QuadraMed AcuityPlus Productivity, Benchmarking and Outcomes System requires entry of both staffing and patient classification data. Actual staff information is key to the direct care productivity indices of Actual Hours Per Workload Index (AHPWI) and Actual Hours Per Patient Day (AHPPD). Staff hours are generally referred to as direct (variable) or non-direct (fixed). Direct staff hours fluctuate with both patient driven workload and census or by census only. Productivity indices for the direct care staff are based on patient workload. Hospital-specific standards are used to determine productivity indices for the non-direct staff. Therefore, it is critical that all hours are collected and recorded as accurately as possible. This includes tracking and recording overtime, hours pulled to and/or from a unit, tardiness, leaving early, and hours not allocated to patient care, such as education and off-unit activity.

The AcuityPlus system defines two categories of staff:

Direct Care Providers – This includes staff who care directly for the patient and whose numbers typically fluctuate with both patient acuity and census, for example, staff nurses, LPNs, and EMTs.

Non-Direct Care Providers – This includes staff whose numbers typically do not fluctuate with patient acuity and census; although, in some cases, they may fluctuate based on census, for example, triage position, nurse manager, clinical specialist, support staff, orientees, and unit secretary.



The AcuityPlus system reports on budgeted, scheduled, actual, and recommended staff data. The AcuityPlus system provides for the entry of budgeted hours per patient day by unit. Budgeted staffing information is reported on the Unit Period Detail report. Scheduled and actual staff figures may be recorded and tracked for an unlimited number of different job titles per unit. The job titles are consolidated into an unlimited number of job skill categories. Each skill category represents a group of interchangeable jobs/positions for which both recommended staff and care hours are reported. For example:

A unit may define multiple descriptions/levels of RN staff, for example, RN I, RN II, and RN III and record scheduled and actual staff by shift by day for each of these titles.

All of the RN job titles/descriptions listed above could be consolidated to the one job skill category of RN for purposes of recommending staff and reporting direct care hours.

A percentage of direct care is assigned to each job title. The scheduled and actual hours reported in the job skill categories are broken down into direct and non-direct care categories providing an “apples to apples” comparison to the recommended staff level. For example:

The job title for the Patient Care Manager (Nurse Manager) may be assigned 0% direct care. If he or she was scheduled and worked 8 hours on a given day, those 8 hours would be reported as non-direct hours for the Nurse Manager job title.

A job title for Assistant Nurse Manager may be assigned 70% direct care. Again, if he or she was scheduled and worked 8 hours, the entire 8 hours would be reported for that job title with 5.6 hours (70% of 8 hours) included in the consolidated skill category RN direct care hours and 2.4 hours included in the non-direct care hours.

Recommended hours/staff are reported for the primary shifts that are defined for each unit. The data is displayed by job skill and in some instances divided into direct and non-direct staff hours or hourly equivalents.

In addition to identifying direct and non-direct categories of staff, the AcuityPlus system allows you to define the following:

Minimum Direct Care Hours – The minimum direct care staff hours required in the event of a low census/workload situation or for safety reasons.

Minimum Non-Direct Care Hours – The staffing standards for the non-direct staff.

Additional Direct Care Hours – The required direct or non-direct staff hours that are not based on patient workload or census, for example, an RN who provides sibling classes or unit-based program activities.

Additional Non-Direct Care Hours – Hours associated with program education, such as sibling classes, etc.

To facilitate entry of scheduled and actual staffing data, the various work shifts are defined for each unit. Hours worked other than those of the defined shifts are entered into the system based on a start and stop time.



Guidelines for Collection of Staffing DataActual staffing data must be entered into the AcuityPlus system for each defined job title by day and by shift to generate productivity reports. Scheduled staffing may be entered in the software, but is not required. The data may be entered manually or imported from a scheduling, time and attendance, or payroll system. Scheduled staffing always represents prospective data, and actual staffing represents retrospective data.

Data EntryAt the Enterprise level (these definitions are available to all facilities/hospitals and units):

Define the Major Skill Categories (staffing is recommended for skill categories).

Define Job Titles.

Assign Job Titles to Major Skill Categories.

At the unit level:

Define all of the shifts for which staff are typically scheduled and work.

Select the Job Titles appropriate to the unit.

Define each Job Title as a Direct or Non-Direct Care Provider.

Assign the Percent of Direct Care to each Job Title (Job Title Parameters). The remaining hours are interpreted as Non-Direct.

Assign the Percent of Direct Care to each Job Skill (Staffing Parameters).

Define how the hours for each Job Skill should be adjusted – by Workload, Census, or Fixed.

Shift Definition ExampleThe following work shifts may be defined for recording actual and scheduled staff hours:

7:00 AM – 3:00 PM

10:00 AM – 6:00 PM

7:00 AM – 7:00 PM

3:00 PM – 11:00 PM

4:00 PM – 8:00 PM

7:00 PM – 7:00 AM

11:00 PM – 7:00 PM

12:00 AM – 12:00 AM (24 hours)



Shifts for staffing recommendations must not overlap. Therefore, a logical consolidation of the shifts above into primary shifts might be:

7:00 AM – 3:00 PM

3:00 PM – 11:00 PM

11:00 PM – 7:00 AM

Job Title and Staffing Parameters ExampleJob Title and Staffing Parameters should be assigned only to the shifts for which staffing will be recommended. The job titles selected for the unit should match positions budgeted for the area. An example of job titles with percent direct care and job skills with percent of direct care follows:

In the example above, the Job Titles ANM, RN, RNII and RN-Orientee are consolidated into the RN Job Skill.

JOB TITLE % DIRECT CARE

NM 0%

ANM 50%

RN 100%

RN II 100%

RN-Orientee 0%

LPN 100%

NA 100%

ED-NA 100%

Unit Clerk 0%

JOB SKILL % DIRECT CARE ADJUST BYMINIMUM DIRECT CARE HOURS

MINIMUM NON-DIRECT CARE HOURS

ADDITIONAL DIRECT CARE HOURS

NM 0% Fixed 8

RN 100% WI 8

LPN 100% WI

Tech 100% WI 8

Clerical 0% Census



Actual Staffing Data CollectionActual staffing represents the number of hours of patient care personnel who actually worked in the area and is entered by shift. The information is collected and recorded retrospectively to accurately reflect changes that may occur with the staffing numbers throughout the course of a shift/day. The information is collected by job title and may be entered and displayed by the number of staff or by the number of hours on a shift.

Additionally, a means of accurately recording hours pulled to or from a unit, hours not available because of tardiness, attendance at inservices, etc., must be considered. Generally, this type of information is most accurately obtained at the unit level, where the patient care manager is held accountable. See Scheduled/Actual Staffing Worksheet on page 92 for a sample form that may be used to record the staffing data.

Hospitals that import the staffing data from another system, such as a scheduling, payroll, or time and attendance system, may need to document changes or exceptions by editing information in the AcuityPlus system or in the other system prior to import.

Recording Partial Shifts and OvertimeIt is recommended that actual staff hours be collected at the unit level. If an employee is off the unit for a significant period of time, such as two hours or more, those hours off the unit should be subtracted from the actual hours for the job title and shift. All overtime hours and hours pulled to the unit should be added to the actual hours for the job title, on the shift on which they occur.

The AcuityPlus system Actual Staff screen also contains an Other tab that allows for the recording of shifts other than those standard shifts defined in the system. The following information is entered in this screen:

OrienteesPersonnel who are in orientation are generally not counted as productive for a defined period of time. During that time they are often involved in classroom orientation activities and/or are paired with another staff member. Guidelines should be developed that identify when to begin including the orientees in the appropriate job category. Prior to that time, a job title identified as Orientee might be defined and used. This job title should be assigned 0% direct care. This provides for the tracking of the orientees’ hours, but does not impact the productivity indices.

JOB TITLE TIME IN TIME OUT TOTAL



Scheduled/Actual Staffing Worksheet

Scheduled Staff

Actual Staff

Unit: Date:

SHIFT JOB TITLES

OTHER:

SHIFT JOB TITLES

OTHER:




Define the data elements included in system control.

Explain methods to identify data inaccuracies and strategies to correct them.

Describe the process of patient classification monitoring, including inter-rater reliability testing, and tracking and reporting reliability.

Explain the use of the National Database in system control.

OverviewThe ultimate success of the QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System depends on the accuracy of system inputs. As with any software, the output data is only as good as the input data. The output data needs to be reliable before any decisions based on that data are made. From the onset of use of the system, mechanisms must be instituted for the ongoing evaluation of the accuracy of system inputs, which include census, acuity, and actual staffing.

For the system control of census, an assessment needs to be made whether an adequate number of patients has been classified. If an inadequate number of patients has been classified, acuity may not be accurate. In addition, the workload index and staffing recommendations will be understated. System controls for census include:

Actual to classified census analysis

Classification census to midnight census (patient classification import)

Guidelines for classification

Daily classification census verification



For the system control of acuity, an assessment needs to be made whether patients have been classified correctly. Accuracy of classification includes both the selection of appropriate indicators and the consistent use of indicators between staff and between units. The system controls for acuity include:

Daily reporting/reviewing of acuity

Acuity target ranges

Classification monitoring, including patient type and indicator agreement reliability

For the system control of actual staffing, an assessment needs to be made whether the actual staffing hours entered or imported into the AcuityPlus system are accurate. Actual staffing is used to calculate the AHPWI and AHPPD productivity indices. Inaccuracy in actual staffing hours results in inaccurate reporting of productivity. The system control for staffing is actual to paid worked hours analysis.

Census

Data Input Via On-Line Use of AcuityPlus SoftwareIn this mode of data input, assessment of whether all patients have been classified is made by comparing the actual census to the classification census. The actual census includes each patient present on the unit during the AcuityPlus-defined 24-hour period. The classification census includes each unique classified patient on the unit during the AcuityPlus-defined 24-hour time period. The AcuityPlus-defined 24-hour time period is based on the start of day defined in System Parameters (typically 7 AM). The variance between the actual census and the classification census represents the number of unclassified patients. The percent of variance can be determined by dividing the number of unclassified patients (variance) by the actual census and multiplying by 100. The recommended variance percent is 2% or less. For a unit with a low census, the recommended variance is one patient or less

In addition to the census volume variance, the hours of unclassified patient time need to be evaluated. This assessment is completed to determine the impact of the unclassified patient hours on the workload index and recommended staffing recommendations. An unclassified patient on the unit for an entire 24 hour period has a greater impact on workload index and recommended staffing than a patient with an unclassified length of stay of one hour. The percent of variance in unclassified patient hours is calculated by subtracting the classification census patient hours from the actual census patient hours to determine the unclassified patient hours. The unclassified patient hours are divided by the actual census patient hours and multiplied by 100 to determine the percent variance. The recommended variance percent is 2% or less.

The variances and variance percents are calculated in the Census Analysis report. This report should be reviewed quarterly, at a minimum, using four weeks of data.



A variance greater than 2% between the actual and classified census/patient hours needs to be investigated to determine what, if any, corrective action needs to be taken. Other than unclassified patients, the variance could be related to issues with the HL7 messages where patients are on the Patient Selection screen, but not present on the unit.

Data Input Via Patient Classification ImportWhen the patient classification import is used, patient classification guidelines are developed at each hospital to allow for the capture of a representative census for each patient care unit. This census is used to project staffing needs for the next 24 hours. At the time of classification, patients who will later be discharged and those who may not have arrived on the unit yet may be classified. It is anticipated that the flow of patients in and out will generally equalize; therefore, the number of patients classified will represent the average for the 24-hour period.

Most hospitals define the patient day count based on the midnight census. The midnight census is therefore used as the control to assess the accuracy of the number of patients captured in the classification census. On a quarterly basis, at a minimum, the average midnight census is compared to the average classification census. It is recommended that four weeks of data be used. A hospital-wide difference of 2% or less is considered acceptable. More importantly, on the unit level, the difference between the average midnight and average classification census should be contained to one patient or less. Unacceptable differences should be investigated for cause and corrective measures instituted. For units with a variance greater than one patient an in-depth analysis needs to be performed to determine the cause. This might include:

Determine the accuracy of the midnight census entered and/or imported into the system by comparing the reported figure with an actual head count.

Monitor the use of the classification guidelines on each unit to ascertain adherence, for example, classifying only one patient per bed or classifying all patients on the unit.

Collection of detailed data on admissions, discharges and transfers. Analyze the data to determine if the classification time is appropriate (see Determination of Classification Time on page 433). An change in classification time might be warranted to more closely align the number of patients with the midnight census.

AcuityAcuity is an extremely sensitive system parameter that can radically alter staffing recommendations. Acuity is the single greatest system control activity. One of the most dangerous things that can happen to any workload measurement system is acuity creep. Acuity creep happens when, over time, the classification of patients is not monitored carefully and the staff applies the indicators inappropriately. The result could be over classification of patients and an artificial increase in patient acuity. Over time, the acuity increase generates very different staffing requirements. These staffing requirements often cannot be supported by what is actually happening and are not believable, damaging the credibility of the system.



Acuity should change only because patients change. Any major fluctuation of acuity should be clearly traceable to a change in patient populations, average length of stay, available services, or physician practices, etc. If acuity increases from one year to the next, there should always be, without exception, something about the patients on the unit that is measurably different. Seek outside verification of an increase in acuity. If there is no evidence of a reason for increased acuity, then the acuity has changed for the wrong reasons, and immediate action should be taken to correct whatever is wrong. Examples of outside verification of increased acuity include:

The average age of patients having a certain procedure has increased over the past two years because of the availability of new anesthesia techniques. As a result the percentage of type III patients has increased by 33%.

Since last year, the average length of stay has decreased from 7.4 to 5.9 days. Pre-treatment workups are not done, and patients are discharged one day earlier. As a result, the percentage of type I patients has decreased by 25%.

In each of these examples, the external verification can support the increase in acuity. When used in this way, acuity and workload information become powerful management tools.

Expected Acuity RangeA target acuity and an expected acuity range are established for each unit to reflect the average acuity, the normal fluctuation, and to give increased meaning to the acuity value. To ensure that the classification process is controlled, the actual acuity is monitored to be certain that it falls within the expected range. Generally, an appropriate range is 10% above or below the expected target acuity. Some units, such as critical care, will have greater fluctuation in acuity, and the expected range may vary as much as 15%. When the acuity is outside of the expected range, it is a signal that something is different about the patient mix; therefore, the workload and staffing status of the unit should be reviewed.

Acuity creep is preventable. Commonly acuity falls outside the range because the patient population is significantly different, not all patients have been classified, or misclassification has occurred. It is extremely important to investigate such a situation. If misclassification is not corrected quickly and/or all patients are not classified, it could lead to continued misrepresentation of the workload. The data becomes meaningless and the integrity of the system suspect. The target acuity and expected acuity ranges should be reviewed regularly to ensure that they are positive and valid indicators of unit workload. At a minimum, semi-annual review is recommended.

The Acuity and Complexity Trend Graph can be generated on a monthly basis for a visual display of acuity by day. The upper and lower acuity ranges are displayed to help you easily identify days where the acuity is out of range for analysis.



Patient Classification MonitoringAn on-going program of patient classification monitoring must be instituted to assess the accuracy of patient classification data and the resulting acuities. QUADRAMED recommends that each unit be monitored by a reliability-tested nurse at specifically defined time intervals. Hospitals may differ in their approach to the monitoring responsibility. A Patient Classification Committee is established during the system implementation and is responsible for monitoring. Often this committee consists of Unit Managers and staff nurse representatives. Staff from education and quality assurance departments are also ideal candidates for performing monitoring activities. It is recommended that staff monitor units other than their own.

Monitoring involves randomly choosing a predetermined number of patients, assessing the patients, reviewing documentation, and interviewing the care provider to determine the appropriate indicators for application to the patient.

Volume to be monitored – 10% of the budgeted daily census for each shift with a defined classification window

Minimum number of patients to be monitored – Three patients for each shift with a defined classification window

Frequency of monitoring (per unit):

Weekly during implementation

Bi-weekly post implementation until the reliability score is 90% for both patient type agreement and indicator agreement

Monthly when reliability agreement is 90% or higher

Return to bi-weekly when reliability agreement is less than 90%

Reliability ScoresTwo levels of reliability must be assessed. At the highest level, acuity patient type agreement is assessed. Acuity patient type inaccuracy impacts the workload index and resulting staffing recommendations. Indicator agreement is a more detailed assessment of accuracy of indicator selection and can assist in determining the accuracy of complexity and educational needs of the staff.

Acuity Patient Type AgreementThe goal is to achieve 100% agreement of acuity patient type between the monitor (control) and the staff who originally classified the patient. Classification monitoring is completed in the AcuityPlus system. The following reports are available for data analysis:

Monitoring Detail report Monitoring Summary report

Monitoring Trend report Over/Under use of Indicators

Classification Accuracy by Classifying Nurse



Indicator AgreementIndicator agreement is based upon the concept that when classifying a patient using the Inpatient methodology, there are 13 decisions to be made on whether an indicator group applies. In this approach, not selecting an indicator or indicator group is a decision. An indicator group may be a single indicator or a set of indicators that are mutually exclusive. For the Inpatient methodology, there are 22 indicators that make up 13 indicator groups. The 13 indicator groups are:

The goal is to achieve 90% or higher agreement on the application of the indicators. The calculation for indicator agreement is:

GROUP NUMBER INDICATOR GROUPNUMBER OF INDICATOR OPTIONS

1 Activities of Daily Living (ADL) 3

2 ADL Rehabilitative 1

3 ADL Assistance 2

4 Communication Support 1

5 Cognitive Support 1

6 Behavior/Emotional Management 2

7 Safety Management 2

8 Isolation Precautions 1

9 Assessment 4

10 Medication Preparation 1

11 Wound/Injury Management 2

12 Healthcare Management Education 1

13 1 to 1 Physiological Intervention 1

number of indicator groups selected correctly

number of indicator groups



Indicator Agreement Examples:

Example 1:

In this example, the only error in this classification is in the ADL group. The calculation is:

Example 2:

In this example, the classifying nurse failed to select Cognitive Support and incorrectly selected Healthcare Management Education. The calculation is:

CLASSIFYING NURSE INDICATORS

MONITORING NURSE INDICATORS

INDICATOR GROUP

ADL – Complete Care ADL – Partial Care ADL Group (Indicators 1-3)

ADL Assistance - 2-3 Caregivers


ADL Assistance Group (Indicators 5-6)

Assessment - q 4 Hours Assessment - q 4 Hours Assessment Group (Indicators 14-17)

Healthcare Management Education - > 1 Hour


Healthcare Management Education Group (Indicator 21)

12 correct indicator groups= 92% indicator agreement

13 indicator groups

CLASSIFYING NURSE INDICATORS

MONITORING NURSE INDICATORS

INDICATOR GROUP

ADL – Rehabilitative ADL – Rehabilitative ADL– Rehabilitative Group (Indicator 4)

Communication Support Communication Support Communication Support Group (Indicator 7)

--------------- Cognitive Support Cognitive Support Group (Indicator 8)

Assessment - q 4 Hours Assessment - q 4 Hours Assessment Group (Indicators 14-17)

Wound/Injury Management Wound/Injury Management Wound/Injury Management Group (Indicators 19-20)


------------------- Healthcare Management Education Group (Indicator 21)

11 correct indicator groups= 79% indicator agreement

13 indicator groups



The calculation of overall indicator agreement is:

The total indicator agreement score for the two examples above is:

Reliability TestingIt is recommended that once per quarter the assigned patient classification monitors be tested for their ability to consistently classify patients by indicator application and acuity patient type. Just as in any other data collection or research study, you must ascertain that each data collector comes up with the same results as another in the same situation. Descriptions of patient scenarios for performing inter-rater reliability testing are provided, see Inpatient Inter-Rater Reliability Test A on page 109 and Inpatient Inter-Rater Reliability Test B on page 116. However, monitors may be tested at any time on the units using real patients. For example, a small group of monitors, 3-4 at a time, can independently classify the same 7 patients and compare their resulting patient types and indicator application for consistency. The Coordinator should act as the answer key. It is expected that type agreement would occur with at least 6 of the 7 patients classified and indicator agreement of 90% or higher.

Total number of correct indicator groups

13 indicator groups x number of patients monitored

23 correct indicator groups = 23 correct indicator groups= 88% indicator agreement

13 indicator groups x 2 patients 26 indicator groups



Guidelines for Monitoring Patient Classification DataMonitoring of patient classification data is performed on a regular basis to ensure the reliability of the reported acuity and to identify and document areas of concern related to the application of the critical indicators. All patient care units using the QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System should be monitored at least once every two weeks. Monitoring is done concurrently and should be scheduled to occur on the shift on which classification occurs.

Professional nurses performing patient classification monitoring should be tested for inter-rater reliability on a quarterly basis. Scenarios provided by QUADRAMED, scenarios created by your hospital, or real patients may be used.

Establish a schedule to ensure that each unit is monitored bi-weekly or monthly, depending on reliability scores on each shift where classification occurs, and that days of the week vary from one period of monitoring to the next. The schedule should occasionally include weekend days.

The following materials should be available for the monitor:

On-line monitoring – Indicator definitions with application examples

Manual monitoring:

Indicator definitions with application examples

A screen print of indicators

Indicator weights and point ranges

Patient’s classification type and indicators selected. Use one of the following documents:

Print screens of the indicators selected for patients to be monitored

The Monitoring Detail report (preferred) or the Indicator Detail by Patient report

Review of indicators selected on-line using the edit classification function

Determine the number of patients to be monitored by multiplying the budgeted daily census times 10% for each shift with a defined classification window.

The monitor classifies the randomly chosen patients via the on-line monitoring function. Data sources may include the patient (observation and interview), all nursing records for the current classification period, and the staff responsible for providing the patient’s care.

For manual monitoring, sum the weights of the indicators, determine the patient types, and record on the Classification Monitoring report. For on-line classification, print the Monitoring Detail report for a comparison of indicators selected by the classifying nurse and the monitor.



The monitor compares the indicators selected by the nurse who classified the patient to those selected by the monitor. If monitoring is not completed on-line, the number of all over and/or under used indicators should be recorded. The monitor is the control in this situation. If the monitor selected an indicator and the staff did not, it is under-use. If the staff selected an indicator, but the monitor determines it inappropriate, it is over-use.

The monitor completes the Indicator Agreement form for each patient monitored. This is used to calculate the indicator agreement percentage.

The monitor discusses the comparison with the nurse who classified the patient, focusing on indicator discrepancies. If appropriate, the monitor may revise her/his classification based on the discussion. The monitor can use this as an opportunity to provide individualized education related to specific indicator definitions/applications.

Both the monitor and the classifying nurse sign the Monitoring Detail report, indicating that the indicator usage was discussed.

Calculate the percent reliability if monitoring manually and complete the Monitoring Detail report/Classification Monitoring report.

When monitoring is completed on-line, the following additional reports are available to provide ongoing information on the application of indicators and data validity:

Over/Under Use of Indicators

Monitoring Summary

Monitoring Trend



AcuityPlus™Inpatient Coordinator Guide Chapter 7 System Control

Patient Classification Monitoring Report Unit: ___________ Date: __________________ Census: __________________ Number of Patients Monitored:__________________

Signature: ______________________________________________

I. Check for the following and circle the appropriate response: III. Calculate Patient Type Reliability Percent: ______________%

All patients classified? Yes No (No. of patients correctly classified / total no. of patients in sample) x 100%

II. Record classification information: Patient Type List Indicators by Number

Room # Patient Name Staff Monitor Overuse Under use Comments

1

2

3

4

5

6

7

8

9

10

IV. Narrative Summary (Actions):

V. Time Started: ______________ Time Completed: ______________ Total Time: ________________



Unit Monitoring Summary

Unit: ___________________

PERIOD ENDING % RELIABILITY SUMMARY – INDICATORS OVER/UNDER USED, ACTIONS



Hospital Monitoring Summary (Acuity Reliability) UNIT ↓ PERIOD ENDING AVERAGE

Period Average



Indicator Agreement Report UNIT: DATE:

INDICATOR GROUP

PATIENT NAME PATIENT NAME PATIENT NAME

AGREE DISAGREE AGREE DISAGREE AGREE DISAGREE

1. Activities of Daily Living (ADL):

ADL – Self/Minimal Care

ADL – Partial Care

ADL – Complete Care

2. ADL - Rehabilitative

3. ADL Assistance


ADL Assistance - 4 or more Caregivers

4. Communication Support

5. Cognitive Support

6. Behavior/Emotional Management

Behavior/Emotional Management

Behavior/Emotional Management - q 1 Hour

7. Safety Management

Safety Management - q 2 Hours

Safety Management - q 30 Minutes

8. Isolation Precautions



9. Assessment

Assessment - q 4 Hours

Assessment - q 2 Hours

Assessment - q 1 Hour

Assessment - q 30 Minutes

10. Medication Preparation - > 20 Minutes


Wound/Injury Management

Wound/Injury Management - > 30 Minutes


13. 1 to 1 Physiological Intervention - > 2 Hours

Sum ------------------- -------------------- -------------------

UNIT: DATE:

INDICATOR GROUP

PATIENT NAME PATIENT NAME PATIENT NAME

AGREE DISAGREE AGREE DISAGREE AGREE DISAGREE



Hospital Indicator Agreement Summary UNIT ↓ PERIOD ENDING AVERAGE

Period Average



Inpatient Inter-Rater Reliability Test AInstructions: For shift based classification, the shift length is 8 hours. Classify the following patients in the scenarios below. Read the scenarios carefully and do not make assumptions.

1. Jayela is a two-week old infant status post arterial switch (1 week post-op). She has a subclavian central line and her IV fluid is running at 30cc/hr, requiring an hourly assessment. She has IV antibiotics ordered every four hours. She has vital signs ordered every four hours and continuous nasogastric feeds. Jayela is on ½ liter oxygen per nasal cannula and has a mid-sternal incision. She has one pleural chest tube and one mid-sternal chest tube requiring respiratory assessments every hour. Her nasogastric medications include Digoxin and Lasix bid and Captopril tid. The patient has a daily CBC and chest x-ray ordered. She will be discharged to home on continuous nasogastric feedings and current medications via the nasogastric tube. Discharge teaching will begin today according to her educational plan and it is expected to take 1 hour.

2. Mr. Grady is a 38-year-old, recovering from a 40% total body surface area burn to chest, arms, and legs. He has 2nd and 3rd degree burns. He has Bacitracin dressing changes twice daily, requiring over one hour of unit-based tech time per dressing change. He has two donor sites, from previous operations, on his back which are healing well. Vital signs are assessed every eight hours and he requires assistance with his ADLs and assistance of 2 staff to ambulate. He has a history of a GI bleed, so he receives Pepcid IV BID. Pain medication is being administered q 4 hours. The MD has begun to discuss Mr. Grady’s impending discharge, and Mrs. Grady is coming in today to learn how to do the dressing changes according to the educational plan and it is expected to take 20 minutes.

3. Mrs. Ellis is a 29-year-old patient who delivered a healthy baby girl early this morning. This is her first child. She attended prenatal and baby care classes. She is currently applying ice to her perineal area for her episiotomy, and she is receiving pain medication PRN. She is breastfeeding, although the infant is having difficulty latching on. The lactation consultant has been contacted and the unit-based RN will do breast feeding teaching today according to the education plan and it is expected to take 1 hour. Mrs. Ellis is up ad lib and requires no assistance with her ADLs.

4. Baby Girl Ellis was born early this morning and is a healthy newborn. The cord site is being assessed at each diaper change. She is being breastfed by her mother.

5. Mrs. Gregory is an 81-year-old female admitted yesterday with a diagnosis of acute bacterial pneumonia. She is very weak and requires assistance with feeding and bathing. She requires the assistance of 2 for positioning in bed. She has a continuous IV for the administration of fluids and for antibiotics that are being administered every 4 hours. Intake and output is being assessed every shift. Her lungs are being auscultated every 4 hours, and oxygen is being administered at 4L/min via face mask. Vital signs are also being assessed every 4 hours. Mrs. Gregory is a long-time smoker, and smoking cessation methods will be discussed today in accordance with her educational plan and this should take 20 minutes.



6. Mr. Lyle is an awake, alert, 72-year-old patient who had a total laryngectomy performed two days ago. He has a Hemovac, a tracheostomy tube, and a nasogastric tube in place. He requires complete assistance with his ADLs. His vital signs are to be assessed every 4 hours, and they are currently stable. He needs to be suctioned every two hours. The head of his bed is elevated. He will be receiving tube feedings via the nasogastric tube. He has IV fluids infusing at a keep open rate for IVPB antibiotics every twelve hours and is receiving pain medication via a PCA pump. His level of pain control is going to be assessed every four hours. Intake and output are to be assessed every shift. Mr. Lyle communicates by writing on a pad. Since his wife passed away one year ago, Mr. Lyle has been depressed. He is withdrawn and not participating in his care, although he is capable of doing so. A psychiatric consult has been ordered. The nursing documentation reflects the patient’s behavior and the need for intervention.

7. Mrs. Small is an unresponsive 66-year-old woman admitted to the ICU today in septic shock. Her status is very unstable. Mrs. Small is receiving total care and is on a documented preventive skin care routine that includes turning q 2 hours and an alternating pressure mattress. It requires 2 staff to turn and position her. A Dopamine drip was initiated due to the patient’s unstable hemodynamic status. The patient’s hemodynamic status, including arterial pressure, is being assessed every five to ten minutes with the nurse continuously at the bedside to determine the need for titration of her Dopamine drip. It is anticipated that the level of assessment related to her hemodynamic status will stabilize after four hours and her vital signs and response to the Dopamine drip will be assessed every hour. She is currently on a ventilator and blood gases were assessed following intubation. For the first four hours of her stay in the ICU, the patient’s pulse ox level will be assessed every 30 minutes followed by every hour. Intake and output is being assessed every hour. Mrs. Smith is also receiving IV boluses, and it is anticipated that she will require a blood transfusion later in the day. She is scheduled for a CAT scan today at 3 p.m. and will require a unit-based RN to accompany her to the test. This will take 80 minutes. Her family is at her side and is visibly upset and requires comforting interventions. Her nurse is instructing them on the need and function of the ventilator as well Mrs. Small’s response.

8. Mr. Usher is a 59-year-old man admitted to the SICU following a CABG. He is intubated and requires total care. Mr. Usher is 400 lbs and requires 5 staff to position him in bed. He is on a cardiac monitor and has arterial, central venous and pulmonary arterial pressure lines for monitoring. He currently has Nitroglycerin and Epinephrine drips infusing, which required continuous assessment at the bedside to evaluate his response to these medications for the first hour following his arrival from the OR. His vital signs will be assessed q 15 minutes for the first hour and then hourly. Mr. Usher has a central line and a peripheral IV with fluids infusing in each. It is anticipated he will be extubated in 8 hours. He has a chest tube and a mediastinal tube. He also has an indwelling foley catheter, and output is assessed hourly. Mr. Usher has both leg and sternal incisions.

9. Mr. Wilbur is a 21 year-old who was in a motorcycle accident and admitted at 0400 for neurological observation and head lacerations. Prior to coming to the unit, he underwent surgical cleansing of gravel from his wounds. He is oriented to person only and complaining of a severe headache for which he is receiving IM pain medication every four hours. Mr.



Wilbur’s vital signs and neurological status is being assessed every two hours. He has a continuous peripheral IV with intake and output assessed every shift. He is on strict bedrest and is requiring some assistance with ADLs. Mr. Wilbur has attempted get out of bed several times. He requires a unit-based sitter at the bedside to ensure that he will not fall.

10. Mrs. Spring is a 74-year-old woman admitted to the unit yesterday after surgery for a left hip fracture. She is able to feed herself, but requires a complete bath because she is afraid to move for fear of hurting her hip. She requires the assistance of two staff to transfer to a chair. Her skin integrity is poor; therefore, a preventive skin care plan has been instituted, including a special mattress and turning q 2 hrs. Wound dressing assessments are done every shift. Vital signs are assessed every 4 hours. Mrs. Spring’s oral intake is low, and she has a continuous IV in place. Intake and output is being assessed every shift. Pain medication is being administered by a PCA pump and her response is assessed every 4 hours. Physical therapy has been scheduled to begin today. Mrs. Spring is confused, is in soft restraints and requires observation for safety every 2 hours.



Answer Key for Test A: Multiple Classification by ShiftAnswers for live multiple classifications by shift (8 hour shift) and/or condition change.

SCENARIO INDICATORS ACUITY COMPLEXITY

A1. Jayela

Acuity: Type IV – 62 pts

Complexity: Type V –55pts

3 – ADL - Complete Care

16 – Physiological Assessment - q 1 Hour

19 – Wound/Injury Management

21 – Healthcare Management Education - > 1 Hour

Activity: Patient/Family Education by RN

21

33

8

0

22

22

6

5

A2. Mr. Grady

Acuity: Type III – 43 pts

Complexity: Type III – 32pts

2 – ADL - Partial Care

5 – ADL Assistance - 2-3 Caregivers

14 – Physiological Assessment - q 4 Hours

20 – Wound/Injury Management - > 30 minutes

Activity: Extensive Wound Management by a non-RN

10

8

16

9

16

0

8

8

A3. Mrs. Ellis

Acuity: Type I – 10 pts

Complexity: Type I – 25 pts

1 – ADL - Self/Minimal Care


21 – Healthcare Management Education - > 1 Hour


2

8

0

14

16

5

A4. Baby Girl Ellis

Acuity: Type II-29 pts

Complexity: Type II – 28pts



21

8

22

6

A5. Mrs. Gregory

Acuity: Type II – 34 pts

Complexity: Type I –24pts




10

8

16

16

0

8

A6. Mr. Lyle


Complexity: Type IV – 43pts


7 – Communication Support

9 – Behavior/Emotional Management



21

1

8

18

8

22

0

1

14

6



A7. Mrs. Small

Acuity: Type VI – 112 pts

Complexity: Type V – 60pts





17 – Physiological Assessment - q 30 Minutes

22 – 1 to 1 Physiological Intervention - > 2 Hours

21

8

1

8

59

15

22

0

0

1

30

7

A8. Mr. Usher

Acuity: Type V – 89 pts

Complexity: Type V –50pts


6 – ADL Assistance - 4 or More Caregivers



21

27

33

8

22

0

22

6

A9. Mr. Wilber



2 – ADL- Partial Care

8 – Cognitive Support

12 – Safety Management - q 30 Minutes



Activity: 1:1 Safety Observation by non-RN

10

5

8

18

8

16

1

0

14

6

A10. Mrs. Spring






11 – Safety Management - q 2 Hours

14 – Assessment - q 4 Hours


10

8

5

4

16

8

16

0

1

0

8

6




Answer Key for Test A: One Time ClassificationAnswers for one time classification per 24-hour period.


A1. Jayela






21 – Healthcare Management Education - 1 Hour


21

33

8

0

22

22

6

5

A2. Mr. Grady






20 – Wound/Injury Management - 30 Minutes

Activity: Extensive Wound Management by a non-RN

10

8

16

9

16

0

8

8

A3. Mrs. Ellis



1 – ADL- Self/Minimal Care



21 – Healthcare Management Education - 1 Hour


2

16

8

0

14

8

6

5

A4. Baby Girl Ellis



3 - ADL - Complete Care

19 - Wound/Injury Management

21

8

22

6

A5. Mrs. Gregory


Complexity: Type I – 24pts




10

8

16

16

0

8

A6. Mr. Lyle


Complexity: Type IV –43pts






21

1

8

18

8

22

0

1

14

6



A7. Mrs. Small







16 – Assessment - q 1 Hour

22 – 1 to 1 Physiological Intervention > 2 Hours

21

8

1

8

33

15

22

0

0

1

22

7

A8. Mr. Usher







21

27

33

8

22

0

22

6

A9. Mr. Wilber


Complexity: Type III –37pts



12 – Safety Management - q 30 Minutes



Activity: 1:1 Safety Observation by non-RN

10

5

8

18

8

16

1

0

14

6

A10. Mrs. Spring






11 – Safety Management - q 2 Hours



10

8

5

4

16

8

16

0

1

0

8

6




Inpatient Inter-Rater Reliability Test BInstructions: For shift-based classification, the shift length is 8 hours. Classify the following patients in the scenarios below. Read the scenarios carefully and do not make assumptions.

1. Mr. Finnigan, age 40, was admitted at 2100 complaining of “crushing” pain in the chest, nausea, diaphoresis, and shortness of breath. His lab results show elevated cardiac enzymes, troponin, triglycerides, and cholesterol. He is on a cardiac monitor and is experiencing tachycardia and premature ventricular contractions. Mr. Finnigan continues to complain of chest pain, and his respirations are shallow and rapid. He has a continuous peripheral IV, and his intake and output is being assessed each shift. He is receiving morphine q 3 hours for pain. Oxygen is being delivered at 3L/minute via NC, and his vitals signs are being assessed hourly. He has a Lidocaine drip infusing continuously with his heart rhythm being assessed hourly. Currently, he is on complete bedrest and is requiring complete assistance with his ADLs. Mr. Finnigan is unusually fearful, asking “am I going to die?” repeatedly, using his call light every 30 minutes for the first 4 hours and nursing has been spending additional time with him, documenting his behavior and their interventions. He is scheduled to undergo conscious sedation at the bedside shortly with 2 unit-based RNs assisting in this procedure, which is expected to take an hour.

2. Ms. Gladding, an obese 36-year-old female, was admitted to the Rehabilitation unit with motor deficits and parasthesias as a result of Guillain-Barre Syndrome. She has a healed tracheostomy in place and is having respiratory treatments daily and as needed. She has a Passe-Muir valve in place to allow her to communicate effectively. Vital signs are assessed every shift. She has a foley catheter in place requiring the monitoring of output. Ms. Gladding is able to feed herself; however, she requires assistance with bathing and dressing. She is experiencing motor return in all her extremities. A plan is in place to increase her ADL function and staff have documented her progress towards meeting the established goals. Because of her obesity, she requires the assistance of four to transfer and ambulate. She has a care plan for the prevention of pressure sores which includes turning q 2 hours and the use of a specialized bed. Upon discharge Ms. Gladding will be going to her parents’ home as they have been participating in her care. All appear to be realistic and optimistic with regard to her recovery.

3. Mr. Charles is a 62-year-old male who suffered a left hemisphere thrombotic stroke three days ago. He has right body weakness, aphasia, and homonymous hemianopsia to the right requiring 2 staff to assist with transfer to a chair. His blood pressure has remained stable and is assessed each shift. As Mr. Charles is right handed and requires assistance with bathing and feeding, as well as ambulating. There is a plan in place for staff to assist him in increasing his independence in ADLs, and staff have documented his progress towards meeting the established goals. The nurse is making multiple calls to both the medical attending and rehabilitation doctor to clarify conflicting medication orders, activity orders and therapy services and the expected time frame is 1 hour.



4. Mr. Horn, 49 years-old, had a partial bowel resection yesterday afternoon. Today he is NPO with a continuous IV infusion of parenteral nutrition and lipids through a central line. Vital signs are assessed q 4 hours. Antibiotics will be administered q 8 hours. Mr. Horn has a nasogastric tube attached to low suction that needs to be flushed prn with normal saline. Blood sugar is to be measured q 6 hours with sliding scale insulin coverage. He has a foley catheter in place with output assessed every two hours. Mr. Horn requires assistance with bathing and requires two people to assist with ambulation. Pain control is via a PCA pump with an assessment of pain relief every three to four hours. His abdominal dressing is to be changed as needed. Mr. Horn will be going off the unit for a series of abdominal x-rays and will be accompanied by a unit-based nursing assistant. It is expected that he will be gone 1 hour.

5. Mr. Roy is a 61-year-old man who has been admitted as a 23 hour Observation patient for recovery post-cardiac catheterization. He is on telemetry, and his vital signs and pedal pulses are to be assessed q 15 minutes x 4, q 30 minutes x 2, q 1 hour x 2, then q 4 hours. The dressing over the puncture site is also to be assessed for bleeding with the vital signs. His left leg is to be immobilized and extended for 6 hours at which time the groin dressing is to be removed and the patient ambulated. A continuous peripheral IV is in place at 75cc per hour until 500 cc of normal saline has infused. Pain medication will be administered q 4 hours. He will receive the typical post procedure diet and will be able to feed himself with setup assistance. Intake and output is assessed q shift. The patient was instructed on post procedure activity limitations and signs and symptoms to report to the nurse.

6. Mr. James is a 14 year-old asthmatic admitted with respiratory distress. He is on 50% O2 per face mask and receiving continuous Albuterol nebulizer treatments requiring an assessment of his response to the medication every 30 minutes, including a respiratory assessment. The Albuterol nebulizer treatments will be continuous for the next 4 hours, then will be given q 4 hours. Once the continuous nebulizer treatment is completed, the patient will be able to feed himself. Patient is on bedrest and requires assistance with ADLs. The patient has a continuous IV with intake and output monitored q shift. Vital signs are to be assessed every two hours. The patient is on a cardiac monitor and a continuous pulse oximeter. His mother will be in today for asthma management education in accordance with the education plan which is scheduled to take 30 minutes.

7. Cassie is a 2-month-old who was transferred from the intermediate care nursery to the NICU due to fever. Upon transfer, she was lethargic, showed minimal response to noxious stimuli, and her extremities were cool and pale. Admission vital signs were as follows: T-103.5, HR-180, R-80, BP 50/p. and her lungs were clear to auscultation. Cassie was placed on a cardiac monitor, O2 was initiated immediately and a peripheral I.V. of Lactated Ringers was started. Shortly after she arrived, she became unresponsive. Her heart rate increased to 190 and her BP was no longer palpable. Her femoral pulses were faint. Cassie required the RN to be at the bedside for the first 2 ½ hours of her stay. After two boluses of IV fluids, Cassie’s vital signs stabilized. A foley catheter was inserted with a urine specimen sent for culture and sensitivity. Cassie was started on a broad spectrum antibiotic IVPB q 8 hours. Cassie is on hourly intake and output and her vital signs are assessed q 1 hour.



8. Mr. Jim is a 60-year-old male with a 20-year history of alcoholism and a 35 pack/year history of cigarette smoking. He was admitted with complaints of cough, hoarseness, dyspnea and hemoptysis. Today, he has been informed that he has Stage III small cell carcinoma of the lung. Due to his advanced tumor size and extensive cardiac history, he is not a candidate for surgery. He can feed himself, but he becomes short of breath when he bathes, and thus needs assistance. His vital signs are assessed every shift. He has a peripheral IV that is infusing at 125cc per hour. He is started on a regime of Cyclophosphamide, Doxorubicin and Vincristine, administered IVPB. It takes the nurse 30 minutes to check and verify the chemo administration orders. He is experiencing nausea and an anti-emetic is being administered q 4 hours. When you walk into his room to hang his 0900 dose of chemotherapy, he is weeping quietly. When you offer support, he becomes visibly angry and loudly orders you to leave his room immediately. Because it is imperative that Jim receives his chemotherapy, you tell him that you will give him privacy and return in 15 minutes. When you return, Jim is flushed and apologizes to you. He confides that his wife has recently filed for a divorce, and that this illness is more than he can cope with right now. He allows you to hang his chemotherapy and agrees to speak with someone regarding his emotional state. You contact the psychiatric liaison nurse, who meets with him for an hour in the afternoon. Jim’s demeanor is calm, yet guarded for the remainder of your shift. His initial emotional state and the need for psychiatric intervention were documented.

9. Ms. Sarah is a 25-year-old HIV positive female patient was admitted for pancytopenia. She received neupogen 300mcg subQ upon admission. Her anti-retroviral medications are on hold. She has a continuous I.V. that is to run at a TKO rate. She is to receive a transfusion of three units of PRBCs to infuse over two hours each and two units of platelets to be run over 15 minutes each. Ms. Sarah’s consent for transfusion will be obtained, and she will be instructed on signs and symptoms to report during the transfusions. With each unit of blood, her vital signs will be assessed prior to initiation, at 15 minutes and upon completion. With platelets her vital signs will be assessed pre and post infusion. After the completion of the transfusions, Sarah’s vital signs are checked every 4 hours. Her intake and output is assessed every shift. Sarah is independent with her ADLs. She will receive a general diet for lunch and be discharged home late this evening and followed up in the outpatient clinic tomorrow morning. She will be given basic discharge instructions on her follow-up appointment at the clinic and medication schedule.

10. Mr. Fred is a 44-year-old paraplegic due to a motor vehicle accident. He was admitted to a skilled nursing unit three weeks ago. He has two stage II decubitus ulcer and one stage III decubitus ulcer on his right buttock. He receives dressing changes to each ulcer on a daily basis. The ulcer wound irrigation and packing take 1 hour. As of this morning, it was determined that the culture from his stage III ulcer is positive for MRSA. He is now on isolation for contact precautions. He has a continuous IV. He will start on high dose Vancomycin, which he will receive IVPB q day. He has recently experienced a ten-pound weight loss and is on a twenty-four hour calorie count today. His oral fluid intake is recorded every two hours. He is on a bladder program that includes straight catheterization every six hours, and he is on an effective bowel-training program. He needs help washing



his lower extremities during his bath and 2 staff to position him in bed. His skin care plan includes turning q 2 hours and use of an air mattress. He takes multi-vitamins by mouth once per day. He is diabetic and is managed on Glucophage. He has a blood glucose level drawn at 7:00 am every morning.

11. Mr. White is a 44 year-old admitted with respiratory distress. He is on 50% O2 per face mask and staff are doing a respiratory assessment every hour. When he arrived on the unit, a nurse noted that his respirations were much less on the right and left. He will be having chest tubes inserted with the assistance of a unit-based RN. This is expected to take 1 hour. Once the procedure is completed, the patient will be able to feed himself. Patient is on bedrest and requires assistance with ADLs. The patient has a continuous IV with intake and output monitored q shift. Vital signs are to be assessed every hour for 4 hours then every 4 hours thereafter. The patient is on a cardiac monitor and a continuous pulse oximeter. His wife is at the bedside.



Answer Key for Test B: Multiple Classification by ShiftAnswers for live multiple classifications by shift (8 hour shift) and/or condition change.


B1. Mr. Finnigan


Complexity: Type IV –49pts


10 – Behavior/Emotional Management - q 1 Hour


Activity: 2:1 by RN

21

13

33

22

5

22

B2. Ms. Gladding




4 – ADL - Rehabilitative

6 - ADL Assistance - 4 or More Caregivers

10

2

27

16

0

0

B3. Mr. Charles


Complexity: Type I – 17pts





Activity: Coordination of Care by RN

10

2

8

1

16

0

0

1

B4. Mr. Horn







Activity: Off Unit Accompanied by non-RN

10

8

18

8

16

0

14

6

B5. Mr. Roy


Complexity: Type IV – 44 pts


16 – Assessment - q 1 Hour


10

33

8

16

22

6

B6. Mr. James




17 – Physiological Assessment - q 30 Minutes

10

59

16

30



B7. Ms. Cassie


Complexity: Type V – 51 pts



22 – 1 to 1 Physiological Intervention - 2 Hours

21

33

15

22

22

7

B8. Mr. Jim






18 – Medication Preparation - 20 Minutes

10

8

16

5

16

1

8

0

B9. Ms. Sarah


Complexity: Type II – 28 pts



2

18

14

14

B10. Mr. Fred





13 – Isolation Precautions



Activity: Extensive Wound management by RN

10

8

6

18

9

16

0

6

14

8

B11 Mr. White





19 – Wound Management

Activity: 1:1 by RN

10

33

8

16

22

6




Answer Key for Test B: One Time ClassificationAnswers for one time classification per 24-hour period.


B1. Mr. Finnigan


Complexity: Type IV – 45pts




Activity: 2:1 by RN

21

8

33

22

1

22

B2. Ms. Gladding






10

2

27

16

0

0

B3. Mr. Charles







Activity: Coordination of Care by RN

10

2

8

1

16

0

0

1

B4. Mr. Horn


Complexity: Type III –36pts





Activity: Off Unit Accompanied by non-RN

10

8

18

8

16

0

14

6

B5. Mr. Roy






10

16

8

16

8

6

B6. Mr. James





10

18

16

4

B7. Ms. Cassie


Complexity: Type V – 51 pts



22 – 1 to 1 Physiological Intervention - 2 Hours

21

33

15

22

22

7



B8. Mr. Jim






18 – Medication Preparation - 20 Minutes

10

8

16

5

16

1

8

0

B9. Ms. Sarah





2

16

14

8

B10. Mr. Fred





13 – Isolation Precautions



Activity: Extensive wound management by RN

10

8

6

18

9

16

0

6

14

8

B11 Mr. White





Activity: 1:1 by RN

10

16

16

8




Acuity SummaryControl Activities

Daily review of acuity and patient mix.

Bi-weekly classification monitoring.

Quarterly testing of patient classification monitors.

Expected Acuities and Ranges

Assess at least twice per year (or when needed) and revise as appropriate.

Review historical acuity fluctuations.

Compare actual acuity with budgeted (targeted) acuity.

Compare actual and budgeted acuity with the National Database.

True Changes in AcuityDirectly related to changes in individual patients and populations served.

Decrease/increase in patient length of stay.

Change in the services of the unit.

Change in the medical staff.

New and different technologies.

Actual StaffingActual staff available to provide patient care is recorded in the system by skill and shift for each day. This input is key to the productivity indices of Actual Hours per Workload Index (AHPWI) and Actual Hours per Patient Day (AHPPD). Recording too few staff hours or too many staff hours will cause the productivity indices to be falsely over or under represented.

The number of actual staff by job title present at the start of each shift should be recorded. Additionally, a record should be maintained of staff hours that are pulled to or from the unit, as well as any overtime or under-time. The software application allows for this level of detailed staffing entry and calculates the actual available direct hours accordingly.



The control to assess the accuracy of the actual staff hours entered into the system is the hospital’s payroll system. Actual staff hours should parallel paid, productive hours to within 2% or less hospital-wide. It is recommended that the actual staff hours entered into AcuityPlus be compared to the payroll paid productive hours at least quarterly using a four week period. Unacceptable variances should be investigated and mechanisms to correct them instituted. One of the most common reasons for significant variances is the failure to accurately record overtime/under-time in the system.

Paid to Actual Staff AnalysisThe accuracy of the actual staff hours reported on AcuityPlus management reports is assessed via comparison to the paid worked hours. The analysis enables verification of the productivity indices AHPWI and AHPPD/AHPPV.

The analysis should be performed quarterly using two consecutive periods of payroll data. If payroll data is reported by calendar month, the comparison may be completed for that timeframe.

Follow the instructions below to complete the Paid to Actual Staff Analysis Worksheet on page 404.

Complete Column A – Paid Staff

1. Obtain the following unit specific data for two consecutive pay periods for all job categories for which actual staffing data is entered into the AcuityPlus system:

Total number of paid worked (productive) hours.

Total number of overtime hours.

2. Total the number of paid worked and overtime hours by unit.

For job categories assigned greater than 0% but less than 100% direct care, calculate the percentage of paid worked hours. For example:

Assistant Nurse Manager: 60% direct care. Paid Worked Hours: 160. 60% of 160 = 96 direct care hours.

Exclude benefit hours (paid but not worked), such as sick, vacation, holiday, jury duty, education, and orientation time.

3. The total hours may be converted to shift equivalents by dividing by the shift length.

4. Enter the total hours or shift equivalent hours in Column A for each unit.

5. Sum the unit totals to obtain a hospital total.



Complete Column B – Actual Staff

1. Obtain the total number of actual staff hours or shift equivalent hours for each cost center (unit) recorded in the QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System for the periods being analyzed. This data can be obtained from one of the following reports:

Staffing Variance report: Print this report (or view the information on the screen) for the date range which coincides with the pay period date range.

Actual Staff By Shift report

2. Enter the total actual hours or the shift equivalent hours for each unit in Column B.

3. Sum the unit totals to obtain the hospital total actual staff.

Complete Columns C and D – Variance and Percent Variance

1. Calculate the difference between the paid and actual hours or the shift equivalent hours:

(A) Paid Staff - (B) Actual Staff = (C) Variance

2. Calculate the percent variance for each unit and the hospital:

((C) Difference / (A) Paid Staff) x 100% = % Variance

A variance of 2% or less is considered acceptable. If the variance is greater than 2%, actual staff capture mechanisms should be reviewed to determine the cause of the discrepancy. Possible causes to consider are:

Discrepancy in capture of overtime hours, partial shifts, float and agency personnel hours.

Inaccurate calculation of shift equivalent hours, for example 12 hour shift = 1.5 FTE.

Transcription or data entry errors.

Non-worked, but paid hours (benefit hours) which may be included in the paid figures, but excluded from the actual hours.

The date range should be specified to include both payroll periods (28 days).



Paid to Actual Staff Analysis Worksheet

Date Range: ______________________

An acceptable variance is 2% or less.

UNIT (A) PAID STAFF (B) ACTUAL STAFF (C) VARIANCE (D) % VARIANCE

Hospital



Paid to Actual Staff Analysis Worksheet Example

Date Range: 1/14/01 - 2/10/01

An acceptable difference is 2% or less.

UNIT (A) PAID STAFF (B) ACTUAL STAFF (C) DIFFERENCE (D) % DIFFERENCE

6C 196.1 190.8 5.3 2.7%

6W 273.9 280.3 -6.4 -2.3%

7E 209.2 210.2 -1.0 -0.5%

7W 261.5 258.4 3.1 1.2%

8E 205.9 201.4 4.5 2.2%

8W 266.1 262.9 3.2 1.2%

4E 195.9 190.5 5.4 2.8%

6E 145.2 139.5 5.7 3.9%

MTR/BABY 167.4 173.0 -5.6 -3.3%

NICU 179.9 178.8 1.1 0.6%

SICU 269.9 261.4 8.5 3.1%

CICU 275.1 270.8 4.3 1.6%

MICU 240.7 240.4 0.3 0.1%

HOSPITAL 2886.8 2858.4 28.4 1.0%



Patient Classification: Framework for Data ValidityPurpose

To insure valid data seven days a week on each shift with a defined classification window.

To inform Unit Managers of their control responsibilities.

Procedure

1. Post Guidelines and Indicator Definitions on all patient care units.

2. Verify the accuracy of patient classification every day.

3. Resolve identified classification problems.

4. Maintain a patient classification log (record late forms, non-compliance).

5. Hold Unit Manager or designee responsible and accountable for:

Accurate/timely classification.

Reviewing and ascertaining completeness of classification (on-line).

Collection of accurate actual staffing data.

6. Incorporate compliance with workload measurement procedures into performance evaluations.

7. Report percent reliability on a regular basis. Institute corrective actions as appropriate.

8. Publish examples of indicator applications specific to your organization.

9. Incorporate guidelines for classification and related workload measurement protocols into policy and procedure manuals.



ObjectivesUpon completion of this section, you will be able to:

List the components to be presented in Patient Classification inservices.

Answer questions frequently asked by staff about how the AcuityPlus system works.

OverviewThis section provides you with an outline of the components to be included in your staff education. Sample indicator application questions and frequently asked questions are included.



Staffing Education OutlineI. Introduction to Project

A. Objective: To implement an ongoing workload measurement system for which one of the inputs is patient classification.

B. Length of project: Eight months.

C. Discuss the objectives of the patient care department/hospital for the system.

II. Potential Uses of Patient Classification Data by Management

A. Purpose of Patient Classification.

1. Measure daily workload on all inpatient units to assist in matching staffing levels to workload.

B. Uses of Patient Classification Data.

1. Staffing: shift-to-shift allocation of staff.

2. Track productivity.

3. Long range budget determination.

C. Advantages of Patient Classification.

1. Objectively quantifies the hours of patient care required to meet workload.

2. Objective data has more credibility with administrators than subjective data.

III. Patient Classification Process

A. Methodology: Patient needs for care versus caregiver tasks.

Indicators of patient needs for care are utilized to objectively categorize each patient. Each indicator has an assigned weight value. The summation of the total weight values for each patient places the patient into a category that reflects the number of patient care hours required for 24 hours.



AcuityPlus - Inpatient Tool

PFS/WM - Mental Health Tool

B. Patient categories with the range of care hours per 24 hours and the relative acuity value (acuity):

CATEGORIES HRS/24 ACUITY

Type 1 0 - 4 0.7

Type 2 4 - 7 1.0

Type 3 7 - 10 1.5

Type 4 10 - 14 2.3

Type 5 14 - 20 3.1

Type 6 20+ 4.6

CATEGORIES HRS/24 ACUITY

Type 1 0 - 3 0.7

Type 2 3 - 5 1.0

Type 3 5 - 7 1.4

Type 4 7 - 10 1.8

Type 5 10 - 16 2.8

Type 6 16+ 5.5

IV. Mechanism of Classification

A. Time of day to classify patients.

B. Guidelines for classification.

C. Indicator definitions and examples of appropriate/inappropriate applications.

D. Means of data input: on-line via terminals/screens on the unit.

If classification is to occur via terminals, education sessions need to include:Process to access the system.Selection of patients to classify.Selecting and accepting indicators.Reviewing patient classification.Resource personnel.



V. Practice Classification

A. Use case study approach or sampling of scenarios provided for inter-rater reliability testing.

B. Discuss indicator applications to the scenarios as appropriate.



Inpatient Indicator Application ExerciseIn selecting the most appropriate answer, base your decision on the facts given in the scenarios. For shift based classification, the shift length is 8 hours. Do not read anything into the scenarios.

1. You are caring for a patient who just returned from an angiogram. You will be assessing the right groin puncture site every 15 minutes x 4, every 30 minutes x 2, every hour x 2 and then q 4 hours. Select the appropriate indicator(s), if any.

a. Wound/Injury Management

b. Assessment – q 4 hours

c. Assessment – q 1 hour

d. a and b

e. a and c

f. None of the above

2. You are caring for a patient who had general anesthesia today for a femoral-popliteal bypass today and is sleepy but arousable and oriented. Select the appropriate indicator(s), if any.

a. Communication Support

b. Cognitive Support

c. a and b

d. None of the above

3. You are caring for a patient who is recovering from septic shock. The patient has a Swan-Ganz line and an arterial line, and you are assessing the patient’s PAWP, CVP, and arterial BP every hour. Select the appropriate indicator(s), if any.

a. Assessment – q 2 Hours

b. Assessment – q 1 Hour

c. Assessment – q 30 Minutes


4. Your patient is on oxygen at 4L/minute via nasal cannula and requires respiratory assessment and NT suctioning every two hours. Select the appropriate indicator(s), if any.


b. Assessment – q 2 Hours

c. Assessment – q 1 Hour




5. Your patient is being discharged today. The case manager made arrangements for a visiting nurse to see your patient three times per week after discharge. You fax a completed form to the home care company that will be providing the visiting nurse visits and call report to the visiting nurse who will be seeing the patient. Select the appropriate indicator(s), if any.

a. ADL – Rehabilitative

b. Healthcare Management Education - > 1 Hour

c. a and b


6. You are caring for a patient who is undergoing chemotherapy and has a history of oral lesions following chemo. You will be providing good oral hygiene every two hours in an effort to prevent oral lesions from developing, and this is documented in the plan of care for your patient. Select the appropriate indicator(s), if any.


b. Wound/Injury Management

c. a and b


7. You are caring for a patient who receives a 7:00 AM dose of Regular insulin 6 units and Lente insulin 24 units followed by fingerstick blood glucose checks every four hours with sliding scale. Select the appropriate indicator(s), if any.





8. You are caring for an intubated patient who is alert and oriented. Select the appropriate indicator(s), if any.



c. a and b




9. You are caring for a three year old who lost consciousness for two minutes after falling down a flight of stairs. You will be doing neurological assessments on the child every two hours for eight hours and then every four hours for sixteen hours. Select the appropriate indicator(s), if any.





10. You are caring for a patient who has been in the hospital for two months because of multiple complications following a small bowel resection. The patient has a flat affect, barely speaks and needs extended encouragement to engage in any activities. The patient has had a psych consult and has been placed on Paxil for clinical depression. You will be following the care plan that provides a consistent approach to encourage the patient’s participation in her care. Select the appropriate indicator(s), if any.



c. Behavior/Emotional Management


11. You are caring for a 26 year old who delivered a healthy baby girl last evening via vaginal delivery with an episiotomy. She is up ad lib and requires no assistance with her ADLs. She will be attending a one-hour baby care class today. Select the appropriate indicator(s), if any.

1. ADL – Self/Minimal Care

2. ADL – Partial Care



a. 1 and 3

b. 2 and 3

c. 1, 3, and 4

d. 2, 3, and 4



12. You are caring for a patient who has continuous IV fluids of D5LR infusing at 40 cc/hour along with continuous TPN and Lipids. The patient’s I&O is being assessed every two hours. Select the appropriate indicator(s), if any.





13. You are caring for a patient who just arrived from the Recovery Room following a thyroidectomy. You will be assessing the patient’s BP, P, R and T every 15 minutes x 4, every 30 minutes x 4, every hour x 4 then every 4 hours as part of her routine post-op care. Select the appropriate indicator(s), if any.




d. Assessment – q 30 Minutes

14. You are caring for a patient who was admitted with chest pain, had a negative cardiac cath and is being discharged today. The patient is being discharged on his pre-hospital medication regimen. Prior to discharge, you will be reviewing with the patient signs and symptoms that should be reported to his physician and follow-up instructions. Select the appropriate indicator(s), if any.

a. Medication Preparation – > 20 Minutes

b. Healthcare Management Education – > 1 Hour

c. a and b


15. You are caring for a patient who was admitted to your unit at 6:00 AM in preparation for a surgical procedure under general anesthesia at 8:30 AM. Your patient expresses some anxiety about having the surgical procedure and anesthesia. The level of anxiety expressed by your patient is the level you routinely see in similar patients. You provide the same level of reassurance to the patient that you routinely provide in this type of situation. Select the appropriate indicator(s), if any.

a. Cognitive Support

b. Behavioral/Emotional Management

c. Behavioral/Emotional Management – q 1 Hour




16. You are caring for a patient with a continuous IV infusion of D5.45 at 125 cc/hour. The patient’s I&O will be assessed every eight hours. Select the appropriate indicator(s), if any.





17. You are caring for a patient in CHF who has been stable on an infusion of renal dose dopamine. The patient’s central line has become occluded, and the Dopamine infusion is being infused peripherally until the physicians can insert a new central line. The peripheral Dopamine infusion will continue for at least four hours, and the IV site will be checked every hour during the peripheral infusion. The patient’s urine output (response to Dopamine) will be assessed every four hours. Select the appropriate indicator(s), if any.





18. You are caring for a patient who was admitted with a diagnosis of CVA and who must be monitored and cued through swallowing during mealtime due to a risk of aspiration. The patient is expected to be able to eat without risk of aspiration at some point in time post-discharge. There is a documented plan of care developed by the patient’s speech therapist in relation to swallow precautions, which you are following. Which ADL indicator should you select?

1. ADL – Self/Minimal Care


3. ADL – Complete Care

4. ADL – Rehabilitative

a. 1

b. 1 and 4

c. 2

d. 2 and 4

e. 3

f. 3 and 4

g. None of the above



19. You are caring for an infant born at 32 weeks gestation. The baby is now at 36 weeks and is in the newborn nursery. The baby is stable, is not on O2, and is not on a monitor. The baby is receiving oral feedings every three hours and still has some mild sucking difficulty. The baby’s I&O is being assessed every eight hours. The baby will be discharged once it reaches a weight of five pounds. Select the appropriate indicator(s), if any.


2. Communication Support

3. Assessment – q 2 Hours

a. 1

b. 1 and 2

c. 1 and 3

d. All of the above

20. You are caring for a patient S/P abdominal surgery with an incisional wound that has wet-to-dry packing being changed every six hours. The wound packing takes approximately five minutes. Select the appropriate indicator(s), if any.


b. Wound/Injury Management – > 30 Minutes

c. Assessment – q 4 Hours

d. a and c

e. b and c


21. You are caring for a patient who is pleasant and cooperative during the day and early evening while his wife is present, but very confused after 8:00 PM due to Sundowner’s Syndrome. Because of his confusion, the patient has a staff member at his bedside from 7:00 PM to 7:30 AM. Select the appropriate indicator(s), if any.

a. Cognitive Support

b. Safety Management – q 2 Hours

c. Safety Management – q 30 Minutes

d. a and b

e. a and c



22. You are caring for a patient with mental status changes due to cerebral arterial vasospasm after a subarachnoid hemorrhage. You will be measuring the patient’s arterial blood pressure and intracranial pressure every fifteen minutes for the next four hours, then every 1 hour. Select the appropriate indicator(s), if any.


b. Assessment – q 1 Hour



23. You are caring for a neonate who will be discharged within a few days. The baby will continue to need supplemental tube feedings via OG tube for several weeks after discharge, and you are teaching the parents how to give the tube feedings at home. It will take 45 minutes to teach the parents. There is an education plan with teaching/learning objectives in place. The parents only speak Spanish, and a translator will be used for the teaching. Select the appropriate indicator(s), if any.


b. Healthcare Management Education - > 1 Hour

c. a and b


24. You are caring for a patient who can wash her face, arms and chest and who receives continuous tube feedings via gastrostomy tube. Which ADL indicator should you select?

a. ADL – Self/Minimal Care

b. ADL – Partial Care

c. ADL – Complete

d. ADL – Rehabilitative

25. You are caring for a patient whose respiratory status has been stabilized after she was placed on CPAP. The patient’s O2 saturation is being assessed and ABGs are being drawn from her arterial line every hour for the next four hours. The patient’s O2 saturation and respiratory rate will be assessed every two hours. Select the appropriate indicator(s), if any.







26. You are caring for a healthy newborn who is being breastfed by his mother. He requires routine cord and circumcision care. Select the appropriate indicators, if any.





a. 1 and 3

b. 1, 3 and 4

c. 2 and 3

d. 2, 3 and 4

e. None of the above

27. You are caring for a patient who is one day post-op from a CABG. The patient is to receive two units of PRBCs over two hours each due to a low hematocrit, slightly decreased SBP and decreased urine output. The patient’s urine output is to be assessed every two hours for the next eight hours, then every four hours. Select the appropriate indicator(s), if any.



c. Assessment – q 1 hour


28. You are caring for a patient who is three days post TURP. The patient’s continuous bladder irrigation has been discontinued, but he still has a foley catheter in place. You are assessing the patient’s urine for hematuria and/or blood clots every 8 hours. Select the appropriate indicator(s), if any.


b. Wound/Injury Management - > 30 Minutes

c. Assessment – q 4 hours

d. a and c

e. b and c




29. You are caring for a neonate who was born two days ago at 30 weeks gestation. The baby is in the NICU and is currently stable on a ventilator. The baby’s vital signs and I&O are being assessed every hour. An umbilical line is being used for monitoring. Feeds are being given via nasogastric tube. IV fluids are being infused with the rate adjusted hourly. The umbilical line dressing will be changed today so that cord care can be done. Select the appropriate indicator(s), if any.


2. Cognitive Support

3. Assessment – q 1 Hour



a. 1, 2, 3, and 4

b. 1, 3, and 4

c. 1, 3, 4, and 5

d. All of the above

30. Your patient had a pacemaker inserted today. He has incisional discomfort and Tylenol #3 two tablets are being administered every 3-4 hours. Select the appropriate indicator(s), if any.





31. Your patient requires chemotherapy administration today. The verification and confirmation of the chemotherapy administration orders will take 25 minutes. Once the chemotherapy infuses over two hours, the patient’s urine pH will be assessed every eight hours. Select the appropriate indicator(s), if any.



c. Medication Prep - > 20 Minutes

d. a and c

e. b and c




32. Your patient was admitted to the unit from the ED by stretcher. The ED RN and transporter assist you and the PCT in moving the patient from the stretcher to the bed. The patient is lethargic and will require two staff to turn and reposition every two hours. Select the appropriate indicator(s), if any.

a. ADL Assistance – 2-3 Caregivers

b. ADL Assistance – 4 or More Caregivers


d. a and c

e. b and c


33. Your patient was admitted to the ICU directly from the OR following a CABG today and will require continuous bedside assessment for the first 2 hours to establish stability of his vital signs and heart rhythm. The patient’s vital signs will then be assessed every hour. Select the appropriate indicator(s), if any.

a. Assessment – q 1 Hour

b. Assessment – q 30 Minutes

c. 1:1 Physiological Assessment - > 2 Hours

d. a and c

e. b and c


34. Your patient had necrotizing fascitis and now has a huge abdominal wound with a wound vac in place. The wound team will be changing the wound vac dressing today, which will require 90 minutes. Select the appropriate indicator(s), if any.


b. Wound/Injury Management - > 30 Minutes


d. a and c

e. b and c




35. Your patient is stable but weak following pneumonia treated successfully with a course of antibiotics and will be ready for discharge to home in a few days. The patient’s husband stays at the bedside around the clock, is very anxious and comes to the nursing station every 30 to 45 minutes insisting on speaking with the patient’s RN. Select the appropriate indicator(s), if any.

a. Behavior/Emotional Management

b. Behavior/Emotional Management – q 1 Hour

c. Safety Management – q > 30 Minutes

d. a and c

e. b and c




Inpatient Indicator Application Exercise Answer Key Multiple Online Classification/24 hours (i.e. q 8 hours) Classification One Time per 24 Hours

1. e 1. d

2. d 2. d

3. b 3. b

4. b 4. b

5. d 5. d

6. d 6. d

7. a 7. a

8. a 8. a

9. b 9. a

10. c 10. c

11. a 11. a

12. b 12. b

13. c 13. a

14. d 14. d

15. d 15. d

16. d 16. d

17. c 17. a

18. d 18. d

19. a 19. a

20. a 20. a

21. e 21. a

22. c 22. b

23. a 23. a

24. b 24. b

25. b 25. a

26. c 26. c

27. b 27. a

28. a 28. a



29. b 29. b

30. a 30. a

31. c 31. c

32. a 32. a

33. d 33. d

34. b 34. b

35. b 35. b

Multiple Online Classification/24 hours (i.e. q 8 hours) Classification One Time per 24 Hours



Answers to Frequently Asked Questions

Patient Classification1. Why is the point score different for each indicator?

Each indicator is weighted according to its ability when combined with other indicators to predict the amount of care required for each patient. Indicator weights are not nursing care time values, nor are they a reference to the importance of one indicator in relation to the others. Point scores indicate a positive association between the indicator itself and categorization of the patient. The more significant the indicator is in predicting care requirements, the higher the point score. The points were derived from regression and factor analysis techniques during the development of the tool and are actually regression weights.

2. I work on an oncology/palliative care unit and our patients, by virtue of their diagnosis and/or physical condition, require a lot of emotional support, yet we are told we cannot use the one of the Behavior/Emotional Management indicators for all of our patients.

The Behavior/Emotional Management indicators are intended for use for those patients and/or family who, because of their excessive need for emotional support, are more dependent on nursing than other patients with a similar diagnosis. The use of these indicators should be reserved for those patients who exhibit behaviors which indicate a need for a greater level of support in accepting the health status or situation. Appropriate use of the indicators will demonstrate the added dependency of the patient/significant other who is having significant difficulty in coping.

3. The points for certain indicators do not seem to reflect the work related to these activities.

The point to remember here is that the points are not an indication of nursing time. The points are merely a reflection of the relative impact that such an assessed need would have on the dependency level and total care requirements of a particular patient. It is also important to note that indicators are not considered in isolation, but must be evaluated along with all indicators used to determine the patient category.

4. How can two patients with different care requirements (a newborn infant and an adult requiring surgical dressing changes) come out as the same type?

Patients within the same patient type are similar in that they require about the same amount of care in 24 hours, although the activities performed on behalf of each patient may be quite different. Therefore, it is possible for two patients to be the same type but have totally different plans of care. It is not the activity or task, but rather the time required to care for a patient over 24 hours that differentiates him/her in the QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System.



5. Our unit experiences a lot of admission/discharge activity during the day and evening shifts, and our patients are constantly changing. I don’t understand how classification done in the morning can truly reflect what our workload is on the evening and the night shift. Would you explain this?

It’s true that patients can change from one hour to the next and from shift to shift. The workload of a unit, as measured by patient classification, is calculated as an average of all patients for the unit for the day. It is assumed that individual patients will change, some will improve, and others will take a turn for the worse. However, studies have shown that on average the unit workload does not often change significantly in spite of the changes in individual patients. However, some patient care units have considerable changes in nursing workload from shift-to-shift. For these units, special classification guidelines can be implemented to ensure that classification is an accurate reflection of workload on all shifts.

6. Post-partum patients tend to type as a type 1. Although they don’t require a lot of care, I don’t feel the patient is a minimal care patient. They are very dependent on me.

It is important to focus on the description of the patient type and its relationship in terms of care requirements to that of other patient types. In your statement, you indicated the post-partum patient does not require a lot of care, which is a description of the type 1 patient. Remember that the staffing framework along with the patient type determines the hours of care.

These patients are well patients, and their dependence on you is generally focused on one major activity: learning. However, they do fit into the generic definition of type 1 patient, because they are minimally dependent on you for meeting their physical needs and the care interventions that are planned for them are intermittent. These patients are not your minimal care patients, but rather your average care patients. Placed into the perspective of hospital-wide patient dependencies, they are indeed minimal care.

7. A patient on our unit takes so long to eat her meals that we have to wait at least an hour before we can do her care. Why can’t we mark ADL with Complete Assistance?

What I’m hearing is that the time it takes this lady to eat interferes with the organization of her care. It does not make her more dependent. It means that the organization of her care must take her slowness into account. Why don’t you rearrange the work plan to allow for this delay?

8. We have a patient who is completely out of it, but really sweet and one of our favorite patients, and she thinks I’m her niece. We marked Cognitive Support, and the classification monitor told us this was wrong. Why?

Confusion is a relative term in classification. It refers to the increased risk associated with confusion that leads to increased dependence on the staff. If the patient is “pleasantly confused” but is not at any risk to herself or others, the indicator does not apply.

This is not an issue in the AcuityPlus software for manual/automated ADT users, since all admissions/transfers/discharges are classified each 24-hour period. In addition, patients whose conditions change may be re-classified.



Workload Index and Acuity1. Is the workload index the same as the census?

No. The actual census is just a “body count” and tells you nothing about the patients other than how many there are. The Workload Index (WI) is also referred to as the “weighted census.” That is, it gives you information about the workload represented by the patients, removing the assumption that “a patient is a patient.”

One way to think about the WI is how it relates to the standard or prototype patient (type 2). The WI weights the census by converting all patients to equivalent type 2 patients. If a unit has a census of 32 and a WI of 29.0, they have the equivalent of 29 type 2 patients; while another unit may have 27 patients and a WI of 39.0, which is the equivalent of 39 type 2 patients. The unit with 27 patients has a significantly greater amount of workload than the unit with 32 patients.

2. The acuity on our unit is lower than any of the other units in the hospital, yet we are very busy and we aren’t getting credit. Shouldn’t we classify differently so that our workload is recognized?

There are several questions here. First if the acuity is lower on your unit, the average workload per patient is lower here than elsewhere. This doesn’t mean that you aren’t a busy unit. It simply means that your patients are more independent.

Second, the level of activity is determined by the type of unit and the characteristics of the unit that generate workload. For example, if the average length of stay is two days, your patients may not become very dependent during this time, but the work associated with making a two-day stay happen efficiently and effectively can be significant. This has nothing to do with patients, but has everything to do with how you must process patients. This is recognized in the staffing methodology.

Finally if you classify “differently,” I assume you mean to over classify patients so that the unit’s acuity increases. This would misrepresent patients. It might make the staff feel better, but the credibility of the system would be lost. What would you do if suddenly a real heavy/dependent patient came along? You would be unable to differentiate that patient from the lighter care patients who have been falsely placed into higher categories. You would have a difficult time defending your case for increased workload and increased staffing needs.

3. Our acuity has increased 25% over the last year. How do we prove we need more staff ?

Simple! Just prove that the increase in acuity is not acuity creep. Document the facts and the justification should follow. Remember: Acuity should change only because patients change. Document specifically how your patients have changed, such as shorter length of stay.



Staffing Framework1. What portion of the target hours accounts for all of the indirect care?

Actual hours of patient care time can be divided into four general categories:

Direct patient care,

Indirect patient care, for example, documentation and making rounds,

Support care often provided by ancillary services, for example, housekeeping, and pharmacy, and

Personal time, for example coffee breaks and lunch.

The portion of time allocated to each of these components of total patient care is a function of the type of care required, the classification categories of the patients, and the extent to which other professional and support services are available. There is no direct formula to establish the exact portion that is allocated to indirect care. However, based on work sampling studies done by QUADRAMED, in most general care units it represents approximately 30-40% of all patient care time.

2. How are all of the patient care tasks included in target hours calculated?

Patient care time as represented by target hours is focused on overall care needs. Patient care is recognized as a process. We do not determine targets by calculating times for tasks and adding them together. Rather, we observe care provided to patients of different levels and determine a range of time to be allocated to each patient type. It is implicit in this time that the tasks associated with meeting patient needs are included in the total time.

3. Our target hours are lower than other units that we think are comparable. Should they be increased?

First, is the staffing recommended for your unit appropriate? If it is, than no change in the target is needed.

It is difficult to compare yourselves just on the basis of unit type. Other factors could affect your target. For example:

If your unit has more support staff and services than other units, their hours may be higher to accommodate the unit staff ’s support responsibilities.

If you have a skill mix which allows for all of your staff to be optimally productive, you may require fewer hours per unit of workload.

Also remember that target hours are always assigned from a range. The target represents the reasonable, achievable productivity, and there can be many reasons why your target might be different than others.



4. Where exactly do target hours come from?

Several factors contribute to the determination of target hours. It is important to note, however, that there is no one right answer to staffing any patient care unit, and therefore no single target that applies in each case. QUADRAMED has developed a range of acceptable target hours for patient care units based on work with nearly 400 hospitals over the past 25 years. When target hours are set, factors that affect how a unit must staff are identified. For example, if the unit is well designed, there is a stable patient population, all RN staffing, and all staff experienced and skilled, the unit could be appropriately staffed at the low end of the range, meaning that the staff can be very productive in the delivery of patient care.




Describe the concepts of target setting.

List three factors to be considered in the target setting process.

Explain how the system recommends staffing using the shift and skill distribution goals and THPWI.

Explain the difference between target-setting for units using the Mental Health Tool and those using the Inpatient Tool.

Differentiate between target issues and workload measurement issues.

Staffing Translation FrameworkThe staffing translation framework consists of a set of procedures, parameters and formulas, which when applied to the workload as determined by patient and procedure classification, provide recommended staffing levels. The three key parameters used in the process are:

Hours Per Workload Index (HPWI) – This value describes the targeted ratio of staffing hours per unit of workload. Its value should represent the level that, within the context of other relevant considerations, optimizes the relationship between resource consumption and quality of care. This parameter serves as a basis for measuring productivity.

Shift Distribution Parameter – This parameter describes the amount of care delivered by shift as a function of patient acuity and is incorporated into the workload calculation. Generally, as acuity increases, care is more equally distributed across the shifts.

Skill Mix Parameter – This parameter describes the targeted mix of skill levels as a function of acuity. Often as patient acuity increases, the percentage of professional care increases.



The following activities are required to develop a staffing framework:

Review and analyze workload and productivity data.

Review budgeted staffing levels and budgetary goals.

Determine Target Hours per Workload Index parameter.

Determine desired Shift and Skill Mix parameters.

A number of data sources are explored in the process. They include current staffing patterns, comparative data from other institutions with similar patient populations, current and potential personnel resources, institutional policy and requirements, care delivery modalities, and the philosophy of the patient care department/hospital. Through the examination of these and other relevant factors, the target parameters are determined.

In Research and Development on page 17 it was noted that the QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System uses a research based methodology to determine staffing needs. The primary reason for this is that determining staffing requirements takes more than applying standard times to tasks. It is necessary to collect significant information about the patients, the staff, and facility in order to fully and accurately apply the staffing methodology.

Patient InformationPatient classification describes the level of a patient’s requirements for care, but other information is necessary before a full understanding of workload related to patient types is achieved. Some of the patient-related factors that can impact staffing are presented here.

Clinical Service – The type of clinical service and the most common treatment interventions provide a picture of the patients on a unit and, more importantly, the first bit of information about care requirements. When diagnoses are known, the types of interventions can often be assumed. Preliminary assumptions can also be made about expected acuity.

Patient Age and Other Factors – The average age of patients and other factors that contribute to patient care also affect interventions. For example, patients may be admitted for specific treatment of one disease, but they may also have secondary diagnoses that routinely affect their care requirements.

Length of Stay – The average length of stay impacts patient care in several ways. Shorter lengths of stay mean more admission and discharge activity. This doesn’t relate to patient dependence, but certainly impacts a caregiver’s time. Additionally, shorter lengths of stay can mean that the care associated with a condition is concentrated into a shorter time



period, making the overall patient care time more intense. And finally, the shorter lengths of stay are often achieved by cutting off the beginning and/or ending of an episode of patient care. This results in a patient population that is present only during the acute stages of illness or treatment, thereby increasing the average acuity.

Unit InformationInformation about the unit itself can also be helpful in understanding patient care requirements.

Number of Beds – There have been many debates about what size a patient care unit should be to facilitate optimum care, but the arguments often don’t address both effectiveness and efficiency. It is well known that smaller units are less efficient in terms of establishing appropriate staff-to-patient ratios, unless the acuity of the unit is such that increased ratios are justified 24 hours a day. General care units that have less than 20 beds, approximately, are less efficient from a staffing perspective than larger units.

Average Occupancy – Occupancy can affect patient care time in two ways. First, if the occupancy fluctuates, planning staff schedules can be difficult unless there are patterns to the peaks and valleys of the census. Second, full occupancy (90 -100%) may be easier to schedule for, but is often more difficult for effective use of time because of admission and discharge activity. If units are 100% full, patients are often admitted “wherever there is a bed” and are later transferred to the appropriate unit. This practice of transferring off-service patients can occur frequently and cause frustration. It is also costly in terms of time and effort.

Geographic Layout – The geographic layout on a patient care unit defines the amount of nursing time that is spent getting from one room/area to another. The Friesen designed hospitals have attempted to place caregivers in the center of patient care activity and eliminate non-essential travel time, thereby allowing more time to be devoted to patient care.

Facilities – The layout of a unit, such as an open ward, all semi-private rooms, all private rooms, or some mixture of these impacts nursing time and observation capabilities. The resources available also impact time in terms of organizing and coordinating work schedules among caregivers. An example is having one bathtub available for 40 patients versus one bathtub in each room.

Bed Allocation – Units that are organized to handle one service are easier to staff than units that have a mixture of clinical services. Teaching units, particularly with various levels of medical students, may require more staffing than non-teaching units, because of a general increase in activity and diagnostic work that usually comes with a unit where education and treatment are combined.



Staff InformationThe caregivers who staff a unit can have a significant impact on patient care requirements. They can also affect care delivery patterns.

Experience – Caregivers’ skill and knowledge in the clinical specialty can determine the efficiency of patient care time. Theoretically, the more experienced the staff the more efficient they can be.

Skill Mix – The proportion of licensed staff to unlicensed staff can affect unit effectiveness as well as unit efficiency. The appropriate skill mix to meet the patient care needs should be established before making staffing recommendations.

Minimum Staff Requirements – Minimum staffing is defined as the minimum number of staff members required per shift in the event of a low workload situation. The AcuityPlus system allows you to identify minimum staffing requirements by skill category per shift for each unit. This assures that staff recommendations never fall below defined minimums.

Organization of Care – Care delivery methods are built from the conceptual framework of patient care established for a unit or hospital. Care delivery methods also impact on staffing requirements. For example, functional nursing requires the least amount of professional staff; primary care requires the most.

Support Personnel – The most efficient use of direct care staff is to ensure that their time is devoted to patient care. The use of support personnel for non-patient care tasks can assist with efficiency. The most obvious of these are:

Clerical – Unit clerks/secretaries should decrease time spent by direct caregivers on essential clerical functions.

Supply Movement – Staff time spent in materials management functions decreases time available to provide direct patient care.

Professional Support – With the increase in specialization of patient care, there are more activities that nurses can depend on other professional staff to perform, including respiratory therapy, physical therapy, and specialized drug therapy. Even within nursing, there are specialists who treat specific aspects of a patient’s needs, for example, enterostomal therapy. The coordination and interaction of all these specialists can positively or negatively impact on patient care time. The relationship between nursing and professional support activities warrants evaluation.

Unit Administration – Most patient care units have one nurse appointed as the Unit Manager. The role and function of this individual is considered fixed time, in that his/her responsibilities are directed at managing the unit and are independent of the direct and indirect patient care requirements. The presence of this administrative support facilitates care delivery at the bedside.



Target Hours Per Workload IndexTarget hours are standards of productivity that define the labor requirements for completing one unit of workload on a patient care unit. The type II patient represents one unit of workload, and the target hours reflect the care requirements for 24 hours.

In addition to the factors mentioned above the following must also be considered when establishing staffing targets:

Workload Measurement Data – The average mix of patient types within a department has an impact on the overall level of productivity that can be achieved by the patient care staff. As a general rule, the more stable the mix of patients, the more productive the staff. During implementation, patient mix and volumes are monitored closely to assess this factor in setting target hours.

Current Actual Staff – The actual staff and their current productivity are important considerations in setting targets. The total number of staff present, the mix in skill levels, the overall experience of the staff, and staff turnover can all impact productivity. For example:

An all RN staff has the highest productivity;

More experienced staff are more productive; and

High staff turnover can have a negative impact on productivity.

Quality – There is a demonstrated relationship between quality and staffing. Low quality scores tend to suggest that current productivity is not optimized and staffing levels are either too high or too low. Quality measures should be assessed along with all other factors to support the establishment of target hours.

Care Delivery Practices – The organization of a patient care unit has a significant impact on productivity. Team nursing, functional nursing, total patient care, primary care, and case management each have their advantages with respect to the philosophy and objectives of nursing practice. In terms of resource management, however, they all have advantages and disadvantages. The care delivery method used with a particular skill mix and patient mix in a clinical specialty can produce a high level of productivity if the combination is appropriate for the patients. For example, when the patient population requires care relative to therapeutic needs, such as monitoring, complex dressings or treatments, and multiple medications, and the staff mix includes a significant percentage of non-professional staff, total patient care assignments would be inappropriate.

Support Services – The presence or absence of unit secretaries, transporters, housekeeping, and materials management support services also affects productivity as it relates to patient workload. The presence of such support services can significantly increase staff productivity, because time can be better directed towards patient care.



Physical Facility – The layout and physical features of the patient care unit affect productivity because they enhance or inhibit the ability of the staff to move around efficiently and effectively. Locations of utility rooms, number of patient bathrooms, and the layout of the entire unit can impact productivity. For example, patient care units with all private rooms require more walking time, and there is a greater need for visits to the patients’ bedsides to visually observe all patients.

When initial target hours are set during the implementation, these and other factors are considered for each service. The initial target productivity takes into account the common needs of patients within a service or department, as well as the unique needs of individual units within the service or department. Often a change in care delivery practices or skill mix can improve productivity. For example, if the unit is a surgical unit with a high percentage of the patients having complex and sophisticated or procedures and the staff is 50% non-RN staff, an interim target may be recommended, followed by a shift in skill mix to a higher percentage of RN staff, followed by a final lower Target Hours Per Workload Index.

The important point is that there is no one right answer to the number of staff required on any patient care unit. Multiple factors interact to determine what is appropriate in each case. For in-patient areas where patient classification is used as the workload measurement tool, pre-established relative values have allowed QUADRAMED to develop a database to reference in setting targets.

Shift Distribution ParametersThe distribution of care that patients require over 24 hours is a function of their needs, how the unit work is scheduled, and patient care practices. When the actual required hours of care are known for patients in different classification categories, it is necessary to distribute those hours to each shift so that care hours are allocated to the shift on which the care will be provided.

This allocation of care can vary for different patient types and different clinical services. The shift distribution parameter defines how recommended hours of care allocated for each shift and for each patient type. When establishing this parameter, consideration should be given to:

The total care requirements for typical patients in each category.

The manner in which care is currently delivered.

The desired delivery of care.

A percentage of care is allocated to each shift for each patient category or type, which defines the general distribution of care.



The following table is an example of a shift distribution parameter for a general care unit:

This example reflects the distribution of care hours across shifts for each patient type. 45% of the Type I patient’s care hours are allocated to the day shift, 35% to the evening shift, and 20% to the night shift. By contrast, the Type VI patient’s care is allocated equally across all shifts, reflecting the continuous care required by a critical patient.

Shift distribution parameters should reflect the real needs of different patient types by unit and should be revised as necessary to reflect changes in how work is scheduled. After reviewing all pertinent information about the patient care unit, shift distribution parameters by patient type are determined using professional judgment.

Skill Mix ParametersOnce the care requirements are known by shift, the next step is to determine the staffing requirements by skill level. Skill mix parameters define what portion of a patient’s care is allocated to the professional versus para-professional staff. Consideration should be given to:

The type of care normally provided to patients.

Resource availability.

Care delivery philosophy.

Desired staffing patterns.

An example of a skill mix table for a general care unit follows:

This example suggests that the Type I patient has 50% of his/her care hour requirements allocated to the RN. Often, this reflects the management of care and teaching activities since the type I patient generally has minimal dependency needs. The Type VI patient, who typically requires one-to-one care, has all of that care allocated to the RN.

TYPE I TYPE II TYPE III TYPE IV TYPE V TYPE VI

Day 45% 45% 40% 37% 35% 34%

Evening 35% 35% 35% 35% 34% 33%

Night 20% 20% 25% 28% 31% 33%

TYPE I TYPE II TYPE III TYPE IV TYPE V TYPE VI

RN 50% 65% 70% 75% 100% 100%

LPN 35% 30% 20% 15%

CNA 15% 10% 10% 10%



As with the shift distribution parameter, the skill mix parameter is developed on a unit specific basis, based on professional judgment after review of all relevant information

System Staffing Framework SummaryHours Per Unit of Workload (HPWI) – Value representing ratio of staffing per unit of workload.

Shift Distribution Parameter – Percent of care delivered by shift per patient type.

Skill Mix Parameter – Percent of care delivered by skill level per patient type.

Staffing Framework ParametersQualityHours Per Workload Index

% of Care by ShiftShift Distribution Parameter

% of Care by RNSkill Distribution Parameter

StaffingMin Max

Target Range

Day Eve Night

Acuity

Acuity



Factors to Consider When Establishing Productivity Targets

Philosophy related to patient care delivery

Care delivery modality

Financial resources and constraints

Quality of care

Physician practices

Skill mix

Minimum staffing

Nursing leadership

Roles and responsibilities

Staff experience and staff stability

Unit size/layout

Workload fluctuation

Support services

Nursing Activities Included in THPWIDirect nursing care

Indirect nursing care, such as counting narcotics

Charting, such as checking MD orders

Reporting, such as shift-to-shift

Administrative, such as staff meetings

Personnel education, on or off unit

Personal/non-productive, such as breaks

Patient support activities, involves interface with support services

Transportation

Unit management

Housekeeping

Dietary


AcuityPlus™Inpatient Coordinator Guide Chapter 9 Staffing Parameters

Target Hours Per Workload Index Analysis Worksheet UNIT CENSUS ACUITY WI DAILY STAFFING AT THPWI

[ ] [ ] [ ]ACTUAL STAFF

BUDGET STAFF

AHPPD BHPPD AHPWI BHPWI



Shift Distribution by Patient Type Worksheet

Skill Distribution by Patient Type by Shift WorksheetShift: _________________

Shift: _________________

SHIFTPATIENT TYPE

I II III IV V VI

I II III IV V VI

RN

LPN

NA

I II III IV V VI

RN

LPN

NA



Shift: _________________

Developing Shift Distribution and Skill Mix GoalsThe QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System recommends staff for an unlimited number of skill categories (job skills). Each cost center (unit) could potentially have a different percent skill mix and shift distribution of staff recommended based on the patient populations serviced and the care delivery model. The Patient Care Unit Manager should have input into the development of the goal sets for staff distribution across the shifts and skill categories. The system requires skill distribution goals to be established for all primary shift. The following instructions and worksheets are designed to assist you in the process of developing goal sets. Prior to beginning, the following information should be obtained:

Budgeted direct (variable) daily staffing coverage by skill category. If not readily available, budgeted information can generally be obtained from the finance department.

Actual direct (variable) daily staffing coverage. This can be obtained from the unit daily staffing pattern.

Desired direct staffing coverage, if different from the actual or budgeted. This should be realistic for the resources available.

Historical patient mix data. This can be obtained from the Unit Period Detail by Day of Week report. Request the report for a year-to-date range.

Use the grid below to determine the overall percentages for the desired shift distribution and skill mix.

1. Enter the number of staff or hours required for each skill level on each shift.

2. Calculate the total number of staff for each shift.

3. Calculate the total number and percent of staff for each skill category.

I II III IV V VI

RN

LPN

NA



Example:

Worksheet:

4. Assess the desired percent shift distribution and skill mix in relation to the budgeted and actual figures. If necessary, revise the desired figures to meet organizational goals and budgetary constraints.

5. Determine the amount of workload by patient type. Multiply the average or total number of patients (census/type) in each type by the relative acuity for the type category.

6. The care hours can also be determined by multiplying Workload Index by the THPWI. This is an optional step.

Example:

RN LPN NA Total %

Day 8 3 2 13 42%

Eve 6 3 2 11 35%

Night 3 2 2 7 23%

Total 17 8 6 31

% 55% 26% 19%

RN LPN NA Total %

Day

Eve

Night

Total

%

Remember, the Mental Health methodology has different acuity values from the Inpatient methodology.

I II III IV V VI Total

Census/Type 5 10 8 2 25

Acuity 0.7 1.0 1.5 2.3 3.1 4.6

Workload 3.5 10.0 12.0 4.6 30.1

Hrs/24



7. Develop the goal sets for shift distribution and skill mix.

Shift Distribution Example:

Skill Mix Example:

Goals should be assigned to all patient type categories. There is no magic formula, just a lot of common sense and good professional judgment.

The category(s) of patients that generates the most workload has the greatest impact on the overall recommendation. It may be wise to assign the desired distribution to that patient type group and build the goal set from that point. Generally as patients become more acute, the requirement for care equalizes across the shifts, and the amount of professional care increases.

I II III IV V VI

Day 46 42 42 38 34 34

Evening 36 35 35 34 33 33

Night 18 23 23 28 33 33

I II III IV V VI

RN 45 56 56 65 100 100

LPN 35 26 26 20

NA 20 18 18 15



Shift Distribution and Skill Mix Worksheet

Unit: __________________

Shift Distribution

Skill MixShift: _________________

I II III IV V VI TOTAL

Cens/Type

Acuity

Workload

Hrs/24

I II III IV V VI

Day

Evening

Night

I II III IV V VI

RN

LPN

NA



Shift: _________________

Shift: _________________

Testing Goal SetsThe goal sets may be tested prior to entry into the AcuityPlus system. Instructions follow for performing manual calculations. These calculations simulate the software algorithm. They demonstrate how closely the goal sets will recommend the desired staffing levels based on the current workload.

1. Using the workload per patient type from step 5 of Developing Shift Distribution and Skill Mix Goals on page 164 and the goal sets for shift distribution defined in step 7 of Developing Shift Distribution and Skill Mix Goals on page 164, calculate the amount of workload per patient type that is allocated to each shift.

2. Calculate the percent of staff hours that will be recommended for each shift:

I II III IV V VI

RN

LPN

NA

I II III IV V VI

RN

LPN

NA



Total WI for Shift / Total Unit Workload (sum of workload by patient type as calculated in step 5 of Developing Shift Distribution and Skill Mix Goals on page 164).

Shift 1: __________________

Shift 2: __________________

Shift 3: __________________

Patient Type

WI % Shift 1

I x =

II x =

III x =

IV x =

V x =

VI x = Total WI % Shift 1

Total WI / = x 100% =

Patient Type

WI % Shift 2

I x =

II x =

III x =

IV x =

V x =


Total WI / = x 100% =

Patient Type

WI % Shift 3

I x =

II x =

III x =

IV x =

V x =


Total WI / = x 100% =



Shift 4: __________________

3. Follow the above procedure to test the skill mix goal set.

Shift 1: __________________

RN

LPN

Patient Type

WI % Shift 4

I x =

II x =

III x =

IV x =

V x =


Total WI / = x 100% =

Patient Type

WI % RN

I x =

II x =

III x =

IV x =

V x =

VI x = Total WI % RN

Total WI (RN Allocation) / = x 100% =

Patient Type

WI % LPN

I x =

II x =

III x =

IV x =

V x =

VI x = Total WI % LPN

Total WI (LPN Allocation) / = x 100% =



NA

Shift 2: __________________

RN

LPN

Patient Type

WI % NA

I x =

II x =

III x =

IV x =

V x =

VI x = Total WI % NA

Total WI (NA Allocation) / = x 100% =

Patient Type

WI % RN

I x =

II x =

III x =

IV x =

V x =



Patient Type

WI % LPN

I x =

II x =

III x =

IV x =

V x =





NA

Shift 3: __________________

RN

LPN

Patient Type

WI % NA

I x =

II x =

III x =

IV x =

V x =



Patient Type

WI % RN

I x =

II x =

III x =

IV x =

V x =



Patient Type

WI % LPN

I x =

II x =

III x =

IV x =

V x =





NA

Shift 4: __________________

RN

LPN

Patient Type

WI % NA

I x =

II x =

III x =

IV x =

V x =



Patient Type

WI % RN

I x =

II x =

III x =

IV x =

V x =



Patient Type

WI % LPN

I x =

II x =

III x =

IV x =

V x =





NA

4. Compare the calculated outcomes to the budgeted and actual staff distributions. Make revisions to the goal sets as necessary.

Sample Recommended Staffing Calculation

Data Elements

Shift Distribution

Patient Type

WI % NA

I x =

II x =

III x =

IV x =

V x =



PATIENT TIME IN TIME OUT LOS PATIENT TYPE

1 7 AM 7 AM 24 Hours II

2 10 AM 7 AM 21 Hours III

SHIFT TYPE I TYPE II TYPE III TYPE IV TYPE V TYPE VI

Day 45% 45% 40% 35% 34% 34%

Eve 35% 35% 35% 30% 33% 33%

Ngt 20% 20% 25% 30% 33% 33%



Skill Distribution

Day Shift

Evening Shift

Night Shift

SKILL TYPE I TYPE II TYPE III TYPE IV TYPE V TYPE VI

RN 65% 65% 70% 75% 80% 80%

LPN 20% 20% 15% 10% 0% 0%

NA 15% 15% 15% 15% 20% 20%


RN 65% 65% 70% 75% 80% 80%

LPN 20% 20% 15% 10% 0% 0%

NA 15% 15% 15% 15% 20% 20%


RN 65% 65% 70% 75% 80% 80%

LPN 20% 20% 15% 10% 0% 0%

CNA 15% 15% 15% 15% 20% 20%


AcuityPlus™Inpatient Coordinator Guide Chapter 9 Staffing Parameters

Calculating Recommended Staffing Example

PATIENT TYPE ACUITY WI THPWISHIFT DISTRIBUTION RECOMMENDED STAFF BY HOUR BY STAFF

DAY EVENING NIGHT DAY EVENING NIGHT

II 1.0 1.0 5.5 45% 35% 20% 0.309 0.241 0.137

III 1.5 1.5 5.5 40% 35% 25% 0.413 0.361 0.258

PATIENTLOS BY SHIFT RECOMMENDED STAFF BY SHIFT

DAY EVENING NIGHT DAY EVENING NIGHT TOTAL

1 8 8 8 2.47 1.93 1.10 5.50

2 5 8 8 2.07 2.89 2.06 7.02

PATIENT

RECOMMENDED STAFF BY SKILL BY SHIFT

DAY EVENING NIGHT

RN LPN NA TOTAL RN LPN NA TOTAL RN LPN NA TOTAL

1 1.61 0.49 0.37 2.47 1.25 0.39 0.29 1.93 0.72 0.22 0.16 1.10

2 1.45 0.31 0.31 2.07 2.03 0.43 0.43 2.89 1.44 0.31 0.31 2.06



Staffing Targets for Non-Direct Care ProvidersThe AcuityPlus system facilitates the recommendations of non-direct care providers. The standards established are unit specific and defined by shift and day of week. Standards are established by determining a fixed set of hours for each non-direct job skill or establishing a census driven recommendation. To set a fixed set of hours, enter the required hours for the job skill in the minimum non-direct hours field. This is typically done for Nurse Managers, Triage Nurses, and/or Clinical Nurse Specialists. The census driven parameters are typically used for clerical staff, where the number of staff may increase or decrease based on unit census. There are fields in the software to define the number of hours for a census range. For example you may enter parameters as follows.

Unit Secretary example:

CENSUS HOURS

0 – 3 0 Hours

3 – 30 8 Hours

30 – 100 16 Hours



ObjectivesDescribe the features within AcuityPlus to enhance system use.

Discuss the purpose of the Staff Assignment function.

Discuss the benefits of workload/complexity based staff assignments.

Describe the purpose of the Outcomes module.

Describe the data evaluation elements available in the Outcomes module.

Discuss the differences between outcome indicators, classification indicators, and outcome data.Discuss the Staffing Ratio Module.

Staff AssignmentsCreating staff assignments is an art, science and common sense based on knowledge of patient care requirements and staff abilities. It is a critical component of labor management; for both the management of the number and type of staff, also for the associated costs. The increasing complexities of patient care coupled with staffing difficulties have made the process of assigning nursing resources to individual patients a difficult one. The assignment tool within AcuityPlus is designed to facilitate the process of creating an assignment through the provision of data.

The decision making process of creating an assignment includes:Knowing how much care a patient requires (patient acuity)Understanding the complexity of the patient's care requirementsKnowledge of specific care needsGeography of unitSkill/experience of staff



Ancillary supportPatient satisfactionStaff satisfactionPatient outcomes

When creating the assignment, AcuityPlus provides the patient's required hours of care by skill, the workload index and the complexity units - basic data for the development of an assignment. This information facilitates the ability to evenly and equitably distribute patient workload and complexity units - in addition to evaluating the required hours of care. The complexity units provide a weighted complexity of care value; the calculation of complexity units is:

Assignments can be updated anytime to add admissions and transfers to the assignments, all changes are tracked and saved. Assignments can be viewed with or without the changes being displayed. Additionally, data will be saved for each person with an assignment. If the staff name is not provided for each assignment, the assignment will be saved with the skill level/number used in the name field. This data can be used to evaluate data by staff member over time; looking at productivity and complexity of assignments.

Complexity units = Complexity Value x Patient acuity value x (Shift LOS/Shift Length)



Sample assignments

Patient Data

Block assignment (assignments by room order)

In this example, you can see that the workload, required hours of care and complexity units are higher for Assignment A - even though each care giver has 45 patients assigned.

PATIENT WORKLOAD COMPLEXITY TYPE SHIFT LOS/SHIFT LENGTH COMPLEXITY UNITS

A 1.5 2 1.0 3.0

B 2.3 3 1.0 6.9

C 2.3 2 1.0 4.6

D 1.0 1 1.0 1.0

E 0.7 2 1.0 1.4

F 1.0 3 1.0 3.0

G 0.7 2 1.0 1.4

H 0.7 2 1.0 1.4

I 0.7 3 1.0 1.4

ASSIGNMENT A ASSIGNMENT B

PATIENT WI HRS COMP UNITS PATIENT WI HRS COMP UNITS

A 1.5 2.13 3.0 E 0.7 1.13 1.4

B 2.3 3.10 6.9 F 1.0 1.50 3.0

C 2.3 3.10 4.6 G 0.7 1.13 1.4

D 1.0 1.50 1.0 H 0.7 1.13 1.4

Total 7.1 9.83 15.5 Tot 3.10 4.89 7.2



Assignment by Workload/Complexity of Care

In this example, the assignments for A and B have been completed to provide each staff member with similar amounts of patient workload and complexity units.

Staffing Assignment ReportThe Staffing Assignment report can be viewed or printed. When printed, the report can be printed with one assignment per page or continuous for all assignments printed. A sample report for one RN is displayed below.

Outcomes module

OverviewThe Outcomes module provides information to evaluate the relationship between staffing and patient and staff outcomes. Appropriate staffing levels, including skill mix, are a critical concern in hospitals due to the effect of staffing on patient safety and outcomes. Current research has demonstrated a relationship between RN staffing and patient outcomes. Article references addressing this topic are listed at the end of the chapter (see References on page 191).

ASSIGNMENT A ASSIGNMENT B

PATIENT WI HRS COMP UNITS PATIENT WI HRS COMP UNITS

A 1.5 2.13 3.0 C 2.3 3.10 4.6

B 2.3 3.10 6.9 F 1.0 1.50 3.0

D 1.0 1.50 1.0 G 0.7 1.13 1.4

E 0.7 1.13 1.4 H 0.7 1.13 1.4

I 0.7 1.13 1.4

Total 5.5 7.86 12.3 Total 5.3 7.99 11.8



This module enables the evaluation, at the unit level, of staffing’s impact on patient outcomes. In addition to evaluating patient outcomes, other organizational factors can be evaluated, such as staff satisfaction, RN turnover, etc.The module is designed with the following options for comparison:

VARIABLE DESCRIPTION

RHPWI Recommended hours per workload index

AHPWI Actual hours per workload index

Variance (HPWI) Recommended - actual hours per workload index

RN RHPWI RN recommended hours per workload index

RN AHPWI RN actual hours per workload index

Variance (RN HPWI) RN recommended - RN actual hours per workload index

RHPPD Recommended hours per patient day

AHPPD Actual hours per patient day

RHPPV Recommended Hours per Patient Visit

AHPPV Actual Hours per Patient Visit

Variance (RN HPPD) RN Recommended – RN actual hours per patient day

% RN - Rec Recommended percent RN

% RN - Act Actual percent RN

Var (% RN) Recommended - actual percent RN

Rec % Licensed Recommended percent licensed staff

Act % Licensed Actual percent licensed staff

Var (% Licensed) Recommended - actual percent licensed staff

Rec % Non-licensed Recommended percent non-licensed staff

Act % Non-licensed Actual percent non-licensed staff

Var (% Non-licensed) Recommended - actual percent non-licensed staff

% Occupancy Percent occupancy, based on budget census

Classification Indicator Methodology specific and user defined classification indicators. Returns zero for each day requested if the day has no data.

Classification Indicator % of Population

Number of times the indicator is selected per patient per day vs. the actual census for that day. For example, if a patient is classified three times in the same day with the same indicator, this counts as one time.

Outcome Indicator Count Outcome indicators as defined in AcuityPlus



* Based on arrivals and departures during the date range selected

Outcome IndicatorsOutcome indicators are defined in System Parameters and are applicable to all patients entered into AcuityPlus, regardless of workload methodology. These indicators are separate from the classification indicators and do not impact the workload associated with the patient. This data is patient specific.

Outcome Indicator % of Population

Number of times the indicator is selected per patient per day vs. the actual census for that day. For example, if a patient is classified three times in the same day with the same indicator, this counts as one time.

Outcomes Data Outcome data definition as defined in AcuityPlus

Hospital Avg LOS Days Hospital average length of stay in days*

Hospital Avg IP LOS Days Hospital average inpatient length of stay in days*

Hospital Avg OP LOS Hours Hospital average outpatient length of stay in hours*

Hospital Avg Age Hospital average age

Hospital Arrivals Volume of overall arrivals to hospital

Unit Avg LOS Days Unit average length of stay in days*

Unit Avg LOS Hours Unit average length of stay in hours*

Unit Avg Age Unit average age

Unit Arrivals Volume of overall arrivals to unit

Unit Avg IP LOS Days Unit average inpatient length of stay in days*

Unit IP Arrivals Unit inpatient arrivals

Unit Avg OP LOS Hours Unit average outpatient length of stay in hours*

Unit Total OP LOS Hours Unit total outpatient length of stay in hours

Unit OP Arrivals Unit outpatient arrivals.

Acuity Acuity score

Complexity Complexity score

Monitor % Agreement by Patient Type

Monitor percent agreement by patient type

Monitor % Agreement by Complexity

Monitor percent agreement by complexity type

Monitor % Agreement by Indicator Group

Monitor percent agreement by methodology specific indicator

VARIABLE DESCRIPTION



The first 20 outcome indicators are reserved. User defined outcome indicators can be added starting with the 21st indicator.

The pre-defined outcome indicators are:

Outcome Data DefinitionsOutcome data definitions are set up in System Parameters. These data definitions can be compared to staffing variables for evaluation of the impact of staffing or compared to each other. The data collection period for outcome data definitions can be defined as monthly, quarterly, or annual.

The first 40 outcome data definitions fields are reserved for future definition with the goal of having comparable data included in the QUADRAMED National Database. User defined outcome data definitions can be added starting with the 41st data definition.

Sample outcome data definitions are:Infection Rate – Lab confirmed infections X 1000 divided by patient days.UTI with Urinary Catheter – Lab confirmed infections with urinary catheter X 1000 divided by number of patient days with urinary catheter.Needle Stick Injuries – Number of staff with a needle stick injury divided by total number of staff.RN Job Satisfaction – RN job satisfaction based on pre-defined survey questions.

ReportsYou can design outcomes reports for data analysis. A correlation coefficient is reported when there are twenty or greater data points. Reports can be shared with multiple users or remain private to the person who designed the report. Two standard reports (accessed from the Reports menu) are also available: the Outcomes Data report and the Outcomes Indicator report.

OUTCOME INDICATOR DESCRIPTION

Patient Fall Select for a patient on the date and time a fall occurred.

Medication Error Select for a patient on the date and time a medication error occurred.

Pressure Ulcer Select for a patient with a pressure ulcer stage II or higher that was not present on admission.

LWBS Select for a patient that left the ED without being seen.

AMA Select for a patient that left against medical advice.

Restraints Select for a patient with vest and/or limb restraints.


AcuityPlus™Inpatient Coordinator Guide Chapter 10 System Features

Reports can be designed for data display by day, month, quarter, or by unit. Display of data by day, month, and quarter provide unit specific data and display by unit provides data for multiple units. Reports can be shown with or without the data tables. When designing a report that uses the outcome indicators, additional filters are available to refine the data. The filters include:

For the AcuityPlus Emerge methodology: if you want to include actual staffing in your outcomes report, you must include the parent ED unit along with the sub-unit. Almost all of the rest of the data is in the sub-unit. This only applies when AcuityPlus Emerge is configured as a parent unit with sub-units.

Age Gender

DRG Admitting Diagnosis

Primary Diagnosis Secondary Diagnosis

Attending Physician Patient Type

Procedures Financial Class

LOS MRNO



Sample Reports



Patient SatisfactionYear Quarter X-Axis Y-Axis2004 4 Q4 94.0002005 1 Q1 95.0002005 2 Q2 94.0002005 3 Q3 91.000

Var (HPWI)Year Quarter X-Axis Y-Axis2004 4 Q4 0.0082005 1 Q1 0.0512005 2 Q2 0.0172005 3 Q3 -0.012

Var (HPWI) vs. Patient Satisfaction10/1/2004 to 9/30/2005

My Unit (QMC) (S)



Var (RN HPWI) vs. Medication Error10/1/2004 to 9/30/2005

My Unit (QMC) (S)



ReferencesAiken, L.H., Clarke, S.P., Sloane, D.M., Sochalsiki, J. & Silber, J.H. 2002. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association 288(16): 1987-93.

Haberfelde, Mimi MSN, RN; Bedecarre, Diane MSN, RN; Buffum, Martha DNSc APRN,BC,CS. June 2005. Nurse-sensitive patient outcomes: An annotated bibliography. Journal of Nursing Administration. 35(6): 293-299.

Lang, Thomas A. MA; Hodge, Margaret EdD, RN; Olson, Valerie BA; Romano, Patrick S. MD, MPH; Kravitz, Richard L. MD, MPH. July/August 2004. Nurse-patient ratios: A systematic review on the effects of nurse staffing on patient, nurse employee, and hospital outcomes. Journal of Nursing Administration. 34(7-8):326-337.

Staffing Ratio Module

OverviewThe Staffing Ratio module is an add-on module designed to provide recommended staffing based on target ratios entered into the AcuityPlus software. You enter ratios by shift for selected skill levels, and define coverage requirements. Each unit has its own staffing ratios.

Example of staffing ratio definition:

In this example, ratio staffing has been defined for the RN skill level with coverage for breaks and meals provided by the RN skill level. Staffing recommendations for the other defined direct care skill categories (i.e. LPN and NA) would be based on either the patient type acuity or complexity methodology.

Example of staffing ratio definition:

SHIFT SKILL 1 SKILL 2 SKILL 3 TARGET RATIO COVERAGE SKILL

7A RN 4 RN


7A RN LPN 4 RN



In this example, ratio staffing has been defined for both the RN and LPN skill categories with coverage for breaks and meals provided by the RN skill level.The ratio applies to the RN and LPN skill levels as a combined group. Staffing recommendations for the other defined direct care skill categories (i.e. NA) would be based on either the patient type acuity or complexity methodology.

Calculating Staffing RatioRatio staffing is calculated based on the number of actual patients on each shift at the time the report is generated. The overall percentage of staff recommended based on either patient type or complexity type is used to determine the number of direct care staff when multiple skill categories are defined in the ratio module setup. Staffing recommendations for the direct skill categories not defined in the staffing ratio setup are based on the patient type acuity or complexity methodology.

When the option to round up the staffing recommendations for ratio staffing is set to Yes, the recommended staff is rounded up to the next highest number.

Example 1: Staffing Ratio Defined for RNsStaffing recommendations by patient type acuity/complexity methodology:

Recommended staffing based on:Census = 25Acuity = 1.27THPWI = 5.2Staffing Ratio setup:

Coverage - Staff coverage for breaks and meals is provided by an RN and the setup is:AM Break - 15 minutes

RECOMMENDED STAFFING

HOURS STAFF (12 HRS) PERCENTAGE

RN 99.06 8.26 60%

LPN 26.42 2.20 16%

NA 39.62 3.30 24%

Total 165.10 13.76 --


7A RN 4 RN



Meal - 30 minutesPM Break - 30 minutes

For an actual census of 25, the following ratio based staffing would be recommended for a 12 hour day shift:

Table Notes:

* For coverage of 30 minute break time and 30 minute meal time, the calculation is: 6.25 x (30 + 30) = 375.0 minutes = 6.25 hours = 0.52 staff (12 hour based shift length)

For coverage with round up option set to Yes, the calculation is 7.0 x (30 +30) = 420 minutes = 0.58 staff (12 hour based shift length).

** Staffing for the LPN and NA is based on the patient type acuity or complexity methodology.

Example 2: Staffing Ratio Defined for RNs and LPNsStaffing recommendations by patient type acuity/complexity methodology:

Recommended staffing based on:Census = 25Acuity = 1.27THPWI = 5.2

SKILL RATIO STAFF ROUND UP OPTION = YES

RN 25/4 6.25 7.00

RN Coverage* 0.52 0.58

LPN** 2.20 2.20

NA** 3.30 3.30

Total 12.27 13.08

RECOMMENDED STAFFING

HOURS STAFF (12 HRS) PERCENTAGE

RN 66.04 5.50 40%

LPN 33.02 2.75 20%

NA 66.04 5.50 40%

Total 165.10 13.75 --



Staffing Ratio setup:

Total recommended hours for RN and LPN = 99.06Total recommended hours for RN = 66.04, RN percentage = 67%Total recommended hours for LPN = 33.02, LPN percentage = 33%

Coverage - Staff coverage for breaks and meals is provided by an RN, and the setup is:AM Break - 15 minutesMeal - 30 minutesPM Break - 30 minutes

For an actual census of 25, the following ratio based staffing would be recommended for a 12 hour day shift:

Table Notes:

* For coverage of 30 minute break time and 30 minute meal time, the calculation is: 6.25 x (30 + 30) = 375.0 minutes = 6.25 hours = 0.52 staff (12 hour based shift length)


7A RN LPN 4 RN

SKILL RATIO % DISTRIBUTION STAFFROUND UP OPTION = YES

RN 25/4 = 6.25 67% 4.19 5.00

LPN 25/4 = 6.25 33% 2.06 3.00

RN Coverage* 0.52 0.58

NA** 5.50 5.50

Total 12.27 14.08



For coverage with round up option set to Yes, the calculation is: 7.0 x (30 +30) = 420 minutes = 0.58 staff (12 hour based shift length)

** Staffing for the NA is based on the patient type acuity or complexity methodology.

Staffing Ratio ReportThe Recommended, Alternative and Actual Direct Staffing with Dollar Variance report summarizes recommended, alternative, and actual direct care staffing hours by shift and skill, and provides a 24 hour summary. The report also summarizes the dollar variance between recommended to alternate, recommended to actual, and alternate to actual. Data is provided in hours and in staff.

Key FeaturesThis report is specific to the staffing ratio module.The report provides information to evaluate the cost of staffing by ratio versus staffing by patient type or complexity.Report can be generated for multiple unit groups.

You can access this report from the Report Selection window.



Recommended, Alternative, and Actual Direct Staffing with Dollar Variance - In StaffQuadraMed Medical Center

Date: 4/1/04 To 4/6/04

3 S

Skill

7A

Rec Alt Act

7P

Rec Alt Act

24 Hrs $ Variance

Rec Alt Act R - Alt R - Act Alt - Act

Mgmt 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00

RN 41.37 34.67 40.90 30.51 30.51 28.85 71.88 65.18 69.75 $2,090.36 $1,298.12 $-792.24

LPN 17.08 17.08 13.71 12.46 12.46 8.85 29.54 29.54 22.56 $-0.00 $1,204.37 $1,204.37

NA 0.00 0.00 3.44 0.00 0.00 1.00 0.00 0.00 4.44 $0.00 $-609.75 $-609.75

OA/MT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00

Sitters 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00

US 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00

Total 58.45 51.75 58.04 42.97 42.97 38.71 101.42 94.72 96.75 $2,090.36 $1,892.75 $-197.61



OverviewThe Transparent Classification module is an add-on module designed to convert data from an Electronic Documentation System to patient classification data. The transparent classification module can be used with any AcuityPlus Methodologies.

It is patient classification as a by-product of the electronic documentation process.

Documentation elements such as admission assessments, shift assessments, physician orders as well as documentation by other departments may be mapped to the patient classification indicators, procedures and outcome indicators.

The data is sent to the AcuityPlus application where patient acuity, complexity, workload and staffing recommendations are generated.

Benefits of Transparent ClassificationIncrease staff satisfaction related to eliminating the task of manually classifying patients.

Decreased need for staff education related to patient classification.

Improvements in patient classification reliability.

Improvements in the documentation process.

Seamless system.

The components required to implement transparent classification are as follows:

QUADRAMED CORPORATION CLIENT HOSPITAL

AcuityPlus Software Electronic Documentation

Methodology Indicator Mapping Table



Mapping TableA mapping table is a document that provides a description of what documentation elements are defined to trigger the use of an indicator, procedure or outcome indicator. Documentation elements such as admission assessments, shift assessments, physician orders as well as documentation by other departments may be mapped.

Below are some examples of indicator mapping data element source:

Orders

Isolation = 13. Isolation Precautions

Frequency of an Order

Fluid balance & replace Q2 Hrs = 15. Assessment Q2 Hours

Care Plan

Deaf, use sign language = 7. Communication Support

Value of data element (numerical or text)

Age < 4 = 3. ADL Complete

Confused = 8. Cognitive Support

Count of Events

VS 8x past 8 hours = 16. Assessment Q1 Hour

HL7 (ADT) Interface Data File

Translation Program

Transparent Classification Import Interface

QUADRAMED CORPORATION CLIENT HOSPITAL


AcuityPlus™Inpatient Coordinator Guide Chapter 11 Transparent Classification

Below is a sample of a mapping table.

QuadraMed Medical Center Mapping Table (General Rules)

Notes:* If more than one indicator is selected in the same group, the highest one will win. There is no need to code this rule in the dictionary.* The four bold columns are columns from the CHART_ITEM table

# DOCUMENTATION CODE

DOCUMENTATION CATEGORY/SOURCE

DESCRIPTION/FIELD NAME RESULT/DESCRIPTION Freq Notes

1 ADL Self/Min careNOT Ind2 AND NOT IND3 (automatic rule)

30014p

Nutrition & Shift Care Bath - Self Self30015

pNutrition & Shift Care Feed-Self Self

30016 NHx ADL/Sleep/Rest independent2 ADL Partial Care

NOT Ind3 (automatic rule)Make this the default if no ADL indicators are selected

31011Intake/Output - Shift Care - Nutrition & Shift Care Bath - Assist Any

31012Intake/Output - Shift Care - Nutrition & Shift Care Feed - Assist Any

31013Intake/Output - Shift Care - Nutrition & Shift Care Ambulate - Assist Any

31014Intake/Output - Shift Care - Nutrition & Shift Care Up in Chair - Assist Any

31015 VHx Activity Protocol "assist", "needed: 1"

3 ADL Complete Careage < 4 years get patient age from encounter

32011Intake/Output - Shift Care - Nutrition & Shift Care Bath - Total If used with Feed, Feeding Tube, NPO

32012

Intake/Output - Shift Care - Nutrician & Shift Care Feed If used with Bath - Total

32013

Intake/Output - Shift Care - Nutrician & Shift Care NPO If used with Bath - Total



Monitoring Patient Classification DataMonitoring of patient classification data is performed during the implementation of transparent classification and ongoing. Monitoring of patient classification data is performed on a regular basis to ensure accuracy related to indicator usage and reported acuity and to identify areas of concern related to either the mapping table, translation program or staff documentation. All patient care units using the QuadraMed AcuityPlus Productivity, Benchmarking and Outcomes System should be monitored weekly during the implementation and at least once every two weeks thereafter. Monitoring of indicator usage is done to reflect the appropriate data input file.

The Project Coordinator should be tested for inter-rater reliability on a quarterly basis. Scenarios provided by QuadraMed, scenarios created by your hospital, or real patients may be used.

Establish a schedule to ensure that each unit is monitored weekly, bi-weekly or monthly, depending on where the hospital is in the transparent classification process. The schedule should include weekend days.

The following materials should be available for the monitor:

Indicator definitions with application examples.

Patient’s classification type and indicators selected via documentation as reported in the data input file. Use one of the following documents:

The Monitoring Detail report (preferred) or the Indicator Detail by Patient report.

The View Chart Item report listed in the transparent classification tools in the software. This report will allow you to review the indicators triggered by the documentation elements identified in the mapping table.

Determine the number of patients to be monitored by multiplying the budgeted daily census times 10% or a minimum of 3 patients for each data input file draw time.

The monitor classifies the randomly chosen patients via the on-line monitoring function. Data sources may include the patient (observation and interview), all nursing records for the current classification period, and the staff responsible for providing the patient's care.

Print the Monitoring Detail report for a comparison of indicators selected via documentation as reported in the data input file.

The monitor compares the indicators via the input file to those selected by the monitor. The monitor is the control in this situation. If the monitor selected an indicator and the input file does not identify this indicator, it is under-use. If the input file does select an indicator, but the monitor determines it inappropriate, it is over-use.

The Monitoring Detail report will calculate the indicator agreement percentage based on the data defined.



Since the classification data is from an input file, no staff names are identified on the Monitoring Detail report. Therefore, monitoring reliability issues related to documentation or timely documentation should be discussed with all the staff on the unit. Documentation issues are best resolved if staff are documenting concurrently.

When monitoring is completed on-line, the following additional reports are available to provide ongoing information on the application of indicators and data validity:

Over/Under Use of Indicators

Monitoring Summary

Monitoring Trend

In addition, the unit Indicator Usage report can be compared to the QuadraMed Databook indicator utilization by clinical specialty.


Chapter 12 Review

Review of Concepts1. A type III patient requires ________ to ______ hours of care per 24 hours.

2. The relative acuity value for a type IV patient is _______.

3. On Unit A today’s WI was 35.6 and the census was 26.0. The average acuity today is _____.

4. Define patient classification.

5. Unit A has the following patient mix: I: 1; II: 15;III: 3; IV: 2; V: 2; VI: 0

The WI is _______ and the acuity is _______.

6. The equivalent number of type II patients is a description of the term _______________.

7. The _______________ of a type III patient is 1.2.

8. A type II patient is defined as requiring _______to ______ hours of care per 24 hours.

9. The QUADRAMED patient classification methodology is based on _______, not ________.

10. A unit has an average WI of 22.8 and a census of 19 patients. The average patient on this unit is a type ________.

11. A type IV patient is defined as a patient requiring ____ to ____ hours of care per 24 hours.

12. The two factors that impact workload index are ___________ and ___________.

13. The WI is 15.8. There are 5 type II patients and 4 type III patients. How many type IV patients are there? __________

14. The HPWI (Hours Per Workload Index) represents the hours of patient care for each ___________.

15. Unit A (from #5 above) had 18 (8-hour staff) caregivers working today. Unit A’s actual HPWI is ________.



Review of Concepts: Answers1. 6 to 8

2. 1.5

3. 1.37

4. A process whereby patients are placed into a category according to the relative need for care

5. WI = 26.4; Acuity = 1.15

6. Workload Index or Weighted Census

7. Relative Acuity Value

8. 5 to 6

9. Patient needs not tasks

10. III (acuity value is 1.2)

11. 8 to 10

12. Census and Acuity

13. 4

14. Equivalent Type II patient; or unit of workload

15. 5.45



ObjectivesUpon completion of this chapter you will be able to discuss features and elements on management reports.

OverviewThe QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System management reporting function provides each level of the organization with the information necessary to analyze and make decisions related to staffing, budgeting, patient workload, productivity and area utilization. Reports can be generated on an as needed basis. There are several standard reports, meaning the data elements displayed have been pre-determined. Where applicable, the user can make the following selections when generating reports:

A shift, all shifts, single day or a date range (user defines the date range)

The data to be reported as averages per day (for the defined date range) or totals for the defined date range

How the staffing data appears on the report (hours or staff)

Staff reporting equivalent hours (i.e. 7.5, 8, 11.25, 12, etc.).

Reports may be generated for single or multiple units by selecting the Unit Group to which the units belong. By default, each unit is defined as a single Unit Group. The user can use the Unit Group function to define groupings of units. An example of a group is Med/Surg. This group would include Medical Unit, Surgical Unit, Medical Stepdown Unit and Surgical Stepdown Unit.

The Daily Assignment report (see page 208) is accessed from the Tools menu or the icon on the Patient Selection Screen.

The reports listed below are used with the Inpatient methodology. Some reports only include valid days of data. A valid day is defined as a day that has both classified patients and actual staffing. Valid day reports are indicated with a plus sign (+) in the list below.

For additional information on accessing and running reports, see the Reports chapter in the AcuityPlus™ User Guide.



Activity Detail (see page 210)

Activity Recommended Hours by Hour of day (see page 212)

Activity Summary (see page 214)

Activity Workload Analysis (see page 217)

Actual and Recommended HPWI Trend Graph (see page 220)

Actual Staffing by Hour of Day (see page 223)

Actual and Scheduled Staffing by Shift(see page 225)

Acuity/Complexity Trend Graph (see page 228)

ADT Activity - Projected and Actual (see page 231)

Budget, Recommended and Actual Productivity (see page 231)+

Census Analysis (see page 237)

Classification Accuracy by Classifying Nurse (see page 241)

Complexity and Acuity Analysis (see page 244)+

Daily Shift Staffing (see page 247)

Daily Staffing (see page 251)

Default Classification Detail (see page 256)

Default Classification Summary (see page 258)

Do Not Classify Detail (see page 260)

Executive Patient Care Summary (see page 262)

Hospital Summary (see page 267)+

Hospital Summary in Dollars (see page 270)+

Indicator Detail by Patient (see page 274)

Indicator Specific (see page 276)

Indicator Usage (see page 278)+

Inpatient Activity Analysis (see page 281)

LOS and Average Daily Patient Turnover (see page 284)

Minimum Direct Staff Analysis (see page 286)+

Monitoring Detail (see page 289)

Monitoring Summary (see page 291)



Monitoring Trend (see page 293)

Multiple Classifications and Edit Classifications Detail (see page 296)

Multiple Classifications and Edit Classifications Summary (see page 298)

Multiple Graphs (see page 299)

Patient Activity by Hour (see page 301)

Patient Classification Detail (see page 304)

Recommended Direct Care Staff with HPWI Target and Min/Max Ranges (see page 306)+

Recommended to Actual Staff (see page 308)+

RN: WI Staff Ratio (see page 310)

Rolling Indicators Detail (see page 313)

Rolling Indicators Summary (see page 314)

Staffing Analysis (see page 315)+

Staffing by Hour by Day of Week (see page 316)

Staffing by MIS Guidelines (see page 318)

Staffing Notes (see page 320)

Staffing Percentages (see page 322)+

Staffing Ratios (see page 324)+

Staffing Recommendation Comparisons (see page 327)+

Staffing Variance (see page 330)+

Treatment Area Workload (see page 335)+

Unclassified Patient Detail (see page 337)

Unclassified Patient Summary (see page 339)

Unit Monthly Trend (see page 340)+

Unit Performance Summary (see page 344)

Unit Period Detail (see page 346)+

Unit Period Detail by Shift (see page 353)+

Unit Statistics (see page 356)

WI Measurement Summary (see page 358)+

Workload Analysis (see page 363)



Workload Analysis by DOW by Hour (see page 365)+

Workload by Hour of Day (see page 368)+

Reports

Daily AssignmentThe Daily Assignment report is a unit specific report that provides a list of the patients classified, displaying their location, patient type, complexity, and workload. A blank column is available for notes. This report is designed to facilitate the use of workload in assigning patients. The report can be generated for all patients on the unit or a subset of patients. When generating this report, a preview of the report appears on the screen. You can enter notes by clicking under the notes column. This information is included in the report when printed, but is not saved within the software.

Key Features

Unit specific display of patients classified with associated patient type, complexity, and workload.

Report can be generated for all patients on the unit or a subset of the unit patient population.

Report can be saved in various file formats so you have copies of the assignments for future reference.



Activity Detail

The Activity Detail report is designed to provide detail informaton for analysis of the event activities, these include ADT, procedures and other workload. For ADT activity, the report displays the event, patient name, date, time, recommended hours and a Y/N to note if the item is set up in System Parameters included in recommended staffing. Procedure classifications are displayed with the patient name, date, start and finish time, recommended hours and a Y/N to note if the procedure classification is set up in System Parameters included in recommended staffing. A procedure must be a minimum of 1 hour in duration for recommended staffing. Other workload will display with the specific workload, date, shift , volume, recommended hours and Y/N to note if the other workload item is set up in System Parameters to be included in recommended staffing.

Key Features

Ability to generate report for one or more event categories.

Patient specific data provided for follow up if required.

Notation if event item is set up in System Parameters to be included in recommended staffing

Ability to view data not included in recommended staffing for analysis.

Select to display one or more event activities on the report

Select to display all events, events included in recommended staffing or events not included in recommended staffing



Unit: OncADT ActivityAdmissionAdmissionAdmissionAdmissionTransfer OutDischargeDischarge

Unit: Onc1 Hr+ Activity Finish Rec Hours1:1 safety observation by non-RN 07:00 AM 24.00Coordination of care by RN 11:00 AM 1.001:1 safety observation by non-RN 07:00 AM 24.00Off unit accompanied by RN 08:30 AM 1.50

Unit: OncOther Activity Date ShiftBld Transf 3/8 D

Volume Rec Hours In Rec 2.00 2.00 Y

Note: Finish times in italics finished on the next day

ChemoPneu, Monia 3/9 07:00 AM YOrtho, Pedic 3/9 07:00 AM Y

ChemoPneu, Monia 3/8 07:00 AM YBroken, Bone 3/8 10:00 AM Y

Treatment Area Patient Name Date Start In Rec

Ortho, Pedic 3/9 08:00 AM 0.50 YBroken, Bone 3/9 10:18 AM 0.25 Y

Pneu, Monia 3/9 10:53 AM 0.50 YCardiac, Cath 3/9 10:52 AM 0.50 Y

Health, Care 3/8 02:00 PM 0.50 YCardio, Vascular 3/8 10:53 AM 0.50 Y

Patient Name Date Time Rec Hours In Rec Infor,Matics 3/8 09:50 AM 0.50 Y

Activity DetailQuadraMed Medical Center

Date: 3/8 to 3/9

AcuityPlus Page: 1 of 1 Run Date: 3/9



Activity Recommended Hours by Hour of Day

The Activity Recommended Hours by Hour of Day report provides recommended staffing by hour of day for RNs and Non-RNs for the event activities. The event activities include ADT, procedures and other workload items. This report enables you to evaluate the time of day that activities occur to facilitate the ability to match resources to workload.

Key Features

Report can be generated for multiple groups.

User defined date range for report summarization.

Report can be run for all days or by day of week.

Select to display the report for events included in recommended staffing or for events not included in recommended staffing

Select to display the report for all days or by day of week.



Unit: OncologyAll Days

Hour of Day RN Non-RN RN Non-RN RN Non-RN7 0.00 0.00 0.00 0.20 0.00 0.008 0.00 0.00 0.00 0.20 0.01 0.009 0.77 0.00 0.50 0.20 0.01 0.00

10 0.83 0.00 0.50 0.20 0.01 0.0011 2.40 0.00 0.00 0.20 0.01 0.0012 1.54 0.00 0.00 0.20 0.01 0.0013 1.13 0.00 0.00 0.20 0.00 0.0014 0.01 0.00 0.00 0.20 0.00 0.0015 0.00 0.00 0.00 0.20 0.00 0.0016 1.10 0.00 0.25 0.20 0.00 0.0017 0.40 0.00 0.00 0.20 0.00 0.0018 3.34 0.00 0.00 0.20 0.00 0.0019 2.30 0.00 0.00 0.20 0.00 0.0020 0.50 0.00 0.00 0.20 0.00 0.0021 0.00 0.00 0.00 0.20 0.00 0.0022 0.00 0.00 0.00 0.20 0.00 0.0023 0.00 0.00 0.00 0.20 0.00 0.000 0.00 0.00 0.00 0.20 0.00 0.001 0.00 0.00 0.00 0.20 0.00 0.002 0.23 0.00 0.00 0.20 0.00 0.003 0.00 0.00 0.00 0.20 0.00 0.004 0.32 0.00 0.00 0.20 0.00 0.005 0.00 0.00 0.00 0.20 0.00 0.006 0.00 0.00 0.00 0.20 0.00 0.00

Avg/Day 13.74 0.00 1.25 4.80 0.05 0.03

ADT Activity 1 Hr + Activity Other Activity

Activity Recommended Hours by Hour of DayRecommended Staffing

QuadraMed Medical CenterDate: 7/1 to 7/30



Activity Summary

The Activity Summary report provides a summary of the event percent utilization, average and total volume, average duration, recommended and total direct staff hours and Y/N indicating if the event item is included in recommended staffing. The report includes an option to include all event categories or a subset of the event categories; and an option to include only events in recommended staffing , not in recommended staffing, or all events regardless of whether they are included in recommended staffing. The report can be printed by unit or by unit group for a summarization of data for all units within the unit group.

Key Features

User defined date range for report summarization

Ability to run report by unit or totaled for unit group

Report can be generated for all events or based on the events being included in recommended staffing.

Select to display the report data by unit or summarized by unit group

Select to display all event activities or only events that are included in or excluded for recommended staffing

Select to display all events or a subset of the three categories



Calculations% Utilization – Total volume per event category divided by total volume of events within each section.

Average Volume – Total volume for each event category divided by days of data in report.

Total Volume – Total volume for each event category for date range.

Average Duration – Total duration for each event category divided by total volume for each event category.

Avg Rec Dir Hours:

ADT Activities – ((Total volume for each ADT activity times the time factor identified in system parameters for specific ADT activity) divided by 60 to convert to hours) divided by total volume for each ADT activity.)

1 Hr +Activity Event – Sum of LOS for each specific 1 Hr + Activities divided by number of each specific 1 Hr + Activity.

Other Workload – ((Total number of each specific other workload category times the time factor identified in system parameters for specific other workload item) divided by 60 to convert to hours) divided by total volume for each other workload category.)

Total Rec Dir Hours:

ADT Activities – ((Total volume for each ADT event times the time factor identified in system parameters for specific ADT event) divided by 60 to convert to hours)

1 Hr +Activities Event – Sum of LOS for each specific procedure.

Other Workload – ((Total number of each specific other workload category times the time factor identified in system parameters for specific other workload item) divided by 60 to convert to hours)

In Rec Staff – Y/N option as defined in system parameters. Yes, means to include in recommended staffing and no means to exclude from recommended staffing.


AcuityPlus™Inpatient Coordinator Guide Chapter 13 Management Reports

ADT Activity % Utilization Average Volume

Total Volume

Average Duration

Avg Rec Dir Hours

Total Rec Dir Hours

In Rec Staff?

Admission 37.2% 4.57 32.00 0.50 2.29 16.00 Y Discharge 34.8% 4.29 30.00 0.50 2.14 15.00 Y Transfer In 11.6% 1.43 10.00 0.25 0.36 2.50 Y Transfer Out 17.4% 2.14 15.00 0.25 0.54 3.75 Y ADT Activity Total 100.00% 12.30 87.00 0.43 5.32 37.25 Y

1 Hr+ Activity % Utilization Average Volume

Total Volume

Average Duration

Avg Rec Dir Hours

Total Rec Dir Hours

In Rec Staff?

1:1 safety observation by non-RN 11.1% 0.29 2.00 24.00 24.00 48.00 Y Coordination of care by RN 22.2% 0.57 4.00 1.00 1.00 4.00 Y Off Unit accompanied by RN 66.7% 1.71 12.00 1.50 1.50 18.00 Y 1 Hr+ Activity Total 100.00% 2.57 18.00 3.89 3.89 70.00 Y

Other Activity % Utilization Average Volume

Total Volume

Average Duration

Avg Rec Dir Hours

Total Rec Dir Hours

In Rec Staff?

Bld Transf 100.00% 0.57 4.00 2.00 0.75 3.00 YOther Activity Total 100.00% 0.57 4.00 2.00 0.75 3.00 Y

Activity SummaryQuadraMed Medical Center

Date: 3/1 to 3/7Unit: Onc

Activity in this report: All Activity AcuityPlus Run Date: 3/31



Activity Workload Analysis

The Activity Workload Analysis report provides summarized information to evaluate the impact of the event data on acuity, workload and recommended staffing. The report provides the volume of event activities; target, classification and overall acuity; procedure, ADT, other, and total workload; and procedure, ADT, other and total recommended direct staffing. It is optional to include classification workload in the workload totals and classification based recommended staffing in the total recommended staffing.

Key Features


Provides data to determine the impact of event workload on unit acuity.

Provides data to determine the recommended staffing associated with event workload.

Select to display data in averages or totals

Select to generate report for recommended staffing or Alternate staffing

Select to include patient classification data in workload and recommended staffing



Unit 1 Hr+ ADT Other Target Class Overall 1 Hr+ ADT Other Total 1 Hr+ ADT Other TotalOnc 2.57 12.30 0.57 1.40 1.40 1.42 0.23 0.12 0.04 0.39 1.25 0.66 0.24 2.15Neuro 0.00 6.70 0.00 1.60 1.59 1.59 0.00 0.07 0.00 0.07 0.00 0.36 0.00 0.36Med/Surg 1.50 9.80 0.00 1.40 1.42 1.43 0.13 0.10 0.00 0.23 0.73 0.53 0.00 1.26Ortho 2.00 3.20 0.00 1.50 1.53 1.54 0.18 0.03 0.00 0.21 0.97 0.17 0.00 1.14ICU 10.00 2.30 0.00 2.90 2.84 2.88 0.34 0.04 0.00 0.38 1.88 0.22 0.00 2.09Totals 16.07 34.30 0.57 1.60 1.61 1.62 0.88 0.35 0.04 1.27 4.83 1.94 0.24 7.00

Activity Workload AnalysisRecommended Staffing - In Staff - Averages

QuadraMed Medical CenterDate: 3/1 to 3/7

Volume Acuity Activity Workload Recommended Staff

Note: Staffing data is reported in 8 hour equivalents AcuityPlus Page: 1

Run Date: 3/8



CalculationsVolume:

1 Hr + Activity – Number of 1 Hr + Activities divided by days of data in report.

ADT – Number of ADT activities divided by days of data in report.

Other – Number of other workload activities divided by days of data in report.

Acuity:

Target – Expected acuity as defined in system parameters.

Class – Classification workload divided by LOS adjusted census.

Overall – (Sum of classification workload and event workload) divided by LOS adjusted census.

Activity Workload:

1 Hr + Activity – Sum of 1 Hr + Activity recommended hours divided by target hours per workload index.

ADT – Sum of ADT recommended hours divided by target hours per workload index.

Other – Sum of other workload recommended hours divided by target hours per workload index.

Total – Sum of 1 Hr + Activity, ADT and other workload. If option is selected, may include patient classification workload.

Recommended Staff:

1 Hr + Activity – Sum of 1 Hr + Activity hours divided by days of data in report.

ADT – ((Sum of each ADT activity times the defined time in system parameters for each ADT activity) divided by 60 to convert to hours) divided by days of data in report.

Other – ((Sum of each other workload activity times the defined time in system parameters for each other workload activity) divided by 60 to convert to hours) divided by days of data in report.

Total – Sum of recommended staffing for 1 Hr + Activity, ADT and other workload. If option is selected, may include recommended staffing for patient classification workload.



Actual and Recommended HPWI Trend Graph

The Actual and Recommended HPWI Trend Graph provides a graphic picture of daily actual and recommended hours per workload index. The minimum and maximum ranges for the target hour per workload index are also displayed.

Supporting data can be displayed on the report. This includes the date, AHPWI, RHPWI, and the minimum THPWI, THPWI, and the maximum THPWI as defined in system parameters.

Key Features

Report can be generated for multiple unit groups.

Graphic picture of actual and recommended HPWI trends.

Option to display supporting data on report.

Select this box to display support data



Actual and Recommended HPWI Trend Graph

Date: 9/1/05 to 9/30/05

QuadraMed Medical Center

THPWI: Daily value shown on graph

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AHPWI RHPWI Min THPWI Max THPWI

Unit: Med Surg



CalculationsMinimum THPWI – The minimum or lower end range for the target hour per workload index as defined in system setup.

THPWI – The target hour per workload index as defined in system setup.

Maximum THPWI – The maximum or upper end range for the target hour per workload index as defined in system setup .

AHPWI – Actual hours per workload index = Actual direct staff in hours per day divided by workload index for same date.

RHPWI – Recommended hours per workload index = Recommended direct staff in hours per day divided by workload index for same date.



Actual Staffing by Hour of Day

The Actual Staffing by Hour of Day report is a unit specific report that provides a detailed record of actual staff by skill level by hour. Totals and averages per hour of day are also provided. This report can be used to validate the actual staff reported, to review the staff mix by hour of day, and to compare staffing with workload.

Key Features


Validation of actual staff data input into system.

Unit specific display of staffing data in hours by hour of day.

Direct staff are displayed on page one of the report.

Non-Direct Staff are displayed on page two of the report.

Option to run report for valid days of data or for all days of data.

Select this box to run report for valid days or for all days. Valid means that both workload and staffing data are present



Actual Staffing by Hour of Day

QuadraMed Medical CenterDate: 9/1/05 to 9/30/05

Unit: Med SurgDIRECT HOURS

HOUR STARTED Mgmt RN LPN NA OA/MT Sitters All

7.00 9.56 1.68 0.56 11.80

8.00 9.56 1.68 0.56 11.80

9.00 9.56 1.68 0.56 11.80

10.00 9.56 1.68 0.56 11.80

11.00 9.56 1.68 0.56 11.80

12.00 9.56 1.68 0.56 11.80

13.00 9.56 1.68 0.56 11.80

14.00 9.56 1.68 0.56 11.80

15.00 9.56 1.68 0.56 11.80

16.00 9.56 1.68 0.56 11.80

17.00 9.56 1.68 0.56 11.80

18.00 9.56 1.68 0.56 11.80

19.00 6.87 1.11 1.38 9.36

20.00 6.87 1.11 1.38 9.36

21.00 6.87 1.11 1.38 9.36

22.00 6.87 1.11 1.38 9.36

23.00 6.87 1.11 1.38 9.36

0.00 6.87 1.11 1.38 9.36

1.00 6.87 1.11 1.38 9.36

2.00 6.87 1.11 1.38 9.36

3.00 6.87 1.11 1.38 9.36

4.00 6.87 1.11 1.38 9.36

5.00 6.87 1.11 1.38 9.36

6.00 6.87 1.11 1.38 9.36

Total Direct Hours

Avg/Hr

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8.22

33.55

1.40

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253.94

10.58



Actual and Scheduled Staffing by Shift

The Actual Staffing by Shift report is a unit specific report that provides a record of actual staff by skill level by shift. Total staff for each shift, each 24-hour period, and the period-to-date cumulative number of staff per skill by shift and by 24-hours are reported. The report can be used to validate the actual staff reported, review the staff mix by shift, and compare actual staffing levels to workload. The report displays all days of data entered. It is not based on valid days of data, so workload does not need to be present to generate the report. The options available for the report are listed below.

Actual Staffing by Shift in Staff - Primary Shifts – Displays actual staff in numbers of staff for the primary shifts as defined in System Parameters. Any data entered in actual staffing for a non-primary shift is converted to number of staff or hours within each primary shift.

Actual Staffing by Shift in Hours - Primary Shifts – Displays actual staff in hours for the primary shifts as defined in System Parameters. Any data entered in actual staffing for a non-primary shift is converted to number of staff or hours within each primary shift.

Actual/Scheduled Staffing by Shift in Staff - Input Detail – Displays actual staff in numbers of staff for each shift of data entered.

Actual/Scheduled Staffing by Shift in Hours - Input Detail – Displays actual staff in hours for each shift of data entered.

When a primary shift report is selected, data is reported by job skill by primary shift. The data is summarized based on the start of day defined in System Parameters.This report is generated at the parent unit level.

Select this to display the primary shifts or to display all shifts with staffing data



Key Features


Unit specific display of staffing data in staff or hours by skill level by shift by day.

Validation of actual staff data.

Actual Staffing By Shift in Staff - Primary Shifts

9/4/2005 9/5/2005 9/6/2005 9/7/2005 9/8/2005 9/9/2005 9/10/2005 9/11/2005 9/12/2005 9/13/2005 9/14/2005 9/15/2005 9/16/2005 9/17/2005 PTDTotal

7A RN 6.5 6.8 7.0 10.1 10.8 11.4 8.3 6.5 8.8 9.0 12.3 9.0 11.0 9.2 126.6

LPN 1.0 1.6 2.0 0.8 2.0 0.0 2.1 2.0 3.1 2.1 2.0 3.1 0.0 2.0 24.0

NA 2.0 0.0 0.0 0.0 0.0 1.6 1.0 1.0 0.0 1.4 0.0 0.8 1.0 1.0 10.0

OA/MT 2.0 1.4 1.4 1.5 1.4 1.6 1.9 1.9 1.4 1.3 1.5 2.2 0.9 1.9 22.2

Sitters 0.0 0.0 0.0 0.0 0.0 0.0 0.3 1.2 0.3 0.0 0.0 0.0 0.0 0.0 1.8

ShiftTotal 11.5 9.8 10.4 12.5 14.2 14.6 13.7 12.7 13.5 13.8 15.8 15.2 12.9 14.1 184.6

7P RN 4.1 3.1 6.2 7.3 7.2 7.3 4.2 5.3 8.1 6.9 9.6 8.1 7.2 4.1 88.6

LPN 1.0 0.0 0.0 1.0 1.0 1.1 1.1 0.0 1.1 2.1 1.0 1.0 2.1 1.0 13.6

NA 2.0 1.0 1.0 1.0 1.0 3.1 2.0 2.0 2.0 2.0 0.0 1.0 2.0 3.1 23.4

OA/MT 0.0 0.0 0.0 0.7 0.9 0.9 0.0 0.0 0.8 0.7 0.4 0.0 1.0 0.0 5.3

Sitters 0.0 0.0 0.0 1.0 0.0 0.0 1.0 1.0 0.0 1.0 0.0 0.0 0.0 0.0 4.0

ShiftTotal 7.0 4.1 7.2 11.1 10.1 12.3 8.3 8.3 12.0 12.7 11.0 10.2 12.3 8.3 134.8

24 HrTotal 18.5 13.9 17.6 23.5 24.3 26.9 21.9 20.9 25.6 26.6 26.8 25.4 25.2 22.4 319.5


Date: 9/4/05 To 9/17/05

Unit: Med Surg



Acuity/Complexity Trend Graph

The Acuity/Complexity Trend Graph report provides a graphic picture of daily acuity and complexity, if applicable, for the selected date range. The minimum and maximum acuity range and target acuity are noted on the report.

Supporting data can be displayed on the report. This includes the date, acuity, complexity minimum target acuity, target acuity, and the maximum acuity as defined in system setup.

Key Features


Graphic picture of acuity trends.

Graphic picture of complexity trends, if applicable.

Option to display supporting data on report.

Select this display supporting data on report

Acuity/Complexity Trend Graph


Date: 9/1/05 to 9/30/05

Unit: Med Surg

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5

9/23

/200

5

9/24

/200

5

9/25

/200

5

9/26

/200

5

9/27

/200

5

9/28

/200

5

9/29

/200

5

9/30

/200

5

Acuity Complexity Max Expected Acuity Min Expected Acuity



CalculationsMinimum Expected Acuity – The minimum or lower end range for the expected acuity as defined in system setup.

Acuity – Sum of workload index divided by sum of LOS adjusted census.

Maximum Expected Acuity – The maximum or upper end range for the expected acuity as defined in system setup.

Complexity – (Sum of individual complexity type x (sum of LOS / 24) / LOS adjusted census.



ADT Activity - Projected and ActualThe ADT Activity - Projected and Actual report provides a comparison of actual ADT activity and projected ADT activity by shift and for the 24 hour period. This report provides the comparative data and the variance to facilitate an analysis of data to determine the impact of using the projected ADT option for recommended staffing. The projected ADT data is based on the most recent 90 days of data by day of week.

Key Features:

Report displays the actual and projected ADT for each type of activity.

Variance between actual and projected ADT by type of activity.

Data provided by shift and for the 24 hour period.

Budget, Recommended and Actual Productivity

The Budget, Recommended and Actual Productivity report displays the budget, midnight and LOS adjusted censuses; target and actual acuity; budget, recommended, and actual hours per workload index; and the budget, recommended, actual hours per patient day; and complexity of care information, if applicable. The report provides the user with the ability to evaluate productivity and variance to budget.

Select these options to display Direct staff only, non-direct staff only or all staff

Report data can be in averages or data in totals

Workload includes classification workload only or all workload associated with the methodology

Budget Staffing: BHPPD calculation based on midnight census, LOS Adjusted census or classification census



Key Features

User-defined parameter for the hours per patient day calculation.

Option to display acuity based on classification data or classification and event workload.

Comparison of recommended and actual hours per workload index and hours per patient day to budget parameters for analysis of productivity and variances to budget.

Report can be generated for multiple unit groups with a summary for each group and a total for all groups.

CalculationsDays of Data – Number of days with both workload and actual staffing data in the database by unit. Group Summary and Hospital Summary days of data with workload and actual staffing for any unit within group/hospital. Note group summary is provided for every group selected for the report. If a unit is included in multiple groups, the data will be included multiple times in the hospital summary.

Budget Census – The average daily budgeted census for each unit as defined in system parameters. The group summary and hospital summary is a sum of the unit data within each group.

Midnight Census:

Average – Sum of midnight census for report date range divided by days of data.

Total – Sum of midnight census

LOS Adjusted Census:

Average – (Sum of length of stay for classified patients divided by 24) divided by days of data.

Total – Sum of length of stay for classified patients divided by 24.

Target Acuity – Target acuity as defined in system parameters for most recent effective date for date range on report.

Acuity – Sum of workload / divided by sum of LOS adjusted census. Classification workload includes data from patient classification only, and overall workload includes workload from patient classification and event classifications.

Complexity – Sum of (Individual patient complexity score x patient LOS)/total patient LOS

Budget HPWI – Budget hours per workload index = As defined in system parameters

Rec HPWI – Recommended hours per workload index = Recommended staff in hours /average daily classification or total workload . Only valid days of data included



Actual HPWI – Actual hours per workload index = Actual staff in hours /average daily classification or total workload . Only valid days of data included

Budget HPPD – Budget hours per patient day = As defined in system parameters

Rec HPPD – Recommended hours per patient day = Recommended staff in hours /average daily census selected. Options include midnight census or LOS adjusted census. Only valid days of data included

Actual HPPD – Actual hours per patient day = Actual staff in hours /average daily census selected. Options include midnight census or LOS adjusted census. Only valid days of data included



Budget, Recommended and Actual Productivity Data - Direct Staff Averages


Date: 7/1/05 to 9/30/05

QuadraMed Medical CenterDays Budget LOS Target Actual Cmplx Budget Rec Actual Budget Rec Actual

Unit of Data Census Mn Cen Adj Cen Acuity Acuity HPWI HPWI HPWI HPPD HPPD HPPD

Med Surg 92 28.00 28.42 27.97 1.60 1.58 2.72 5.50 5.42 5.64 8.80 8.42 8.76

MH 92 6.00 5.98 6.07 1.56 1.74 -- 5.51 5.46 7.47 8.60 9.64 13.19

Ortho 92 22.00 22.97 22.51 1.58 1.52 3.04 5.44 5.38 5.49 8.60 8.00 8.17

Med 92 27.00 27.07 26.89 1.55 1.55 3.43 5.16 5.15 5.43 8.00 7.93 8.36

Surg 92 18.00 17.55 17.37 1.48 1.41 2.77 5.54 5.49 5.76 8.20 7.65 8.02

MSICU 92 5.00 5.07 5.10 2.70 2.87 4.94 5.95 5.90 11.64 16.00 17.02 33.59

CVICU * 88 2.50 2.60 2.53 2.98 2.76 4.82 6.04 5.96 18.86 18.00 15.95 50.49

Med SD 92 27.00 26.79 27.08 1.83 1.79 4.30 5.63 5.58 6.96 10.30 10.12 12.63

Neuro 92 25.00 25.21 24.65 1.55 1.60 3.15 5.42 5.34 6.28 8.40 8.37 9.84

NICU 92 37.00 37.35 37.42 1.79 1.88 3.94 5.70 5.60 5.62 10.20 10.54 10.57

Onc 92 17.00 17.39 17.42 1.49 1.56 3.55 5.27 5.19 6.06 7.85 8.09 9.45

Peds 92 6.60 7.09 7.00 1.44 1.49 3.35 6.40 5.94 6.86 9.22 8.71 10.07

PICU * 89 2.50 2.45 2.53 2.14 2.14 4.30 10.13 9.18 11.70 21.65 20.26 25.84

Summary -- 223.60 225.74 224.34 -- 1.68 3.38 -- 5.52 6.51 9.33 9.22 10.88

Total -- 223.60 225.74 224.34 -- 1.68 3.38 -- 5.52 6.51 9.33 9.22 10.88

Notes: HPPD in Mn Census

** Data crosses more than 1 effective date range

* Missing Days of Data



Budget, Recommended and Actual Productivity Data - NonDirect Staff Averages


Date: 7/1/05 to 9/30/05

QuadraMed Medical CenterDays Budget LOS Target Actual Cmplx Rec Actual Budget Rec Actual

Unit of Data Census Mn Cen Adj Cen Acuity Acuity HPWI HPWI HPPD HPPD HPPD

Med Surg 92 28.00 28.42 27.97 1.60 1.58 2.72 0.65 0.70 1.04 1.02 1.09

MH 92 6.00 5.98 6.07 1.56 1.74 -- 1.52 3.16 3.24 2.68 5.58

Ortho 92 22.00 22.97 22.51 1.58 1.52 3.04 0.90 0.94 1.29 1.35 1.40

Med 92 27.00 27.07 26.89 1.55 1.55 3.43 0.86 0.86 0.98 1.33 1.33

Surg 92 18.00 17.55 17.37 1.48 1.41 2.77 1.14 1.00 1.18 1.60 1.39

MSICU 92 5.00 5.07 5.10 2.70 2.87 4.94 1.23 1.57 2.02 3.55 4.52

CVICU * 88 2.50 2.60 2.53 2.98 2.76 4.82 3.18 2.73 3.62 8.52 7.31

Med SD 92 27.00 26.79 27.08 1.83 1.79 4.30 2.35 2.31 3.52 4.27 4.20

Neuro 92 25.00 25.21 24.65 1.55 1.60 3.15 0.97 1.76 1.69 1.52 2.75

NICU 92 37.00 37.35 37.42 1.79 1.88 3.94 0.90 0.79 1.78 1.70 1.48

Onc 92 17.00 17.39 17.42 1.49 1.56 3.55 1.03 0.82 1.59 1.60 1.29

Peds 92 6.60 7.09 7.00 1.44 1.49 3.35 2.47 2.23 2.89 3.63 3.27

PICU * 89 2.50 2.45 2.53 2.14 2.14 4.30 3.70 1.97 5.91 8.17 4.34

Summary -- 223.60 225.74 224.34 -- 1.68 3.38 1.24 1.30 1.82 2.07 2.18

Total -- 223.60 225.74 224.34 -- 1.68 3.38 1.24 1.30 1.82 2.07 2.18

Page 1 of 1




Run Date: 01:31:09 PM



Budget, Recommended and Actual Productivity Data - Total Staff Averages


Date: 7/1/05 to 9/30/05

QuadraMed Medical CenterDays Budget LOS Target Actual Cmplx Rec Actual Budget Rec Actual

Unit of Data Census Mn Cen Adj Cen Acuity Acuity HPWI HPWI HPPD HPPD HPPD

Med Surg 92 28.00 28.42 27.97 1.60 1.58 2.72 6.07 6.34 9.84 9.44 9.86

MH 92 6.00 5.98 6.07 1.56 1.74 -- 6.98 10.64 11.84 12.31 18.77

Ortho 92 22.00 22.97 22.51 1.58 1.52 3.04 6.28 6.43 9.89 9.35 9.57

Med 92 27.00 27.07 26.89 1.55 1.55 3.43 6.01 6.29 8.98 9.26 9.69

Surg 92 18.00 17.55 17.37 1.48 1.41 2.77 6.63 6.75 9.38 9.24 9.41

MSICU 92 5.00 5.07 5.10 2.70 2.87 4.94 7.13 13.21 18.02 20.57 38.10

CVICU * 88 2.50 2.60 2.53 2.98 2.76 4.82 9.14 21.59 21.62 24.48 57.80

Med SD 92 27.00 26.79 27.08 1.83 1.79 4.30 7.93 9.28 13.82 14.39 16.83

Neuro 92 25.00 25.21 24.65 1.55 1.60 3.15 6.31 8.04 10.09 9.89 12.59

NICU 92 37.00 37.35 37.42 1.79 1.88 3.94 6.50 6.40 11.98 12.23 12.05

Onc 92 17.00 17.39 17.42 1.49 1.56 3.55 6.22 6.89 9.44 9.69 10.73

Peds 92 6.60 7.09 7.00 1.44 1.49 3.35 8.41 9.09 12.11 12.35 13.34

PICU * 89 2.50 2.45 2.53 2.14 2.14 4.30 12.87 13.67 27.56 28.43 30.18

Summary -- 223.60 225.74 224.34 -- 1.68 3.38 6.76 7.81 11.15 11.30 13.06

Total -- 223.60 225.74 224.34 -- 1.68 3.38 6.76 7.81 11.15 11.30 13.06






Census Analysis

The Census Analysis report provides census and compliance data in totals and averages. Average data is by patient and in patient hours. The actual, classification, LOS adjusted and midnight census is displayed, with variances between the censuses and the percentage of classification compliance. This report is designed to facilitate analysis of classification compliance.

Key Features

User-defined date ranges for summarizing data.


Classification compliance by unit and totaled for the unit groups selected.

Census and patient hours data are available by unit and totals for the unit groups selected.



Census Analysis - In Averages

All Inpatient Units


Date: 9/1/05 to 9/30/05

Days Actual Class LOS MN Variance

Unit of Data Cen Cen Adj Cen Cen A-C Cen M-C Cen M-LOS Cen % Compliance

Med Surg 30 39.90 39.80 29.77 30.33 0.10 -9.47 0.56 99.75 %

Ortho 30 34.03 33.90 24.66 24.67 0.13 -9.23 0.00 99.61 %

Med 30 32.37 31.93 24.42 24.47 0.43 -7.47 0.05 98.66 %

Surg 30 24.67 24.30 18.19 18.40 0.37 -5.90 0.21 98.51 %

CVICU 30 4.00 3.97 2.95 2.97 0.03 -1.00 0.02 99.17 %

MSICU 30 8.97 8.83 6.74 6.83 0.13 -2.00 0.09 98.51 %

Med SD 30 41.73 41.30 29.56 29.37 0.43 -11.93 -0.20 98.96 %

Neuro 30 33.13 32.63 26.50 27.17 0.50 -5.47 0.67 98.49 %

NICU 30 41.40 41.27 39.64 39.70 0.13 -1.57 0.06 99.68 %

Onc 30 23.00 22.87 19.46 19.37 0.13 -3.50 -0.09 99.42 %

Peds 30 11.70 11.57 7.08 7.07 0.13 -4.50 -0.01 98.86 %

PICU 30 4.07 3.70 2.59 2.50 0.37 -1.20 -0.09 90.98 %

Hospital -- 298.97 296.07 231.55 232.83 2.90 -63.23 1.29 99.03 %

% Variance -- -- -- -- -- 0.97 % -27.16 % 0.55 % --



Census Analysis - Patient Hours In Averages

All Inpatient Units


Date: 9/1/05 to 9/30/05

Days Actual Actual Variance

Unit of Data Patient Hrs Cl Patient Hrs A-C Cen % Variance

Med Surg 30 716.73 714.56 2.17 99.70 %

Ortho 30 592.39 591.95 0.44 99.93 %

Med 30 587.60 586.10 1.50 99.74 %

Surg 30 438.30 436.49 1.80 99.59 %

CVICU 30 70.84 70.74 0.11 99.85 %

MSICU 30 162.50 161.80 0.71 99.57 %

Med SD 30 712.02 709.51 2.51 99.65 %

Neuro 30 638.66 635.94 2.72 99.57 %

NICU 30 951.75 951.25 0.50 99.95 %

Onc 30 467.82 466.93 0.89 99.81 %

Peds 30 171.02 169.83 1.19 99.31 %

PICU 30 63.85 62.06 1.79 97.20 %

Hospital -- 5,573.48 5,557.15 16.33 99.71 %

% Variance -- -- -- 0.29 % --



CalculationsActual Census – The actual number of patients on the unit divided by days of data. If a patient arrives on Unit A, is transferred to Unit B, and then transferred back to Unit A within the same 24 hour report period, the patient will count as 1 actual census.

Class Census – The number of classified patients divided by days of data.

LOS Adjusted Census – (Sum of patient hours divided by 24) divided by days of data.

Midnight Census – Total number of patient's on unit at 12am divided by days of data.

Variance:

Actual - Class – (Total number of actual patients minus the total number of class patients) divided by days of data x 100.

MN - Class – (Total number of patients on the unit at midnight minus the total number of patients classification ) divided by days of data x 100.

MN - LOS – (Total midnight census minus LOS adjusted census) divided by days of data x 100.

Compliance – (Number of classified patients divided by number of actual patients) x 100.

Total – (Sum of actual census - class census or midnight census - class census or midnight census - LOS adjusted census ) divided by days of data x 100.

% Variance:

Actual - Class – Variance divided by (actual census divided by days of data).

MN - Class – Variance divided by (midnight census divided by days of data).

MN - LOS ajdusted – Variance divided by (midnight census divided by days of data).




The Classification Accuracy by Classifying Nurse report is a unit specific report displaying all staff that have classified patients during the report date range. The number of classifications each nurse has completed, the number of classifications that have been monitored, the percentage of classifications monitored, the percentage of agreement between the monitor and the nurse classifying, and the percentage of patients under-classified and/or over-classified when compared to the monitor’s classification are included.

This report is designed to provide the unit manager with the classification accuracy by nurse, and to provide the monitor with a report regarding the distribution of monitoring by classifying nurse.

Key Features

Provides information on the accuracy of classifications completed by unit staff for feedback to staff and inclusion in employee evaluations.

Provides the monitors with information on which nurses have been evaluated for classification accuracy.



CalculationsClassifying Nurse – First and last name of the nurse that classified a patient on the unit during defined date range.

# Classifications – The number of patients each nurse has classified.

# Classifications Monitored – The number of classifications that have been monitored.

% Classifications Monitored – (The number of classifications monitored by nurse divided by number of classifications completed by nurse) x 100.

% in Agreement by Type – (The number of monitored classifications in agreement by type divided by number of monitored classifications) x 100.

% Under Classified – (The number of monitored classifications where the patient was under classified by type divided by number of monitored classifications) x 100.

% Over Classified – (The number of monitored classifications where the patient was over classified by type divided by number of monitored classifications) x 100.



7 0 0% 0%Jones, April 0% 0%1 1 100% 0%Jones, Christine 100% 0%7 1 100% 0%Jones, Cynthia 14% 0%3 1 100% 0%Jones, Denise 33% 0%7 1 100% 0%Jones, Joy 14% 0%6 1 100% 0%Jones, Julia 17% 0%3 0 0% 0%Jones, Karen 0% 0%10 1 100% 0%Jones, Kathy 10% 0%5 1 100% 0%Jones, Kristy 20% 0%2 1 100% 0%Jones, Laurie 50% 0%3 0 0% 0%Jones, Leanne 0% 0%1 1 100% 0%Jones, Michael 100% 0%3 1 100% 0%Jones, Michaellyn 33% 0%1 1 100% 0%Smith, Noeme 100% 0%5 1 100% 0%Smith, Olivia 20% 0%3 1 100% 0%Smith, Penny 33% 0%9 1 100% 0%Smith, Rhonda 11% 0%1 0 0% 0%Smith, Sabrina 0% 0%3 1 100% 0%Smith, Sue 33% 0%3 1 0% 100%Smith, Theres a. 33% 0%5 1 100% 0%Smith, Tonya 20% 0%2 1 100% 0%Smith, Tracie 50% 0%3 1 100% 0%Smith, Valerie 33% 0%1 1 100% 0%Smith, Windy 100% 0%94 20 21% 95% 5% 0%Unit Total


Date: 9/29/2005 to 9/30/2005QuadraMed Medical Center

Classifying Nurse#

Classifications#

ClassificationsMonitored

%Classifications

Monitored

% inAgreement by

Type

% UnderClassified

% OverClassified

Med Surg (QMC)Unit:



Complexity and Acuity Analysis

The Complexity and Acuity Analysis report provides a cross tab view of acuity and complexity. The percentage of patients by acuity and complexity is shown. This report can assist you in the implementation of the Complexity of Care module and determining the skill distributions by complexity.

Key Features


There are user-defined date ranges for summarizing data.

Number and percentage of patients by acuity and complexity are shown.

Data is available for 24 hour period, by shift for all shifts, or by specific shift.

Ability to display or not display percentages by patient type and complexity type on the report.

Select to print the report for 24 hour total, by shift for all shifts or for one specific shift

Select to display the number of classifications by type or both the number and percentage of patients by type



CalculationsVolume – (Number of patients by patient type and complexity type)divided by days of data in report.

% Within Complexity Type – ((Number of patients by patient type and complexity type) divided by number of patients with same complexity type) x 100.

% Within Acuity Type – ((Number of patients by patient type and complexity type) divided by number of patients with same patient type) x 100.

A total volume and % by Acuity Type is displayed across bottom of report. The last column displays a total volume and % within Complexity Type.



Unit: Med Surg

ComplexityType

Acuity Type

1 2 3 4 5 Total

1 0.01 3.61 1.05 4.67

2 1.60 10.64 0.03 12.27

3 0.09 4.60 0.25 4.94

4 2.15 3.30 5.45

5 2.40 0.03 2.44

0.01 5.31 18.43 5.99 0.03 29.77





Unit: Med Surg

ComplexityType

1 2 3 4 5 Total

1 Volume

% within Complexity Type

% within Acuity Type

0.01

0.3 %

100.0 %

3.61

77.3 %

68.1 %

1.05

22.4 %

5.7 %

4.67

15.7 %

--

2 Volume



1.60

13.0 %

30.2 %

10.64

86.7 %

57.7 %

0.03

0.3 %

0.6 %

12.27

41.2 %

--

3 Volume



0.09

1.9 %

1.7 %

4.60

93.1 %

24.9 %

0.25

5.0 %

4.1 %

4.94

16.6 %

--

4 Volume



2.15

39.5 %

11.7 %

3.30

60.5 %

55.1 %

5.45

18.3 %

--

5 Volume



2.40

98.6 %

40.2 %

0.03

1.4 %

100.0 %

2.44

8.2 %

--

Volume

% by Acuity Type

0.01

0.0 %

5.31

17.8 %

18.43

61.9 %

5.99

20.1 %

0.03

0.1 %

29.77

--



Daily Shift Staffing

The Daily Shift Staffing report provides shift specific information including the number of classified patients, actual census, LOS census, acuity, complexity, overall workload, and job skill staffing data for each unit. This report may be used in allocating nursing resources based on staffing recommendations as indicated by current workload information. Comparisons are made to scheduled staffing. This report can display recommended and alternate staffing; and the report displays direct staff, non direct staff, or all staff on the report. The report is designed for use on a concurrent and prospective basis.

Key Features

Report can be generated based on the recommended staffing method or the alternative staffing method.

Displays current classification census, acuity, complexity, and overall workload information for the selected shift.

Both recommended and scheduled staffing are reported by job skill.

Staffing information may be displayed in hours or number of staff.

Displays information for future shifts using current overall workload.

Displays multiple units and hospital total.

All data is shift specific.

Select any of the option to display the recommended staffing or the alternate recommended staffing



User defines shift to be reported.

Daily Shift Staffing Report Calculations

Class Census – Number of patients classified on this shift.

Actual Census – Actual number of patients on the unit this shift. This census includes all patients on the unit regardless of LOS. Consequently, both admissions, transfers, and discharges are included in the census.

LOS Census – Number of patient hours for the defined shift divided by shift length. This census includes classified patients only.

Class Acuity – Classification workload normalized for 24 hours divided by LOS adjusted census. Normalized for 24 hours means the relative acuity value for 24 hours is used for each 8 hour period to determine acuity. For example: A type II patient is on the unit the entire shift: RAV=1 and the LOS adjusted census=1, thus acuity is 1/1=1.

Complexity – (Sum of individual patient complexity score X (LOS/24)) / LOS Adjusted Census.

Class WI – Class workload plus event workload

WI = what is in guide for shift WI

Event workload = Sum of recommended staffing for all events divided by target hours per workload index.

Shift WI:

When printing for multiple units, all selected units must have the same recommended shifts defined, for example, all Day, Evening, and Night shifts (8 hour shifts), or 7a – 7p and 7p – 7a shifts (12 hour shifts).

Sum for this shift ((Total Type I patients length of stay on this shift / specific shift length) X (specific shift distribution percentage) X methodology specific relative acuity value)

+ Sum for this shift ((Total Type II patients length of stay on this shift / specific shift length) X (specific shift distribution percentage) X methodology specific relative acuity value)

+ Sum for this shift ((Total Type III patients length of stay on this shift / specific shift length) X (specific shift distribution percentage) X methodology specific relative acuity value)

+ Sum for this shift ((Total Type IV patients length of stay on this shift / specific shift length) X (specific shift distribution percentage) X methodology specific relative acuity value)



LOS Adjusted CensusRecommended Staffing:

Non-Direct Staff:

Fixed – The number of staff as defined by unit, by job title, by day of the week for this shift.

Census adjusted staff – The number of staff as required by census as defined by job title for this shift.

Direct Staff:

The recommended staffing for each job skill level is compared to the minimum staffing as defined for each unit in System Parameters. If recommended staffing is lower that the minimum staffing defined, it is replaced with the minimum staffing.

Scheduled Staff – The number or hours of staff scheduled to work this shift by job skill from the scheduled staffing input.

Variance – Scheduled staff – Recommended staff for this shift.

+ Sum for this shift ((Total Type V patients length of stay on this shift / specific shift length) X (specific shift distribution percentage) X methodology specific relative acuity value)

+ Sum for this shift ((Total Type VI patients length of stay on this shift / specific shift length) X (specific shift distribution percentage) X methodology specific relative acuity value)

Sum for each direct job skill defined on this shift ((WI for Type I patients on this shift X target hour per workload index) X skill distribution for specific job skill)

+ Sum for each direct job skill defined on this shift ((WI for Type II patients on this shift X target hour per workload index) X skill distribution for specific job skill)

+ Sum for each direct job skill defined on this shift ((WI for Type III patients on this shift X target hour per workload index) X skill distribution for specific job skill)

+ Sum for each direct job skill defined on this shift ((WI for Type IV patients on this shift X target hour per workload index) X skill distribution for specific job skill)

+ Sum for each direct job skill defined on this shift ((WI for Type V patients on this shift X target hour per workload index) X skill distribution for specific job skill)

+ Sum for each direct job skill defined on this shift ((WI for Type VI patients on this shift X target hour per workload index) X skill distribution for specific job skill)



Daily Staffing

The Daily Staffing report is used to assist in daily staffing decisions. The report provides recommended and scheduled staff by shift, with the variance between recommended and scheduled staffing. Census data is provided for beginning census (census at start of day), number of arrivals, number of departures, current census (census at time the report ran), classification census and the LOS adjusted census. The estimated number of arrivals and departures displays to the right of the census information. The estimated numbers are based on the most recent 90 days of data by day of week. The classification workload, activity workload, projected ADT workload, classification acuity, overall acuity and complexity of care measure are displayed on the report. If the option to use projected ADT is set to yes, the projected ADT workload is included with classification workload to determine recommended staffing. The projected ADT workload is used for the first 4 hours of each shift to determine recommended staffing. After the first 4 hours, actual ADT data is used. The patient distribution by patient type and complexity type, and recommended and budgeted hours per patient day for direct and non-direct care providers are included. Variance data reported includes the variance between recommended and scheduled staff, and the variance between alternate recommended staff and scheduled staff. Staffing for the next day can be based on current workload or average workload for the past 24 hour period. The second part of this report is the Recommended Staffing Detail. This part provides a detailed breakdown of the recommended staff by shift, for direct and non-direct categories.

This report is used when classification is being completed from the prospective approach.

Key Features

Ability to define the starting shift, with data for the following 24 hours shown.

Unit specific display of staffing data in hours or number of staff.

Select to display only the daily staffing or recommended staffing detail. If you select both, both will print

Select to display staff in terms of whole number or in hours

Select to display direct staff, non-direct staff or both



Option to display direct staff, non-direct staff, or all staff.

Staffing reported for all shifts.

Recommended to Scheduled staff variance and Alternate Recommended to Scheduled staff variance by job skill.

Census, acuity, complexity, workload, and patient distribution by patient type and complexity type displayed.

Totals by shift and for 24-hour period of direct, non-direct, and all staff.

When acuity is above or below the defined range, a note appears stating below minimum or above maximum.

When minimum staffing occurs, a note appears stating the job skills impacted by minimum staffing.

Notes appear at the bottom of the report detailing the basis for recommended and alternate recommended staffing, and the basis for calculating projected staffing.

When printing for multiple units, all selected units must have the same recommended shifts defined, for example, all Day, Evening, and Night shifts (8 hour shifts), or 7a – 7p and 7p – 7a shifts (12 hour shifts).



Daily Staffing Report Calculations

Beginning Census – Census at beginning of shift.

Arrivals – Number of patient arrivals between start of the report initial shift and time report generated.

Departures – Number of patient departures between start of the report initial shift and time report generated.

Current Census – Census at time report generated

Class Census – Number of patients classified at time report generated

LOS Adjusted Census – Sum of patient hours for classified census at time report generated divided by 24

Patient Type Census – Number of patients classified by type.

Complexity Type Census - Number of patients classified by complexity type.

Total Workload – Class workload plus event workload

Class Workload:

Procedure Workload – Recommended staff hours divided by THPWI.

Class Acuity – Class Workload / LOS Adjusted Census.

Sum over all shifts ((Total Type I patients length of stay on each shift / specific shift length) X (specific shift distribution percentage) X methodology specific relative acuity value)

+ Sum over all shifts ((Total Type II patients length of stay on each shift / specific shift length) X (specific shift distribution percentage) X methodology specific relative acuity value)

+ Sum over all shifts ((Total Type III patients length of stay on each shift / specific shift length) X (specific shift distribution percentage) X methodology specific relative acuity value)

+ Sum over all shifts ((Total Type IV patients length of stay on each shift / specific shift length) X (specific shift distribution percentage) X methodology specific relative acuity value)

+ Sum over all shifts ((Total Type V patients length of stay on each shift / specific shift length) X (specific shift distribution percentage) X methodology specific relative acuity value)

+ Sum over all shifts ((Total Type VI patients length of stay on each shift / specific shift length) X (specific shift distribution percentage) X methodology specific relative acuity value)



Complexity Score – (Sum of individual patient complexity value X (LOS/24)) / LOS adjusted census.

Direct Budget HPPD – Budget HPPD as defined in System Parameters for direct care providers.

NonDirect Budgeted HPPD – Budget HPPD as defined in System Parameters for non-direct care providers.

Direct Recommended HPPD – Recommended direct staff hours / LOS Adjusted census.

NonDirect Recommended HPPD – Recommended non-direct staff hours / LOS adjusted census.

Scheduled Staff – The number or hours of staff scheduled to work by shift by job skill from the scheduled staffing input.

Recommended Staffing – Recommended staffing and alternate recommended staffing are defined in System Parameters.

Direct Staff:

Workload adjusted staff – (The sum of the classification workload X THPWI (Target Hours Per Workload Index) X the shift distribution percentage for specific patient type) divided by the shift length = Hourly Recommended Staff by Shift. Sum of LOS by patient type by shift X recommended staff by hour for each specific shift X skill distribution for specific shift plus the event workload based on shift occurred and skill identified with event.

The recommended staffing for each job skill level by shift is compared to the minimum staffing as defined by each unit. If recommended staffing is lower than the minimum staffing it is replaced with the minimum staffing.

Non-Direct Staff:

Fixed – The number of staff as defined by unit, by job title, by day of the week.

Census adjusted staff – The number of staff as required by census as defined by job title.

Variance – Recommended staffing minus scheduled staffing.

Total Direct, Total Non-Direct, and Total of all staff for each shift and 24-Hour Total.

Recommended staffing includes the recommended hours from the ADT events and procedure events if the option to include in staffing is set to Yes. It also includes recommended hours related to other workload.



Next Day – Provides the scheduled and recommended staffing for direct and non-direct staff and the variance for the following day shift. Data is based on either the current workload or the average workload for the 24 hour period, as defined in the system parameters.

19 (est) Class Workload 25.60 I I I I I I I V V V I0 3.5 Activity Workload 0.0 0 12 6 2 0 0

Departures 0 2 Projected ADT WI 0.81 1 9 5 5Current Census 20 Class Acuity 1.28Class Census 24.00 Overall Acuity 1.32LOS Adj Census 18.94 Complexity 2.7

Direct Recommended 6.86

Budgeted 7.56

NM NA US Dir N-Dir TotalDay Sch 1.0 5.0 1.0 3.0 1.0 9.0 2.0 11.0 0.6 Est

Rec 1.0 5.7 3.6 1.0 9.3 2.0 11.3 0.0 Act Alt 1.0 5.1 4.2 1.0 9.3 2.0 11.3 -0.6 Var A-E

Var R-S 0.0 0.7 -1.0 0.6 0.0 0.3 0.0 0.3Var A-S 0.0 0.1 -1.0 1.2 0.0 0.3 0.0 0.3

Eve Sch 4.0 2.0 1.0 6.0 1.0 7.0 0.0 EstRec 3.8 2.0 1.0 5.8 1.0 6.8 0.0 Act

Alt 3.5 2.3 5.8 0.0 5.8 0.0 Var A-EVar R-S 0.0 -0.2 0.0 0.0 0.0 -0.2 0.0 -0.2Var A-S 0.0 -0.5 0.0 0.3 -1.0 -0.2 -1.0 -1.2

Night Sch 2.0 1.0 1.0 4.0 0.0 4.0 0.0 EstRec 1.9 1.9 3.8 0.0 3.8 0.0 Act

Alt 2.0 1.8 3.8 0.0 3.8 0.0 Var A-EVar R-S 0.0 -0.1 -1.0 0.9 0.0 -0.2 0.0 -0.2Var A-S 0.0 0.0 -1.0 0.8 0.0 -0.2 0.0 -0.2

24 Hour Sch 1.0 11.0 2.0 6.0 2.0 19.0 3.0 22.0 0.0 EstTotal Rec 1.0 11.4 0.0 7.5 2.0 18.9 3.0 21.9 0.0 Act Alt 1.0 10.6 0.0 8.3 1.0 18.9 2.0 20.9 0.0 Var A-E

Var R-S 0.0 0.4 -2.0 1.5 0.0 -0.1 0.0 -0.1Var A-S 0.0 -0.4 -2.0 2.3 -1.0 -0.1 -1.0 -1.1

Next Day Sch 1.0 6.0 4.0 1.0 10.0 2.0 12.0 0.0 EstRec 1.0 5.7 3.6 1.0 9.3 2.0 11.3 0.0 Act

Day Alt 1.0 5.1 4.2 1.0 9.3 2.0 11.3 0.0 Var A-E Var R-S 0.0 -0.3 0.0 -0.4 0.0 -0.7 0.0 -0.7

Var A-S 0.0 -0.9 0.0 0.2 0.0 -0.7 0.0 -0.7

Total

ArrivalsBeginning Census Type

Patient Type CensusComplexity Type Census

HPPD

LPNRNADT Rec

NonDirect2.751.68

Daily Staffing - In StaffQuadraMed Medical Center

Unit: OncologyDate: 7/1



Default Classification Detail

The Default Classification report is a unit specific report that provides a detailed record of patients that have been classified by a default classification during the specified timeframe. This report displays the patient location, name, account number, starting and ending date/time for the default classification, and the hours of default classification. The total actual census, patient hours, number of default classifications, number of default classification hours, and the percentage of default classification hours is shown.

Key Features

The report provides data to evaluate how frequently new arrivals to the unit (admits/transfers in) are classified by default versus assessed and classified by the staff.

The report provides the percentage of patient hours that are patient hours with a default classification.

Report data is displayed as average data by day, by shift for a specific shift, and by shift for all shifts.

Select one of these to have start of day time the same for all units, or to have each unit the start of day time defined in system parameters

Select one of these to generate report by Day (24 hours), for all shifts or for a selected shift.



CalculationsTotal Actual Census – Total number of patients on unit during the report date range.

Total Hours – The total number of patient hours during date range.

# Default Patients – The number of patients with a default classification during report date range.

Number of Default Hours – The total hours of default patient classification time.

% Default Hours – (Number of patient default hours divide by total patient hours) x 100.



Default Classification Summary

The Default Classification Summary report is a multiple unit report that provides a summary of the number of patients that have been classified by a default classification during a specified timeframe. Unit specific and group total information for default classifications includes the number of patients with a default classification, the patient hours for these classifications, and the percentage of default patient hours. Total patient hours and actual census are shown.

Key Features

The report includes summarized data on the number of default classifications, default patient hours, and the percentage of default patient hours.


Select to generate report by Day (24 hours), for all shifts or for a selected shift

Select to display the start of day time the same for all units, or to have each unit use the start of day time defined in System Parameters



CalculationsDefault:

Patients – Number of patient default classifications by unit during report date range.

# Hours – Number of patient default classification hours by unit during report date. range.

% Hours – (Number of patient default classification hours divided by total patient hours) x 100.

Total:

# Hours – Sum of patient hours during report date range by unit.

Actual Census – Number of patients on unit during report date range by unit.

Totals line – Totals for each column for all units in report.



Do Not Classify Detail

The Do Not Classify Detail report is a unit specific report that provides a detailed record of patients who have been classified with the Do Not Classify feature. The report includes the patient name, location, account number, start date and time, end date and time, and hours of do not classify time. The Do Not Classify feature is appropriate to use for patients who have arrived on the unit/clinic via the HL7 interface, but are not physically present. For example, you could use the Do Not Classify option for a patient who is going directly to surgery from the ED and has been admitted to the unit at the time of departure from the ED. Thus the patient has an arrival time earlier than the time the patient actually arrives on the unit.

Key Features

Provides an accurate unit specific patient LOS.

Display of patients and time associated with the Do Not Classify feature.

Percentage of do not classify hours.


Select one of these to have the start of day time the same for all units, or to have each unit use the start of day time defined in System Parameters

Generate report by Day (24 hours), for all shifts or for a selected shift.

Select to include discharged/transferred patients only in the report



CalculationsTotal Actual Census – Number of patients on unit divided by days of data in report date range

Total Hours – Sum of patient length of stay in hours divided by days of data in the report date range.

# Default Patients – The number of patients with a default classification divided by days of data in the report date range.

Number of Default Hours – The total hours of default patient classification time divided by days of data in the report date range.

% Default Hours – (Number of patient default hours divide by total patient hours) x 100.

Location Patient Name Ending Date/TimeStart Date/TimeAccount Number Hours

Delayed , Arrival01 6/27/2006 9:00:00 AMdnc1 6/27/2006 11:00:00 AM 2.0Patient in, Surgery02 6/27/2006 11:00:00 AMdnc2 6/27/2006 3:00:00 PM 4.0

Do Not Classify Detail


Med Surg (QuadraMed Medical Center)Unit:

10

6.0

2# Do Not Classify Patients:

Total Actual Census:

# Do Not Classify Hours:

% Do Not Classify Hours:

Total Hours: 234.0

3%



Executive Patient Care Summary

The Executive Patient Care Summary report displays census, acuity, complexity, workload, staffing, productivity, percent RN, and system control data. Data is average daily data presented by month, with period-to-date and year-to-date summaries. The report can be generated by unit or summarized for a group of units. This report is designed to facilitate analysis of data over time, facilitating analysis of meeting productivity goals, system changes, and seasonal changes.

Key Features

Ability to generate report by unit or summarized for a group of units.

Provides monthly productivity and system control data for analysis.

Staffing displayed in either hours or staff.



CalculationsWorkload Measurement:

MN Census – Sum of midnight census for each month divided by valid days of data in specific month

LOS Adjusted Census – Sum of LOS adjusted census for each month divided by valid days of data in specific month. (LOS adjusted census = sum of patient hours divided by 24)

Workload Index – Sum of workload index per month divided by valid days of data in specific month

Acuity – Sum of workload index for each month divided by Sum of LOS adjusted census for specific month (valid days only)

Complexity – (Sum of individual complexity type x (LOS/24)) divided by LOS adjusted census

Direct Staffing Data:

Budget Staffing – ((Budget hours per patient day for direct staff as defined in system parameters times (sum of midnight census for each month)) divided by shift length) divided by valid days of data in specific month

Recommended Staffing – ((Target hours per workload index times (sum of classification workload for each month)) divided by equivalent hours for reports as defined in system parameters) divided by days of valid data in specific month.

Actual Staffing – Sum of direct actual staffing for each month divided by valid days of data for each specific month.

R-A variance – (Sum of recommended direct staff minus sum of actual direct staff for valid days each month) divided by valid days of data for each specific month.

Productivity:

RHPWI – Recommended hours per workload index – Sum of recommended staff in hours for valid days each month divided by sum of workload index for valid days for each specific month

AHPWI – Actual hours per workload index – Sum of actual staff in hours for valid days each month divided by sum of workload index for valid days for each specific month

RHPPD – Recommended hours per patient day – Sum of recommended staff in hours for valid days each month divided by sum of midnight census for valid days for each specific month



AHPPD – Actual hours per patient day: Sum of actual staff in hours for valid days each month divided by sum of midnight census for valid days for each specific month

Skill Mix – (Sum of actual RN staff for valid days each month divided by sum of actual direct staff for valid days in each specific month) times 100

System Control:

Census:

Actual/Class Census % Variance – ((Sum of actual census for all days each month minus sum of unique classified census for all days each month) divided by sum of actual census) x 100

Acuity:

Monitored Volume – Sum of monitored classifications each month

% Reliability Patient Type – (Sum of number of patient classifications monitored with agreement by patient type divided by sum of number of patient classifications monitored) x 100

% Reliability Complexity – (Sum of number of patient classifications monitored with agreement by complexity type divided by sum of number of patient classifications monitored) x 100

% Reliability Indicators – (Sum of (Number of correct indicators selected by indicator group per monitored classification divided by 16 (number of indicator groups for Inpatient methodology)) divided by number of classifications monitored) x 100



86.03 84.97 85.65 93.19 92.96 95.13 90.43 91.71 91.93 77.97 87.52 92.80 89.15 90.3685.39 83.27 84.59 91.82 91.77 93.87 89.48 90.49 90.94 77.31 86.41 91.98 88.07 89.30

128.67 124.56 125.73 139.98 139.86 142.68 136.78 139.04 138.90 118.05 131.39 140.01 133.74 136.241.51 1.50 1.49 1.52 1.52 1.52 1.53 1.54 1.53 1.53 1.52 1.52 1.52 1.532.91 2.90 2.89 2.98 3.00 2.95 3.00 3.02 2.99 3.00 3.01 2.95 2.97 2.99

60.05 59.22 59.72 65.08 64.99 66.48 63.17 64.06 64.25 54.48 61.14 64.85 62.26 63.1457.69 55.81 56.29 62.69 62.71 63.95 61.27 62.29 67.91 53.19 60.38 62.94 60.56 61.8964.91 64.44 63.96 67.82 67.20 67.33 65.42 66.42 65.85 58.31 62.30 64.94 64.89 65.04-7.22 -8.63 -7.67 -5.13 -4.49 -3.38 -4.16 -4.13 2.06 -5.11 -1.91 -2.00 -4.32 -3.14

5.38 5.38 5.37 5.37 5.38 5.38 5.38 5.38 5.87 5.41 5.52 5.39 5.43 5.456.05 6.21 6.10 5.81 5.77 5.66 5.74 5.73 5.69 5.93 5.69 5.57 5.82 5.738.05 7.88 7.89 8.07 8.09 8.07 8.13 8.15 8.86 8.19 8.28 8.14 8.15 8.229.05 9.10 8.96 8.73 8.67 8.49 8.68 8.69 8.60 8.97 8.54 8.40 8.73 8.64

79.2% 79.5% 80.3% 79.6% 80.0% 79.5% 79.7% 78.6% 78.7% 79.0% 80.2% 81.3% 79.6% 79.6%

0.2% 0.3% 1.2% 0.3% 0.2% 0.2% 0.2% 0.2% 0.3% 0.6% 0.2% 0.4% 0.4% 0.3%

11 11 18 13 12 12 13 13 13 24 23 19 182 142100.0% 90.9% 88.9% 100.0% 100.0% 100.0% 100.0% 92.3% 92.3% 83.3% 100.0% 94.7% 94.5% 95.1%100.0% 81.8% 88.9% 100.0% 100.0% 100.0% 100.0% 92.3% 92.3% 75.0% 100.0% 94.7% 92.9% 93.7%100.0% 97.7% 97.2% 100.0% 100.0% 100.0% 100.0% 96.6% 98.1% 96.4% 99.2% 99.0% 98.5% 98.6%

MN CensusLOS Adj CensusWorkload IndexAcuityComplexity

Budgeted StaffRecommended StaffActual StaffR-A Variance

RHPWIAHPWIRHPPDAHPPD

Actual %RN

CensusAct/Class Census %VarAcuityMonitored Volume%Reliability Pt Type%Reliability Complex%Reliability Indicators

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD FYWORKLOAD MEASUREMENT

DIRECT STAFFING DATA

PRODUCTIVITY

SKILL MIX

SYSTEM CONTROLS

Executive Patient Care Summary - In Staff

Date: 10/1/2004 to 9/30/2005

QuadraMed Medical CenterQM MS Untis (I)



28.48 27.83 26.32 30.55 30.89 31.10 27.30 28.23 29.77 26.81 28.19 30.33 28.80 29.2227.68 26.99 25.87 29.61 30.24 30.36 26.67 27.62 29.27 26.48 27.66 29.75 28.17 28.6143.87 43.21 40.56 46.11 47.37 47.69 43.13 43.91 45.81 41.97 44.10 46.37 44.48 45.141.58 1.60 1.57 1.56 1.57 1.57 1.62 1.59 1.57 1.59 1.59 1.56 1.58 1.582.79 2.86 2.75 2.77 2.79 2.79 2.86 2.83 2.72 2.76 2.78 2.62 2.77 2.77

20.89 20.41 19.30 22.40 22.65 22.80 20.02 20.70 21.83 19.66 20.68 22.24 21.12 21.4319.82 19.52 18.32 20.83 21.40 21.54 19.48 19.83 26.31 19.23 21.47 21.20 20.73 21.2421.72 21.51 19.86 22.12 22.67 23.02 20.72 21.43 21.54 20.09 21.04 21.16 21.40 21.53-1.91 -2.00 -1.54 -1.30 -1.28 -1.48 -1.24 -1.60 4.76 -0.85 0.43 0.04 -0.67 -0.28

5.42 5.42 5.42 5.42 5.42 5.42 5.42 5.42 6.89 5.50 5.84 5.49 5.59 5.655.94 5.98 5.88 5.76 5.74 5.79 5.76 5.86 5.64 5.74 5.72 5.48 5.77 5.728.35 8.41 8.35 8.18 8.31 8.31 8.56 8.43 10.60 8.61 9.14 8.39 8.64 8.729.15 9.28 9.06 8.69 8.81 8.88 9.11 9.11 8.69 8.99 8.95 8.37 8.92 8.84

77.5% 79.3% 78.8% 77.7% 77.4% 76.2% 74.9% 73.6% 74.7% 73.3% 75.9% 77.6% 76.4% 75.7%

0.2% 0.0% 2.7% 0.1% 0.1% 0.1% 0.0% 0.1% 0.0% 0.2% 0.0% 0.4% 0.3% 0.1%

3 3 10 5 5 4 5 5 5 11 11 6 73 57100.0% 66.7% 80.0% 100.0% 100.0% 100.0% 100.0% 80.0% 80.0% 90.9% 100.0% 83.3% 90.4% 93.0%100.0% 33.3% 80.0% 100.0% 100.0% 100.0% 100.0% 80.0% 80.0% 90.9% 100.0% 83.3% 89.0% 93.0%100.0% 91.7% 95.0% 100.0% 100.0% 100.0% 100.0% 93.8% 95.0% 98.9% 100.0% 97.9% 97.9% 98.6%

Unit: Med Surg

MN CensusLOS Adj CensusWorkload IndexAcuityComplexity



Actual %RN

CensusAct/Class Census %VarAcuityMonitored Volume%Reliability Pt Type%Reliability Complex%Reliability Indicators

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD FYWORKLOAD MEASUREMENT


PRODUCTIVITY

SKILL MIX

SYSTEM CONTROLS

Executive Patient Care Summary - In Staff

Date: 10/1/2004 to 9/30/2005

QuadraMed Medical CenterMed Surg (QMC) (S)



Hospital SummaryThe Hospital Summary report summarizes workload, productivity, and recommended and actual staffing for each unit, and provides a hospital average for each statistic. Management may use this report in the decision-making process. The report can display the HPPD for budgeted, recommended, and actual staffing data, calculated using either the Length of Stay (LOS) adjusted census or the midnight census. The days of data in the date range selected is displayed in the report header, units with less days of data have an asterisk by the unit name. Data is displayed in averages and totals, with staffing data in hours or by numbers of staff.

Key Features


User-defined date ranges for summarizing data are available.

Census, workload, acuity, and complexity information is available for comparison and benchmarking.

Recommended and actual staff (direct, non-direct, and total) are reported.

Recommended HPWI is reported. Recommended HPWI incorporates minimum staffing when applicable.

HPPD statistics are reported.

Group and hospital summary information is provided at bottom of report.

Complexity of Care score is displayed by unit (where applicable) and as a total for all units.

Hospital Summary Report Calculations

Classification Census – Total number of patients classified / days of valid data.

LOS Adjusted Census – [Sum of (Total length of stay for all patients in a 24 hour period / 24 hours)] / days of valid data.

Midnight Census – Total number of patients at midnight / days of valid data.

WI – Total workload index / days of valid data.

Acuity – (Total workload / total LOS adjusted census).

Complexity – (Sum of individual complexity type x (LOS/24)) / LOS adjusted census.

Each line represents one unit within the hospital average.



Recommended Staff:

Direct – Total number of recommended direct care staff / days of valid data.

Non-Direct – Total number of recommended non-direct care staff / days of valid data.

Total – Total number of direct + non-direct care staff / days of valid data.

Actual Staff:

Direct – Total number of actual direct care staff / days of valid data.

Non-Direct – Total number of actual non-direct care staff / days of valid data.

Total – Total number of direct + non-direct care staff / days of valid data.

Direct Care Staff:

Recommended HPWI – Total recommended staff in hours / total workload index.

Actual HPWI – Total actual direct staff / total classification workload index.

Actual HPPD – Total actual direct staff / total midnight census or LOS adjusted census.

Rec. HPPD – Total recommended direct staff hours / total midnight census or LOS adjusted census.

Bud HPPD – Identified per unit in System Parameters (for direct care givers only).

Total Staff:

Actual HPWI – (Total actual direct + non-direct staff) / total workload index.

Actual HPPD – (Total actual direct + non-direct staff) / total midnight census or LOS adjusted census.

Bud HPPD – Identified per unit in System Parameters.




Hospital Summary - Averages In Staff

Date: 7/1/05 to 9/30/05 (92valid days)QuadraMed Medical Center

Direct Total

LOS Rec Staffing Act Staffing Rec Actual Rec Actual Budget Actual Rec Actual Budget

Unit Cl Cen Adj Cn MN Cn WI Acuity Cmplx Dir N-Dir Total Dir N-Dir Total HPWI HPWI HPPD HPPD HPPD HPWI HPPD HPPD HPPD

Med Surg 38.00 27.97 28.42 44.18 1.58 2.72 19.95 2.41 22.36 20.76 2.59 23.34 5.42 5.64 8.42 8.76 8.80 6.34 9.44 9.86 9.84

MH 7.29 6.07 5.98 10.55 1.74 -- 4.80 1.33 6.13 6.57 2.78 9.35 5.46 7.47 9.64 13.19 8.60 10.64 12.31 18.77 11.84

Ortho 31.22 22.51 22.97 34.16 1.52 3.04 15.32 2.58 17.89 15.63 2.68 18.31 5.38 5.49 8.00 8.17 8.60 6.43 9.35 9.57 9.89

Med 35.24 26.89 27.07 41.69 1.55 3.43 17.89 3.00 20.89 18.86 3.00 21.86 5.15 5.43 7.93 8.36 8.00 6.29 9.26 9.69 8.98

Surg 23.46 17.37 17.55 24.46 1.41 2.77 11.19 2.33 13.52 11.73 2.03 13.77 5.49 5.76 7.65 8.02 8.20 6.75 9.24 9.41 9.38

MSICU 7.01 5.10 5.07 14.61 2.87 4.94 7.18 1.50 8.68 14.18 1.91 16.08 5.90 11.64 17.02 33.59 16.00 13.21 20.57 38.10 18.02

* CVICU 3.48 2.53 2.60 6.97 2.76 4.82 3.46 1.85 5.31 10.95 1.59 12.53 5.96 18.86 15.95 50.49 18.00 21.59 24.48 57.80 21.62

Med SD 37.89 27.08 26.79 48.59 1.79 4.30 22.60 9.53 32.13 28.20 9.37 37.57 5.58 6.96 10.12 12.63 10.30 9.28 14.39 16.83 13.82

Neuro 31.36 24.65 25.21 39.49 1.60 3.15 17.57 3.20 20.77 20.66 5.78 26.44 5.34 6.28 8.37 9.84 8.40 8.04 9.89 12.59 10.09

NICU 39.17 37.42 37.35 70.28 1.88 3.94 32.80 5.28 38.08 32.90 4.61 37.50 5.60 5.62 10.54 10.57 10.20 6.40 12.23 12.05 11.98

Onc 20.71 17.42 17.39 27.10 1.56 3.55 11.72 2.32 14.05 13.70 1.86 15.56 5.19 6.06 8.09 9.45 7.85 6.89 9.69 10.73 9.44

Peds 10.77 7.00 7.09 10.40 1.49 3.35 5.15 2.14 7.29 5.95 1.93 7.88 5.94 6.86 8.71 10.07 9.22 9.09 12.35 13.34 12.11

* PICU 3.51 2.53 2.45 5.41 2.14 4.30 4.14 1.67 5.80 5.27 0.89 6.16 9.18 11.70 20.26 25.84 21.65 13.67 28.43 30.18 27.56

GroupSummary 288.84 224.34 225.74 377.42 1.68 3.48 173.48 39.01 212.49 204.70 40.92 245.62 5.52 6.51 9.22 10.88 9.33 7.81 11.30 13.06 11.15


Notes: Staff reported in 12 hour equivalents, HPPD in Mn Census


Data crosses more than 1 effective date range



Hospital Summary in DollarsThe Hospital Summary in Dollars report summarizes workload, productivity, and recommended and actual staffing for each unit in both numbers and dollars. Dollar calculations are based on the average salary by job title entered into the AcuityPlus software. A hospital average for each statistic is provided. Management may use this report in the decision-making process. The report can display the HPPD for budgeted, recommended, and actual staffing data, calculated using either the Length of Stay (LOS) adjusted census or the midnight census. Data is displayed in averages and totals, with staffing data in hours or numbers of staff. The Missing Staffing Parameters tab of the report displays the job skills without salary information to facilitate evaluation of the data.

The days of data for each unit is displayed in the first column.

Key Features

User-defined date ranges for summarizing data are available.

Census, workload, acuity, and complexity information is available for comparison and benchmarking.

Recommended and actual staff (direct, non-direct, and total) are reported.

Recommended $PWI is reported. Recommended $PWI incorporates minimum staffing when applicable.

$PPD statistics are reported.

Productivity percentage is based on recommended dollars divided by actual dollars.

Group and hospital summary information is provided.



Date: 7/1/05 to 9/30/05 (092 days)

Hospital Summary in Dollars - Averages In Staff



Days LOS Rec Staffing Act Staffing

Unit of Data Cl Cen Adj Cn MN Cn WI Acuity Cmplx Dir N-Dir Total Dir N-Dir Total

Med Surg 92 38.00 27.97 28.42 44.18 1.58 2.72 19.95 2.41 22.36 20.76 2.59 23.34

MH 92 7.29 6.07 5.98 10.55 1.74 -- 4.80 1.33 6.13 6.57 2.78 9.35

Ortho 92 31.22 22.51 22.96 34.16 1.52 3.04 15.32 2.58 17.89 15.63 2.68 18.31

Med 92 35.24 26.89 27.07 41.69 1.55 3.43 17.89 3.00 20.89 18.86 3.00 21.86

Surg 92 23.46 17.37 17.55 24.46 1.41 2.77 11.19 2.33 13.52 11.73 2.03 13.77

MSICU 92 7.01 5.10 5.07 14.61 2.87 4.94 7.18 1.50 8.68 14.18 1.91 16.08

CVICU * 88 3.48 2.53 2.60 6.97 2.76 4.82 3.46 1.85 5.31 10.95 1.59 12.53

Med SD 92 37.89 27.08 26.79 48.59 1.79 4.30 22.60 9.53 32.13 28.20 9.37 37.57

Neuro 92 31.36 24.65 25.21 39.49 1.60 3.15 17.57 3.20 20.77 20.66 5.78 26.44

NICU 92 39.17 37.42 37.35 70.28 1.88 3.94 32.80 5.28 38.08 32.90 4.61 37.50

Onc 92 20.71 17.42 17.39 27.10 1.56 3.55 11.72 2.32 14.05 13.70 1.86 15.56

Peds 92 10.77 7.00 7.09 10.40 1.49 3.35 5.15 2.14 7.29 5.95 1.93 7.88

PICU * 89 3.51 2.53 2.45 5.41 2.14 4.30 4.14 1.67 5.80 5.27 0.89 6.16

Group Summary 92 288.84 224.34 225.73 377.42 1.68 3.48 173.48 39.01 212.49 204.70 40.92 245.62






Date: 7/1/05 to 9/30/05 (092 days)



Direct Non Direct

Rec Actual Rec Actual % Rec Actual Rec Actual %

Unit $PWI $PWI $PPD $PPD Prod $PWI $PWI $PPD $PPD Prod

Med Surg $161.50 $167.92 $251.02 $261.01 96 % $10.30 $10.06 $16.02 $15.63 102 %

MH $131.82 $191.51 $232.66 $338.02 69 % $16.68 $59.24 $29.44 $104.56 28 %

Ortho $121.56 $125.52 $180.90 $186.80 97 % $14.20 $13.71 $21.14 $20.40 104 %

Med $143.71 $146.69 $221.34 $225.94 98 % $14.39 $12.62 $22.17 $19.43 114 %

Surg $129.07 $140.10 $179.85 $195.23 92 % $11.86 $10.28 $16.52 $14.32 115 %

MSICU $188.65 $378.05 $544.19 $1,090.54 50 % $12.94 $16.35 $37.31 $47.16 79 %

CVICU $193.24 $595.40 $517.24 $1,593.69 32 % $58.78 $56.88 $157.34 $152.24 103 %

Med SD $175.98 $220.52 $319.16 $399.95 80 % $30.50 $28.11 $55.31 $50.99 108 %

Neuro $164.44 $199.22 $257.63 $312.11 83 % $18.44 $27.17 $28.88 $42.57 68 %

NICU $190.90 $191.20 $359.21 $359.79 100 % $11.85 $10.51 $22.30 $19.78 113 %

Onc $163.76 $195.23 $255.23 $304.27 84 % $17.19 $9.15 $26.80 $14.26 188 %

Peds $181.82 $211.16 $266.84 $309.90 86 % $42.25 $42.84 $62.01 $62.88 99 %

PICU $315.37 $386.41 $696.39 $853.25 82 % $83.57 $47.17 $184.53 $104.17 177 %

Group Summary $165.10 $196.84 $276.05 $329.12 84 % $18.48 $18.68 $30.89 $31.24 99 %

Run Date:






Date: 7/1/05 to 9/30/05 (092 days)



Total

Rec Actual Rec Actual %

Unit $PWI $PWI $PPD $PPD Prod

Med Surg $171.80 $177.98 $267.03 $276.64 97 %

MH $148.50 $250.75 $262.10 $442.58 59 %

Ortho $135.77 $139.23 $202.04 $207.19 98 %

Med $158.10 $159.31 $243.51 $245.37 99 %

Surg $140.93 $150.38 $196.37 $209.55 94 %

MSICU $201.59 $394.40 $581.51 $1,137.70 51 %

CVICU $252.02 $652.28 $674.58 $1,745.93 39 %

Med SD $206.48 $248.64 $374.48 $450.93 83 %

Neuro $182.88 $226.39 $286.51 $354.68 81 %

NICU $202.75 $201.72 $381.51 $379.57 101 %

Onc $180.96 $204.38 $282.03 $318.53 89 %

Peds $224.07 $254.00 $328.85 $372.78 88 %

PICU $398.94 $433.59 $880.92 $957.42 92 %

Group Summary $183.58 $215.52 $306.94 $360.36 85 %






Indicator Detail by PatientThe Indicator Detail by Patient report displays the patient name, location, indicators selected, total points, and patient type for all patients classified for a selected date. This is a unit specific report.

Key Features


Displays the indicators selected for each patient on the unit.

Displays the total points and patient type for each patient.

Ability to print the report in landscape or portrait format.



Indicator Detail by Patient

Unit: Med Surg

Patient Name

Location

Classification Time

2 ADL - Partial Care

3 ADL - Complete

4 ADL - Rehabilitative

5 ADL 2 or more

6 Communication Support

7 Cognitive Support

8 Close Observation for Patient Safety

11 Fluid Management

14 Medication Management

15 Medication Management - Complex

17 Pulmonary Management

18 Pulmonary Management - Complex

20 Cardiovascular/Neurological Management

21 Cardiovascular/Neurological Mgmt. - Complex

23 Preventive Skin Care

24 Wound/Injury Management

25 Wound/Injury Management - Complex

27 Information/Instructional Needs

28 Educational Needs - Life Style Change

Points

Patient Type

Complexity Type

Smith,Hattie

453 A

8:04:16 AM

Jones,Leatha

454 A

1:49:56 PM

Jones,William

455 A

4:45:31 PM

Smith,Wayne

455 A

1:50:13 PM

Jones,Grace

456 A

4:45:51 PM

Smith,Teresa

456 A

1:50:27 PM

X XX

X X XX X X

XXX

X X X X XX X X

X X XX X X X

XX X X X

XX X X X X XX X X X X X

X X X X X XX X75

4

5

52

3

3

51

3

3

40

2

1

66

4

3

46

3

3



Indicator SpecificThe Indicator Specific report searches the database and identifies patients for which a specific indicator has been selected. If during the classification process, a patient is classified on another unit, the indicators marked for the redirected workload appear on the report for the unit to which the workload was assigned.

The report displays the data in three formats:

The first option (selecting both Display Date Classified and Display Who Classified) displays the patient name, account number, Medical Record Number (MRN), location, classification date, and name of classifying nurse for each classification with the specific indicator selected.

The second option (selecting Display Date Classified) displays the same data as the first tab without the name of the classifying nurse.

The third option is to not select either option (Display Date Classified or Display Who Classified). The report displays the patient name, account number, and the Medical Record Number.

A notes column appears on each of the three report options. This report could be used for monitoring, research purposes, infection control, risk management, or quality improvement.

Key Features

Report can be generated for multiple unit groups, but unit groups must all use the same methodology.

Displays the name, location, account number, and MRN of patients with the defined indicator selected.

Option to print report with the name of the classifying nurse.

Option to print report with the data displaying one time over the date range versus for each classification.

Displays QUADRAMED defined and/or user defined indicators.

Space provided for note-taking.



Indicator Specific


Date: 9/15/05 to 9/15/05

Unit: Med Surg

Name Acct Number MRN Location Class Date Notes

Jones, Andrea 22425626545422 12345-6789 461 A 9/15/2005

Jones, Brenda 38815210340038 12345-6789 448 A 9/15/2005

Jones, Frances 07225387892307 12345-6789 455 A 9/15/2005

Jones, James 24425093177024 12345-6789 454 A 9/15/2005

Jones, Karen 01225659547401 12345-6789 445 A 9/15/2005

Jones, Kay 25325583235325 12345-6789 456 A 9/15/2005

Jones, Paul 21525713969021 12345-6789 470 A 9/15/2005

Smith, Carolyn 06325320419506 12345-6789 449 A 9/15/2005

Smith, Faye 27225220560327 12345-6789 446 A 9/15/2005

Smith, Jane 36525380304036 12345-6789 458 A 9/15/2005

Smith, Kathy 28225724411028 12345-6789 476 A 9/15/2005

Smith, Mark 29425893242429 12345-6789 447 A 9/15/2005

Smith, Minnie 01525409940401 12345-6789 450 A 9/15/2005

Smith, Stephen 21525986587021 12345-6789 443 A 9/15/2005

Smith, Theodore 05525670120505 12345-6789 463 A 9/15/2005

ADL 2 or moreIndicator Selected: 5



Indicator UsageThe Indicator Usage report provides data on the selection of indicators by unit and summarized data for all units selected. Data is displayed by number or percentage. The report displays data by number of times the indicator was selected or in percentage of use by patient type, the total number of times the indicator was selected, and overall percentage of indicator use for the defined date range. Be sure to select units of the same methodology when running this report.

Key Features


The report displays the percentage of use of each indicator by patient type and overall.

The report displays the number of times each indicator was selected.

Summary data for all units in selected group is available by percentage and number of indicators selected.

Do Not Classify (DNC) records are excluded from this report.



Indicator Usage Percents

Date: 9/1/05 To 9/30/05


Unit: Med SurgPercentage by Patient Type

Indicators I II III IV V

Total

N %ADL - Self/Minimal Care 100% 7% 1% 26 2%

ADL - Partial Care 26% 16% 4% 196 16%

ADL - Complete 2% 9% 100% 39 3%

ADL - Rehabilitative 65% 82% 87% 996 79%

ADL 2 or more 18% 46% 81% 100% 593 47%

Communication Support 3% 7% 10% 100% 87 7%

Cognitive Support 50% 3% 10% 12% 100% 115 9%

Close Observation for Patient Safety 2% 4% 23 2%

Close Observation for Patient Safety: 1 to 1

Isolation Precautions (Transmission-Based) 3% 2% 2% 29 2%

Fluid Management 24% 87% 86% 915 73%

Fluid Management - Intermediate 1% 14% 100% 41 3%

Fluid Management - Complex 0% 1 0%

Medication Management 85% 87% 59% 1016 81%

Medication Management - Complex 3% 11% 40% 100% 192 15%

Medication Mgmt. - Continuous Assessment

Pulmonary Management 39% 85% 17% 769 61%

Pulmonary Management - Complex 5% 83% 100% 248 20%

Pulmonary Management - Intensive

Cardiovascular/Neurological Management 36% 78% 16% 708 56%

Cardiovascular/Neurological Mgmt. - Complex 5% 84% 100% 255 20%

Cardiovascular/Neurological Mgmt. - Intensive

Preventive Skin Care 87% 94% 93% 100% 1167 92%

Wound/Injury Management 50% 93% 96% 95% 100% 1203 95%

Wound/Injury Management - Complex 1% 5% 22 2%

Wound/Injury Mgmt. - Extensive and Complex

Information/Instructional Needs 50% 90% 92% 97% 100% 1169 93%

Educational Needs - Life Style Change 11% 26% 21% 274 22%

Coping Support 2% 6% 6% 63 5%

Extensive Coordination

Restraints 1% 1% 6 0%

Total Classifications 2 275 726 258 1 1262

WinPFS Report Version 6.0. Page 1 of 12 Run Date: 12/13/2005 01:31:14 PM



Indicator Usage

Date: 9/1/05 To 9/30/05


Unit: Med SurgPercentage by Patient Type

Indicators I II III IV V

Total

NADL - Self/Minimal Care 2 19 5 26

ADL - Partial Care 72 114 10 196

ADL - Complete 14 24 1 39

ADL - Rehabilitative 180 592 224 996

ADL 2 or more 49 333 210 1 593

Communication Support 7 52 27 1 87

Cognitive Support 1 7 76 30 1 115

Close Observation for Patient Safety 13 10 23

Close Observation for Patient Safety: 1 to 1

Isolation Precautions (Transmission-Based) 8 15 6 29

Fluid Management 65 629 221 915

Fluid Management - Intermediate 5 35 1 41

Fluid Management - Complex 1 1

Medication Management 233 630 153 1016

Medication Management - Complex 7 80 104 1 192

Medication Mgmt. - Continuous Assessment

Pulmonary Management 108 617 44 769

Pulmonary Management - Complex 33 214 1 248

Pulmonary Management - Intensive

Cardiovascular/Neurological Management 99 568 41 708

Cardiovascular/Neurological Mgmt. - Complex 38 216 1 255

Cardiovascular/Neurological Mgmt. - Intensive

Preventive Skin Care 240 686 240 1 1167

Wound/Injury Management 1 257 700 244 1 1203

Wound/Injury Management - Complex 8 14 22

Wound/Injury Mgmt. - Extensive and Complex

Information/Instructional Needs 1 247 670 250 1 1169

Educational Needs - Life Style Change 29 191 54 274

Coping Support 5 43 15 63

Extensive Coordination

Restraints 4 2 6

Total Classifications 2 275 726 258 1 1262




Inpatient Activity AnalysisThe Inpatient Activity Analysis report is designed to provide you with the ability to evaluate various target hours per workload index and compare the target to the current recommended and actual hours per workload index. The report displays census, volume, workload, acuity, recommended staffing, actual staffing and the projected, recommended, and actual hours per workload index. The classification volume is the number of unique patients classified on an average daily basis, and the procedure and ADT volumes are the number of each event on an average daily basis.

Key Features

Ability to evaluate the impact of procedure, ADT, and other workload on recommended staffing and the target hour per workload index.

Ability to evaluate various target hours per workload index.

Report can be generated for a single unit or multiple unit groups.


Data can be displayed in staff or in hours.

Report can be run for Recommended Staffing or Alternate Staffing.

Data can be for all days or by day of week.

Budget staffing can be in Midnight census, LOS Adjusted census, or Class census.



Days ofUnit Data Actual Class LOS Adj MN Budget ADT 1 Hr+ Other Target Class Overall Class OverallOnc 7 32.10 22.48 19.80 19.91 20.00 12.30 2.57 0.57 1.40 1.40 1.42 27.72 28.11Neuro 7 28.40 21.90 21.70 21.90 23.00 6.70 0.00 0.00 1.60 1.59 1.59 34.50 34.57Med/Surg 7 34.10 25.95 24.30 24.45 25.00 9.80 1.50 0.00 1.40 1.42 1.43 34.51 34.73Ortho 7 25.10 24.01 21.90 22.01 22.00 3.20 2.00 0.00 1.50 1.53 1.54 33.51 33.72ICU 7 12.00 19.80 9.70 9.80 10.00 2.30 10.00 0.00 2.90 2.84 2.88 27.55 27.93Averages -- 131.70 114.14 97.40 98.07 100.00 34.30 16.07 0.57 1.60 1.61 1.62 157.78 159.06

Inpatient Activity Analysis - Averages In StaffAll Activity

QuadraMed Medical CenterDate: 3/1 to 3/ 7

All DaysCensus Volume Acuity WI

Staffing data is reported in 8 hour equivalents. AcuityPlus Page: 1 Run Date: 3/9



Days of Actual DirUnit Data Target Class Overall Class Proc ADT Other Total Staffing Projected Rec ActualMed/Surg 1 1.50 1.45 1.71 23.70 3.50 0.78 0.00 27.98 29.00 5.50 5.30 5.70Averages -- 1.50 1.45 1.71 23.70 3.50 0.78 0.00 27.98 29.00 5.50 5.30 5.70

Recommended staffing by Complexity of Care

All Days Report THPWI = 5.3Acuity Recommended Direct Staffing Hours per Workload Index

Target Analysis - Averages In StaffRecommended StaffingQuadraMed Medical Center

Date: 1/30/2008 to 1/30/08 12:00:00 AM



LOS and Average Daily Patient TurnoverThe LOS and Average Daily Patient Turnover report provides the average midnight census, inpatient and outpatient data for LOS, average LOS per unit, admissions and discharges; number of patient transfers on and off the unit, and the average daily percent turnover for each unit. This report provides data specific to each unit in relation to patient LOS and turnover statistics.

This report is only available with a manual or automatic ADT method for data input, and includes all data in the database.

Key Features

Data is unit specific.


Midnight Census includes all patients in a bed at midnight.

LOS and turnover data includes all patients (inpatient or outpatient status) on the unit.



LOS and Average Daily Patient Turnover

Date: 7/1/05 7a To 10/1/05 7a


Unit MnCensus LOS Days Admissions Transfers

In

TotalPatients

InDischarges Transfers

Out

TotalPatients

Out

Avg Daily %Turnover

Inpatient Outpatient Total Inpatient Outpatient Inpatient Outpatient

Med Surg 28.42 3.50 0.98 3.06 6.70 1.50 0.74 8.93 7.26 1.42 0.03 8.72 31.05 %

Ortho 22.66 3.49 1.10 2.63 4.87 2.92 0.42 8.22 5.40 2.49 0.13 8.02 35.83 %

Med 27.07 3.80 1.28 3.48 2.67 0.63 4.26 7.57 6.14 0.83 0.49 7.46 27.75 %

Surg 17.55 4.20 0.89 3.03 1.88 1.66 1.98 5.52 3.46 1.78 0.22 5.46 31.27 %

CVICU 2.48 2.85 0.73 2.67 0.47 0.08 0.35 0.89 0.51 0.08 0.27 0.86 35.31 %

MSICU 5.07 2.94 0.24 2.89 0.76 0.01 1.10 1.87 0.55 0.02 1.04 1.62 34.44 %

Med SD 26.79 3.04 1.14 2.69 4.79 0.92 4.40 10.12 7.08 1.52 1.07 9.66 36.92 %

Neuro 25.21 4.49 0.87 4.02 3.01 0.51 2.64 6.16 4.99 0.64 0.14 5.77 23.67 %

NICU 37.35 17.57 17.57 0.51 0.00 1.18 1.70 1.54 0.00 0.05 1.60 4.41 %

Onc 17.37 5.38 0.90 4.94 2.67 0.34 0.37 3.38 2.96 0.35 0.04 3.35 19.37 %

Peds 7.09 3.04 0.97 2.03 1.10 1.33 1.10 3.52 1.78 1.63 0.12 3.53 49.77 %

PICU 2.37 3.46 0.41 2.20 0.36 0.41 0.35 1.12 0.22 0.39 0.49 1.10 46.79 %



Minimum Direct Staff AnalysisThe Minimum Direct Staff Analysis report is a unit specific report displaying recommended staffing without minimums, recommended staffing with minimums and actual staffing by day, by shift, and by job skill. A second report tab provides a 24-hour average of the data.

Key Features


Provides data by day to evaluate the impact of minimum staffing by job skill and by shift.

Provides average daily data to evaluate the impact of minimum staffing by job skill.



Minimum Direct Staff Analysis - Shift Totals

5NTH

7-3Shift:

Unit:

Facility 1Date: 7/1/05 to 7/14/05

Rec Staff w/Minimums 7/1/2005 7/2/2005 7/3/2005 7/4/2005 7/5/2005 7/6/2005 7/7/2005 7/8/2005 7/9/2005 7/10/2005 7/11/2005 7/12/2005 7/13/2005 7/14/2005 Avg

RN 2.94 2.86 3.35 3.34 3.40 3.38 3.51 3.11 3.32 3.36 2.71 2.30 3.05 2.73 3.10

NA 1.96 1.91 2.24 2.23 2.27 2.25 2.34 2.08 2.21 2.24 1.81 1.53 2.03 1.82 2.07

Total 4.90 4.77 5.59 5.57 5.67 5.63 5.85 5.19 5.54 5.60 4.52 3.83 5.08 4.55 5.16

Rec staff w/oMinimums 7/1/2005 7/2/2005 7/3/2005 7/4/2005 7/5/2005 7/6/2005 7/7/2005 7/8/2005 7/9/2005 7/10/2005 7/11/2005 7/12/2005 7/13/2005 7/14/2005 Avg

RN 2.94 2.86 3.35 3.34 3.40 3.38 3.51 3.11 3.32 3.36 2.71 2.30 3.05 2.73 3.10

NA 1.96 1.91 2.24 2.23 2.27 2.25 2.34 2.08 2.21 2.24 1.81 1.53 2.03 1.82 2.07

Total 4.90 4.77 5.59 5.57 5.67 5.63 5.85 5.19 5.54 5.60 4.52 3.83 5.08 4.55 5.16

Act Staff 7/1/2005 7/2/2005 7/3/2005 7/4/2005 7/5/2005 7/6/2005 7/7/2005 7/8/2005 7/9/2005 7/10/2005 7/11/2005 7/12/2005 7/13/2005 7/14/2005 Avg

RN 2.19 1.70 1.49 1.93 1.63 2.26 2.89 2.62 2.89 2.39 2.81 2.28 2.33 2.31 2.27

LPN 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

NA 1.69 1.72 1.89 0.67 1.65 1.33 1.29 1.56 1.21 1.36 1.38 1.37 0.93 2.01 1.43

Total 3.88 3.42 3.38 2.59 3.28 3.59 4.18 4.19 4.10 3.75 4.19 3.65 3.26 4.32 3.70



Minimum Direct Staff Analysis - 24 Hour Totals

5NTHUnit:

Facility 1

Date: 7/1/05 to 7/14/05

Rec Staff w/Minimums 7/1/2005 7/2/2005 7/3/2005 7/4/2005 7/5/2005 7/6/2005 7/7/2005 7/8/2005 7/9/2005 7/10/2005 7/11/2005 7/12/2005 7/13/2005 7/14/2005 Avg

RN 6.70 8.03 8.99 9.59 9.31 8.14 9.42 8.58 8.59 9.43 5.95 6.47 7.92 6.10 8.09

LPN 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

NA 4.40 4.97 5.57 5.92 5.78 5.10 5.88 5.32 5.35 5.84 4.12 4.18 4.94 4.28 5.12

Rec staff w/oMinimums 7/1/2005 7/2/2005 7/3/2005 7/4/2005 7/5/2005 7/6/2005 7/7/2005 7/8/2005 7/9/2005 7/10/2005 7/11/2005 7/12/2005 7/13/2005 7/14/2005 Avg

RN 6.70 8.03 8.99 9.59 9.31 8.14 9.42 8.58 8.59 9.43 5.95 6.47 7.92 6.10 8.09

LPN 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

NA 4.19 4.97 5.57 5.92 5.78 5.08 5.88 5.32 5.35 5.84 3.74 4.02 4.93 3.86 5.03

Act Staff 7/1/2005 7/2/2005 7/3/2005 7/4/2005 7/5/2005 7/6/2005 7/7/2005 7/8/2005 7/9/2005 7/10/2005 7/11/2005 7/12/2005 7/13/2005 7/14/2005 Avg

RN 5.91 5.42 5.65 5.77 5.05 6.27 6.18 6.28 5.94 5.47 6.52 6.08 6.48 6.57 5.97

LPN 0.68 0.65 0.00 0.69 0.67 0.00 0.34 0.67 0.63 0.61 0.33 0.35 0.33 0.33 0.45

NA 3.04 3.37 3.71 2.67 4.31 3.28 3.30 3.25 3.22 3.42 3.10 4.12 3.55 3.70 3.43

Days of Data: 14

THPWI

RHPWI

AHPWI

7/1/2005

4.65

4.74

4.11

7/2/2005

4.65

4.65

3.37

7/3/2005

4.65

4.65

2.99

7/4/2005

4.65

4.65

2.74

7/5/2005

4.65

4.65

3.09

7/6/2005

4.65

4.66

3.36

7/7/2005

4.65

4.65

2.98

7/8/2005

4.65

4.65

3.41

7/9/2005

4.65

4.65

3.26

7/10/2005

4.65

4.65

2.89

7/11/2005

4.65

4.83

4.77

7/12/2005

4.65

4.72

4.68

7/13/2005

4.65

4.66

3.75

7/14/2005

4.65

4.85

4.95



Monitoring DetailThe Monitoring Detail report is a unit specific report displaying the patient’s name and account number, the classifying nurse and indicators selected, and the monitoring nurse and indicators selected. The resulting patient type is displayed at the bottom of each column. The resulting patient type, complexity type (if applicable), and indicator group agreement percentage are shown. This report is designed for the monitoring nurse to share with the classifying nurse to review the appropriate application of indicators.

Key Features

Provides the name of the classifying nurse and name of the monitoring nurse.

Provides a comparison between the indicators selected by the classifying nurse and the indicators selected by the monitor.

Calculates the patient type and complexity type (if applicable) for each patient monitored.

Calculates the indicator group agreement percentage.

Provides space at the bottom of the report for staff and monitor signatures post review of classifications.

Reports can be generated by day, by shift for a specific shift and by shift for all shifts.



Patient Name / Account Number Fractured, Hip Neuro, Logical System, Integration24625065130324

10/1/20057:55:53 AM

10/1/200510:15:55 AM

10/1/200511:39:48 AM

10/1/20052:00:00 PM

10/1/20051:29:34 PM

Smith, Sandra Smith, Olaf Wood, HeatherWood, Heather

10/1/20053:00:00 PM

IndicatorJones, Laurie Wood, Heather

Classified Classified Monitored Classified MonitoredMonitored22725454192222 24725985281124

2. ADL - Partial Care XX X

3. ADL - Complete X X

4. ADL - Rehabilitative X

5. ADL 2 or more X XXX XX

6. Communication Support X X

7. Cognitive Support X X8. Close Observation for PatientSafety X X

11. Fluid Management X XXX XX

14. Medication Management X XXX XX

17. Pulmonary Management XX XX20. Cardiovascular / NeurologicalManagement XX XX

23. Preventive Skin Care X XXX XX

24. Wound / Injury Management X XXX XX

27. Information / Instructional Needs X XXX X28. Educational Needs - Life StyleChange X X

29. Coping Support X XX X

PointsPatient Type

Staff Signatures:

Monitor Signature:

49.03

73.043

49.0 69.03 3 4

53.0 51.0

Complexity Type 3 433 3 4Indicator Group Agreement, % 100% 94%94%

Percent Agreement by Patient Type (Unit Total): 100%

Monitoring Detail ReportMed Surg (QMC)

Date: 10/1/2005 to 10/1/2005



Monitoring SummaryThe Monitoring Summary report provides a summary of the recommended number of patients to be monitored, number of patients monitored, number of unique patients monitored, number of patients under-classified or over-classified, number of patients in agreement by type, and the percentage agreement by patient type, complexity type (if applicable) and indicator group agreement. The number of patients recommended to be monitored is 10% of the budgeted daily census bi-weekly. If the budgeted daily census is not entered in System Parameters in the AcuityPlus application, the number of patients to be monitored field is blank. All units in the selected unit group display on the report even if there is no monitoring data for each unit.

Key Features

Provides a summarized report displaying the number of patients classified by unit, and percentage of agreement by patient type, complexity type (if applicable), and indicator group agreement.

Provides a summary of patient type, complexity type (if applicable), and indicator group agreement for all units on the report.




5 94 26 1 0 5 83% 83% 98%Med Surg (QMC) 6 67 112 07 0 0 7 100% 100% 100%Ortho (QMC) 6 76 95 16 0 0 6 100% 100% 99%Onc (QMC) 6 60 0 00 0 0 0Surg (QMC) 6 0

Monitoring Summary Report


Unit # of UniquePatients

# ClassifiedHigher by

Staff

# ClassifiedLower by Staff

# inAgreement by

Type

% PatientType

Agreement

% ComplexityType

Agreement

% IndicatorGroup

Agreement

Rec # ofPatients to be

Monitored

#ofClassifications

Monitored

95% 99%0119 95%18Total 24 19

Note: The recommended # of patients to monitor is based on a standard two-week period.



Monitoring TrendThe Monitoring Trend report provides the percentage of agreement by patient type, complexity of care (if applicable), or indicator group for each period of monitoring. You identify a start date and select the period as weekly, bi-weekly, monthly, or quarterly. You also identify the type of report – agreement by patient type, agreement by complexity type, or agreement by indicator group agreement. The report can be used to evaluate the frequency of monitoring, the positive and/or negative changes in patient type agreement, and the effect of indicator education. It can also be used to assess the overall reliability of the reported acuity for the period trended.

When no data is available the report shows a blank field. Zero percent appears in a cell if there is data and the percent agreement is 0.

Key Features

Provides a trend analysis of the percent agreement by patient type, complexity type (if applicable), or indicator group.

Provides a summary analysis of the percent agreement by patient type, complexity type (if applicable), or indicator group for all units on the report.




Med Surg (QMC) 100% 50% 75% 100% 100% 100% 67% 75% 91% 100% 83%100% 90%Ortho (QMC) 100% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100%100% 97%Onc (QMC) 100% 100% 100% 100% 100% 100% 100% 100% 67% 100% 100%100% 97%Surg (QMC) 0%Total 100% 90% 92% 100% 100% 100% 91% 92% 83% 100% 95%100%

* Note: blanks cells have no data; if "0%" appears there is data but the number in agreement is 0.

95%

Monitoring Trend Report

Monthly (10/1/2004 - 9/1/2005)QuadraMed Medical Center

Unit 10/1/2004 11/1/2004 12/1/2004 1/1/2005 2/1/2005 3/1/2005 4/1/2005 5/1/2005 6/1/2005 7/1/2005 8/1/2005 9/1/2005

Percent Agreement by Patient Type

Total

Med Surg (QMC) 100% 50% 75% 100% 100% 100% 67% 75% 91% 100% 83%100% 90%Ortho (QMC) 100% 100% 100% 100% 100% 100% 100% 100% 70% 100% 100%100% 96%Onc (QMC) 100% 100% 100% 100% 100% 100% 100% 100% 33% 100% 100%100% 95%Surg (QMC) 0%Total 100% 90% 92% 100% 100% 100% 91% 92% 75% 100% 95%100%


93%



Unit 10/1/2004 11/1/2004 12/1/2004 1/1/2005 2/1/2005 3/1/2005 4/1/2005 5/1/2005 6/1/2005 7/1/2005 8/1/2005 9/1/2005

Percent Agreement by Complexity Type

Total



Med Surg (QMC) 100% 92% 95% 100% 100% 100% 94% 95% 99% 100% 98%100% 98%Ortho (QMC) 100% 100% 100% 100% 100% 100% 100% 100% 94% 98% 100%100% 99%Onc (QMC) 100% 100% 100% 100% 100% 100% 96% 100% 94% 100% 99%100% 99%Surg (QMC)Total 100% 98% 97% 100% 100% 100% 97% 98% 96% 99% 99%100%


99%



Unit 10/1/2004 11/1/2004 12/1/2004 1/1/2005 2/1/2005 3/1/2005 4/1/2005 5/1/2005 6/1/2005 7/1/2005 8/1/2005 9/1/2005

Percent Agreement by Indicator Group

Total



Multiple Classifications and Edit Classifications DetailThe Multiple Classifications and Edit Classifications Detail report is a unit specific report that displays detailed data on patients with more than one classification within a classification period (per 24 hours or per shift if using shift based classification) and/or if the classification has been edited. The data displayed includes the patient’s name, location, patient type, date and time of classification, classifying nurse, and editing nurse for the defined date range. A summary of the actual census, classification census, number and percentage of patients with multiple classifications, and the number and percentage of patients with edited classifications is provided.

Key Features

Provides detailed data on patients with multiple classifications.

Provides detailed data on patient classifications that have been edited.

Provides the names of the classifying and editing nurses.




Jones, Eileen465 A 9/28/2005 7:00 AM Sicnarfr, Ct 9/28/2005 3:27 PM2465 A 9/28/2005 3:27 PM Snikpoho, Gorge 9/29/2005 7:00 AM3465 A 9/29/2005 7:00 AM Ehtaba, Cynthia9/29/2005 8:47 AM3465 A 9/29/2005 8:47 AM Ehtaba, Cynthia9/30/2005 7:00 AM3

Jones, Joanne442 A 9/29/2005 3:50 PM Trawetst, Kristy9/29/2005 4:25 PM4442 A 9/29/2005 4:25 PM Trawetst, Kristy9/30/2005 7:00 AM4

Jones, Margaret448 A 9/28/2005 7:00 AM Maha, Luann9/28/2005 9:16 AM3448 A 9/28/2005 9:16 AM Maha, Luann9/29/2005 7:00 AM3

Jones, Marie471 A 9/29/2005 3:25 PM Trawetst, Kristy9/29/2005 4:25 PM4471 A 9/29/2005 4:25 PM Trawetst, Kristy9/30/2005 7:00 AM4

Jones, Myrtle440 A 9/28/2005 5:09 PM Notfilcl, Joy9/28/2005 10:01 PM3440 A 9/28/2005 10:01 PM Notfilcl, Joy9/29/2005 7:00 AM4

Jones, Vennie442 A 9/29/2005 7:00 AM Iksnyzrksk, MichaelEnroho, Leanne9/29/2005 12:00 PM3Septic, Shock459 A 9/29/2005 7:00 AM Tterahcsc, April9/29/2005 2:21 PM2

459 A 9/29/2005 2:21 PM Tterahcsc, April9/30/2005 7:00 AM3Smith, Mildred451 A 9/29/2005 7:00 AM Selimi, Joy9/29/2005 1:15 PM2

451 A 9/29/2005 1:15 PM Selimi, Joy9/29/2005 2:16 PM3

Multiple Classifications and Edit Classifications Detail


Location Patient Name Starting Date/Time Ending Date/Time Classifying Nurse Editing Nurse

Med Surg (QMC)Unit:

Type

63

7

11%

1

2%

64Actual Census:

Classification Census:

# of Patients with Multiple classifications:

% of Patients with Multiple classifications:

# of Patients with Edited classifications:

% of Patients with Edited classifications:



Multiple Classifications and Edit Classifications SummaryThe Multiple Classifications and Edit Classifications Summary report provides summarized data by unit and a total for all units selected. The data displayed includes the actual census, classification census, number and percentage of patients with multiple classifications, and the number and percentage of patients with edited classifications.

Key Features

Provides summarized data on the number and percentage of patients with multiple classifications.

Provides summarized data on the number and percentage of patient classifications that have been edited.


296 295 5 18%Med Surg (QMC) 54 2%278 278 6 21%Ortho (QMC) 59 2%227 225 4 19%Med (QMC) 42 2%183 181 2 19%Surg (QMC) 34 1%32 32 4 16%CVICU (QMC) 5 13%62 62 6 3%MSICU (QMC) 2 10%

333 333 14 12%Med SD (QMC) 39 4%193 192 5 19%Neuro (QMC) 37 3%88 88 3 10%NICU (QMC) 9 3%

122 121 7 33%Onc (QMC) 40 6%122 122 3 2%Peds (QMC) 2 2%44 44 2 0%PICU (QMC) 0 5%

Multiple Classifications and Edit Classifications Summary


Unit ActualCensus

ClassCensus

# of MultipleClassifications

# of EditedClassifications % Multiple % Edited

Totals 1980 1973 323 61 16% 3%



Multiple GraphsThe Multiple Graphs report provides data in a graphic format to facilitate data interpretation. The graphic options include: average daily acuity and complexity; average daily acuity variance target to actual; average daily workload and staffing; average daily workload variance budget to actual; average daily workload variance budget to actual; average daily staffing variance recommended to actual; average daily staffing variance budget to actual; percent RN; and % RN variance recommended to actual.

Key Features

Report can be printed for 1 to 4 graphs per page.

Report will display up to 10 units per graph.

Staffing data can be in hours or number of staff.

Budget variance data can be based on midnight census, LOS adjusted census or classification census.

Staffing data can be for direct staff, non-direct staff or all staff.



Over/Under Use of IndicatorsThe Over/Under Use of Indicators report displays the indicator over and under usage based on the monitoring data. To use this report, monitoring must be completed within the AcuityPlus system. Under use of an indicator occurs when the monitor selects an indicator and the classifying nurse did not select the same indicator. Over use of an indicator occurs when the classifying nurse selects an indicator and the monitoring nurse did not select the same indicator. The number of patients monitored is noted on the report.

Key Features

Provides the indicator name and the number of times the indicator was under used for the defined date range.

Provides the indicator name and the number of times the indicator was over used for the defined date range.


3. ADL - Complete 1 04. ADL - Rehabilitative 0 111. Fluid Management 1 027. Information / Instructional Needs 0 2

Number of Patients Monitored: 28

Number of Classifications Monitored: 28

Date: 7/1/2005 to 9/30/2005

QuadraMed Medical CenterOver/Under Use of Indicators

Med SurgUnit:

Indicator # Under Selected # Over Selected



Patient Activity by HourThe Patient Activity by Hour report provides patient flow activity by hour. Data includes actual census, admissions, transfers in from the ED, transfers in from units other than the ED, total patients that arrived on the unit, transfers out, discharges, total patients that depart the unit, and a percent turnover by hour of day.

An option to include the patient name and account number on the report has been added. This information will display when the option Include Patient Name is checked. When the option is not checked, this information will not display and the word (hidden) will display.

Key Features


User-defined date ranges for summarizing data.

The transfers in from the ED column is shown only when applicable.

Report can be generated by day of week or for all days.

Data is based on admission, transfer, and discharge activity as entered into the system either manually or via an HL7 interface.

Report can be displayed as a graph or as data. If both options are selected, the data will be displayed with the graph.



Patient Activity by Hour of Day


Date: 10/1/04 to 9/30/05

HourStarted

ActualCensus

Admissions TransfersIn - ED

Transfers In Total In TransfersOut

Discharges Total Out % Turnover

7.00 29.38 0.01 0.01 0.00 0.02 0.01 0.00 0.01 0.05 %

8.00 29.39 0.02 0.01 0.00 0.04 0.00 0.04 0.04 0.14 %

9.00 29.29 0.07 0.00 0.00 0.07 0.01 0.35 0.36 0.73 %

10.00 29.18 0.57 0.01 0.01 0.58 0.00 1.25 1.26 3.15 %

11.00 28.49 0.85 0.01 0.01 0.86 0.00 1.72 1.72 4.53 %

12.00 28.03 0.84 0.00 0.01 0.85 0.01 1.15 1.16 3.59 %

13.00 27.72 0.81 0.00 0.01 0.82 0.02 1.25 1.27 3.77 %

14.00 27.39 0.83 0.01 0.01 0.85 0.03 1.18 1.20 3.76 %

15.00 27.32 0.92 0.01 0.02 0.95 0.01 0.83 0.84 3.27 %

16.00 27.36 0.84 0.01 0.02 0.87 0.02 0.58 0.61 2.69 %

17.00 27.46 0.62 0.01 0.03 0.67 0.02 0.28 0.30 1.76 %

18.00 27.73 0.50 0.02 0.01 0.54 0.01 0.23 0.24 1.41 %

19.00 27.87 0.37 0.00 0.01 0.39 0.01 0.07 0.08 0.84 %

20.00 28.24 0.39 0.03 0.01 0.42 0.01 0.03 0.04 0.82 %

21.00 28.47 0.26 0.04 0.00 0.29 0.02 0.02 0.03 0.57 %

22.00 28.65 0.17 0.01 0.01 0.19 0.00 0.01 0.02 0.36 %

23.00 28.82 0.16 0.05 0.00 0.22 0.01 0.01 0.01 0.40 %

0.00 28.91 0.08 0.02 0.00 0.11 0.01 0.00 0.01 0.21 %

1.00 29.00 0.07 0.03 0.00 0.10 0.00 0.00 0.00 0.18 %

2.00 29.12 0.08 0.04 0.00 0.12 0.01 0.00 0.01 0.22 %

3.00 29.20 0.06 0.03 0.00 0.09 0.00 0.00 0.00 0.15 %

4.00 29.28 0.05 0.03 0.00 0.08 0.00 0.00 0.00 0.13 %

5.00 29.31 0.03 0.01 0.00 0.04 0.00 0.00 0.00 0.07 %

6.00 29.35 0.03 0.01 0.00 0.04 0.00 0.01 0.01 0.08 %

Avg/Day 38.64 8.65 0.40 0.16 9.22 0.19 9.01 9.20 23.84 %

Unit: Med Surg



Patient Activity by Hour of Day


Date: 10/1/04 to 9/30/05

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.807.

00

8.00

9.00

10.0

0

11.0

0

12.0

0

13.0

0

14.0

0

15.0

0

16.0

0

17.0

0

18.0

0

19.0

0

20.0

0

21.0

0

22.0

0

23.0

0

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Total In

Total Out

Unit: Med Surg



Patient Classification DetailThe Patient Classification Detail report is used to validate data input and management reports. The report provides the account number, patient name, treatment area, time patient arrived on unit, time patient left the unit, LOS for the 24-hour period (Mental Health units only), patient type, complexity and complexity points, if applicable, and total acuity indicator points for each patient.

The time in reflects the start of the classification, it is blank if the patient was on the unit at the start of day time defined in System Parameters. The time out reflects the time the classification ends, it is blank if the patient was on the unit at the end of the 24 hour period. For patients classified more than one time per 24-hour period, the in time is the start time for the classification and the end time is the end time for the classification.

This report can be generated for one (1) day or for a user-defined date range.

An option to include the patient name and account number on the report has been added. This information will display when the option Include Patient Name is checked. When the option is not checked, this information will not display and the word (hidden) will display.

Key Features


Displays the account number for each patient.

Displays the treatment area selected for each patient on the unit. Do Not Classify is indicated in this column, if appropriate.

Displays the total acuity indicator points and patient type of each patient.

Displays the complexity type and complexity points, if applicable.



Patient Classification Detail


Date: 10/3/05

Unit: Med Surg

Start of Day: 07:00:00

Acct Number Patient Name Treatment Area Time In Time Out LOS PatientType

Cmplx IndicatorPoints

00725462363300 Software, Development 24.00 3 3 54.00

01525238562301 Lacerated, Wrist 13:12:00 17.80 4 4 65.00

02725040207302 Tension, Hyper 24.00 4 4 62.00

02725522650102 Smith, Andrew 14:19:00 16.68 3 2 45.00

03625734995403 Head, Ache 10:00:00 21.00 4 4 65.00

04225793611504 Smith, Louise 12:00:00 5.00 2 1 33.00

04425148071404 Hemorrhage, Intracranial 16:36:00 14.40 4 4 65.00

05425697871205 Smith, Ronnie 14:22:00 7.37 3 2 45.00

05425754841505 Blue, Cross 24.00 2 1 30.00

05525133615505 Smith, Anna 24.00 2 1 25.00

05725258625305 Blue, Shield 24.00 3 2 47.00

21725221385421 Jones, Grace 24.00 3 1 46.00

22625718890322 Net, Work 18:30:00 12.50 3 4 58.00

22725454192222 Neuro, Logical 24.00 3 2 56.00

22725862806322 Jones, William 24.00 3 2 45.00

23225615392423 Sore, Throat 12:19:00 18.68 4 4 65.00

23425644287123 Jones, Leatha 10:00:00 3.00 2 2 39.00

23625605162323 Crisis, Hypertension 11:57:00 19.05 4 5 72.00

23725734278123 Smith, Janet 16:06:00 9.10 3 2 47.00

24225688209224 Cardiac, Arrythmia 12:38:00 18.37 4 4 65.00

24625065130324 Fractured, Hip 24.00 2 1 31.00

24725347785424 Seizure, Grand 24.00 4 5 82.00

24725985281124 System, Integration 24.00 3 1 49.00

25725915885425 Foot, Drop 24.00 2 2 36.00



Recommended Direct Care Staff with HPWI Target and Min/Max RangesThe Recommended Direct Care Staff with HPWI Target and Min/Max Ranges report is a unit specific report that provides recommended direct care staffing by shift by day based on the target hour per workload index, the minimum and maximum hour per workload index range entered in System Parameters, and the actual staff by day. This report is designed to provide a recommended staffing range based on the target hour per workload index ranges and thus provide a range for recommended staffing that can be used to provide information to regulatory agencies.

Key Features


User defined date range.

Provides a range for recommended staffing by shift by day.



Recommended Direct Care Staff based on Min and Max Targets

Unit: Med SurgDate: 9/4/05 to 9/17/05


9/4/2005

Sun

9/5/2005

Mon

9/6/2005

Tue

9/7/2005

Wed

9/8/2005

Thu

9/9/2005

Fri

9/10/2005

Sat

9/11/2005

Sun

9/12/2005

Mon

9/13/2005

Tue

9/14/2005

Wed

9/15/2005

Thu

9/16/2005

Fri

9/17/2005

Sat PTD

7A Class Cen

WI

Acuity

Cmplx

Rec Staff

Rec Min Staff

Rec Max Staff

Actual Staff

28.00

22.69

1.55

2.43

10.25

9.23

11.27

9.54

26.00

17.91

1.43

1.94

8.09

7.28

8.90

8.35

29.00

17.06

1.42

2.31

7.71

6.94

8.48

8.98

36.00

24.10

1.54

2.88

10.89

9.80

11.97

10.98

33.00

26.15

1.57

2.68

11.81

10.63

12.99

12.83

40.00

29.48

1.66

2.81

13.32

11.99

14.64

13.00

32.00

24.41

1.50

2.62

11.02

9.93

12.12

11.42

28.00

22.43

1.42

2.40

10.13

9.12

11.14

9.60

35.00

23.09

1.54

2.44

10.43

9.39

11.47

11.88

40.00

27.29

1.62

2.85

12.32

11.10

13.55

12.52

39.00

29.38

1.54

2.49

13.27

11.95

14.59

14.29

39.00

27.34

1.46

2.31

12.35

11.12

13.58

12.94

44.00

27.51

1.50

2.60

12.43

11.19

13.66

12.02

36.00

24.47

1.36

2.19

11.05

9.95

12.15

12.23

34.64

24.52

1.51

2.51

11.08

9.97

12.18

11.47

7P Class Cen

WI

Acuity

Cmplx

Rec Staff

Rec Min Staff

Rec Max Staff

Actual Staff

2.00

16.21

1.53

2.38

7.32

6.59

8.05

7.02

3.00

11.42

1.48

2.13

5.16

4.64

5.67

4.10

3.00

17.15

1.59

2.88

7.75

6.97

8.52

7.23

4.00

20.49

1.73

3.36

9.26

8.33

10.18

9.35

8.00

20.53

1.64

2.89

9.27

8.35

10.20

9.21

4.00

24.91

1.86

3.38

11.25

10.13

12.37

11.42

4.00

17.08

1.54

2.65

7.71

6.94

8.48

7.29

0.00

15.71

1.44

2.46

7.09

6.39

7.80

7.25

6.00

22.50

1.83

3.18

10.16

9.15

11.17

11.21

4.00

24.59

1.72

3.27

11.11

10.00

12.21

11.04

3.00

23.05

1.64

2.69

10.41

9.38

11.45

10.60

3.00

22.12

1.55

2.62

9.99

9.00

10.99

10.19

4.00

24.21

1.67

3.05

10.93

9.84

12.02

11.35

2.00

16.38

1.43

2.33

7.40

6.66

8.14

8.25

3.57

19.74

1.63

2.84

8.92

8.03

9.80

8.97

24 Hrs Class Cen

WI

Acuity

Cmplx

Rec Staff

Rec Min Staff

Rec Max Staff

Actual Staff

30.00

38.90

1.54

2.41

17.57

15.82

19.32

16.56

29.00

29.33

1.47

2.02

13.25

11.93

14.57

12.46

32.00

34.21

1.47

2.62

15.45

13.91

16.99

16.21

40.00

44.60

1.62

3.13

20.14

18.14

22.15

20.33

41.00

46.68

1.59

2.79

21.08

18.98

23.18

22.04

43.00

54.39

1.74

3.10

24.57

22.12

27.01

24.42

36.00

41.49

1.52

2.64

18.74

16.87

20.60

18.71

28.00

38.14

1.43

2.43

17.23

15.51

18.94

16.85

40.00

45.59

1.65

2.83

20.59

18.54

22.64

23.08

43.00

51.88

1.65

3.08

23.43

21.10

25.76

23.56

42.00

52.43

1.58

2.59

23.68

21.32

26.04

24.90

42.00

49.46

1.50

2.47

22.34

20.11

24.57

23.13

48.00

51.72

1.57

2.83

23.36

21.03

25.69

23.38

37.00

40.85

1.40

2.26

18.45

16.61

20.29

20.48

37.93

44.26

1.57

2.68

19.99

18.00

21.98

20.44

Page 1 of 1 Run Date:Note: Minimum Hours not included in Rec Staff

12/10/2005 11:05:56 AM



Recommended to Actual Staff

The Recommended to Actual Staff report is a unit specific report that provides recommended and actual staffing by skill level by day, day of week or by month. Data is displayed totaled for the 24 hour period, by shift for all shifts or for a specified shift. The variance between actual and scheduled staff is also displayed. The actual and LOS adjusted census is included on the report if desired. The last column can be an average of the daily staffing or a total of all days of staffing in the report. .

Key Features

Comparison of recommended and actual staffing by job skill by day, day of week or by month.

Comparison of recommended and actual staffing by job skill for 24 hour totals, for all shifts or for a specific shift.

Option to include actual and LOS adjusted census on the report.

Select to display by day, day or week or by month

Select to display data for 24 hour totals, by shift for all shifts or by shift for a defined shift

Check to have the actual and LOS census display on the report



3/1 3/2 3/3 3/4 3/5 3/6 3/7 3/8 3/9 3/10 Totals

Mgt/Adm 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 8.00 CN 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 30.00RN 12.60 11.60 12.50 14.80 14.30 12.40 14.70 12.50 14.10 14.50 134.00LPN 0.00NA 8.40 7.80 8.30 9.60 9.30 8.20 7.90 8.90 9.10 9.30 86.80US 3.00 3.00 3.00 3.00 3.00 2.00 2.00 3.00 3.00 3.00 28.00Dir 24.00 22.40 23.80 27.40 26.60 23.60 25.60 24.40 26.20 26.80 250.80N-Dir 4.00 4.00 4.00 4.00 4.00 2.00 2.00 4.00 4.00 4.00 36.00Total 28.00 26.40 27.80 31.40 30.60 25.60 27.60 28.40 30.20 30.80 286.80

30.00 30.00 288.00LOS Adj 25.20 23.10 24.60 28.30 27.40 25.10 22.10 25.40 26.50 27.80 255.50

3/1 3/2 3/3 3/4 3/5 3/6 3/7 3/8 3/9 3/10 Totals

Mgt/Adm 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 8.00CN 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 30.00RN 12.00 12.00 12.00 14.00 12.00 12.00 10.00 12.00 12.00 14.00 122.00LPN 1.00 2.00 2.00 1.00 6.00NA 8.00 7.00 9.00 10.00 9.00 7.00 8.00 8.00 9.00 10.00 85.00US 3.00 3.00 3.00 3.00 3.00 2.00 2.00 3.00 3.00 3.00 28.00Dir 24.00 22.00 24.00 27.00 26.00 24.00 21.00 24.00 24.00 27.00 243.00N-Dir 4.00 4.00 4.00 4.00 4.00 2.00 2.00 4.00 4.00 4.00 36.00Total 28.00 26.00 28.00 31.00 30.00 26.00 23.00 28.00 28.00 31.00 279.00

3/1 3/2 3/3 3/4 3/5 3/6 3/7 3/8 3/9 3/10 Totals

Mgt/Adm 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CN 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00RN 0.60 -0.40 0.50 0.80 2.30 0.40 4.70 0.50 2.10 0.50 12.00LPN -1.00 0.00 0.00 0.00 -2.00 -2.00 0.00 -1.00 0.00 0.00 -6.00NA 0.40 0.80 -0.70 -0.40 0.30 1.20 -0.10 0.90 0.10 -0.70 1.80US 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00Dir 0.00 0.40 -0.20 0.40 0.60 -0.40 4.60 0.40 2.20 -0.20 7.80N-Dir 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00Total 0.00 0.40 -0.20 0.40 0.60 -0.40 4.60 0.40 2.20 -0.20 7.80

29.00

RecUnit: Onc

Recommended to Actual Staff QuadraMed Medical Center

Date: 3/1 to 3/10

Var

Act

29.00 30.00Actual Cn 28.00 27.00 33.00 27.00 25.00

Note: recommended staffing is based on overall workload AcuityPlus Page: 1



RN: WI Staff RatioThe RN: WI Staff Ratio report is designed to provide information on the ratio of RNs to Workload Index and convert this information to RN-to-patient ratios. The report displays shift specific census, workload, RHPWI, and RN HPWI. Complexity of care information is included, if applicable. Recommended RNs, RN/WI and RN-to-patient ratios based on workload and ratio targets defined in System Parameters, and actual staff are shown.

Key Features


Recommended and actual RN-to-patient ratio based on workload and acuity by unit.

Recommended RN-to-patient ratio based on target ratios defined in System Parameters.

RN: WI Staff Ratio Calculations

Shift Census – (Patient hours per shift / shift length) / days of data.

Shift Workload – Prorated workload by shift for date range / days of data.

Complexity – (Sum of individual patient scores X (LOS / 24)) / LOS adjusted census.

RHPWI – Recommended hours for date range / workload for date range.

RN HPWI:

Rec – Recommended RN hours for date range / workload for date range.

Ratio – (((Patient hours for date range / shift length) / RN ratio target) x shift length)) / workload for date range.

WI Recommended:

# RNs – (Recommended RN hours for date range / shift length) / days of data.

WI/RN – Workload by shift for date range / ((Recommended RN hours for date range / shift length) / (24/shift length).

RN:Pt – Total patient hours per shift / total RN recommended hours.




Ratio Target Recommended:

# RNs – ((Total patient hours per shift / shift length) / days of data) / RN ratio target.

WI/RN – Workload by shift for date range / ((total patient hours per shift / shift length) / days of data) / RN ratio target) / (24 / shift length).

RN:Pt – Target ratio in system parameters for specific shift.

Actual:

# RNs – ((Total actual RN hours per shift / shift length) / days of data.

WI/RN – Workload by shift for date range / ((actual RN hours for date range / shift length) / (24 / shift length).

RN:Pt – Total patient hours per shift / total RN actual hours.



RN : WI Staff Ratio by Shift

Date: 9/1/05 to 9/30/05Note: Data crosses more than 1 effective date range


RN HPWI WI Recommended Ratio Target Recommended Actual

Unit Shift ShiftCen

ShiftWI

Cmplx RHPWI Rec Ratio Actual # RN's WI / RN RN:Pt # RN's WI / RN RN:Pt # RN's WI / RN RN:Pt

Med Surg 7A 29.30 25.66 2.45 5.42 4.55 0.00 4.47 9.74 5.27 1: 3.01 0.00 0.00 1:0 9.56 1: 5.37 1: 3.06

Med Surg 7P 30.25 20.76 2.79 5.42 3.58 0.00 3.97 6.19 6.71 1: 4.89 0.00 0.00 1:0 6.87 1: 6.04 1: 4.40

Ortho 7A 24.62 20.04 2.89 5.38 4.04 0.00 4.29 6.74 5.95 1: 3.65 0.00 0.00 1:0 7.17 1: 5.59 1: 3.43

Ortho 7P 24.71 17.26 3.14 5.38 3.71 0.00 3.68 5.34 6.47 1: 4.63 0.00 0.00 1:0 5.29 1: 6.52 1: 4.67

Med 7A 24.43 20.50 3.38 5.15 3.19 0.00 3.48 5.45 7.52 1: 4.48 0.00 0.00 1:0 5.95 1: 6.89 1: 4.11

Med 7P 24.41 16.88 3.42 5.15 4.12 0.00 3.40 5.80 5.83 1: 4.21 0.00 0.00 1:0 4.79 1: 7.06 1: 5.10

Surg 7A 18.04 13.67 2.72 5.49 4.12 0.00 5.63 4.69 5.83 1: 3.85 0.00 0.00 1:0 6.41 1: 4.27 1: 2.81

Surg 7P 18.33 12.26 2.92 5.49 4.12 0.00 3.83 4.21 5.83 1: 4.36 0.00 0.00 1:0 3.92 1: 6.26 1: 4.68

CVICU 7A 2.92 4.13 4.75 5.96 5.07 0.00 14.20 1.74 4.74 1: 1.68 0.00 0.00 1:0 4.89 1: 1.69 1: 0.60

CVICU 7P 2.97 4.03 4.90 5.96 5.47 0.00 12.44 1.84 4.39 1: 1.62 0.00 0.00 1:0 4.18 1: 1.93 1: 0.71

MSICU 7A 6.71 9.49 4.93 5.90 5.19 0.00 8.91 4.11 4.62 1: 1.63 0.00 0.00 1:0 7.05 1: 2.69 1: 0.95

MSICU 7P 6.77 9.77 4.94 5.90 5.19 0.00 8.18 4.23 4.62 1: 1.60 0.00 0.00 1:0 6.66 1: 2.93 1: 1.02

Med SD 7A 29.71 31.28 4.23 5.58 4.63 0.00 5.58 12.07 5.18 1: 2.46 0.00 0.00 1:0 14.55 1: 4.30 1: 2.04

Med SD 7P 29.41 22.10 4.32 5.58 5.30 0.00 6.23 9.76 4.53 1: 3.01 0.00 0.00 1:0 11.47 1: 3.85 1: 2.56

Neuro 7A 26.16 21.60 3.20 5.34 4.54 0.00 5.26 8.17 5.29 1: 3.20 0.00 0.00 1:0 9.48 1: 4.56 1: 2.76

Neuro 7P 26.84 22.49 3.26 5.34 4.27 0.00 4.58 8.01 5.62 1: 3.35 0.00 0.00 1:0 8.59 1: 5.23 1: 3.12

NICU 7A 39.53 38.27 3.93 5.60 5.60 0.00 5.68 17.86 4.29 1: 2.21 0.00 0.00 1:0 18.11 1: 4.23 1: 2.18

NICU 7P 39.74 37.30 3.96 5.60 5.49 0.00 5.32 17.06 4.37 1: 2.33 0.00 0.00 1:0 16.54 1: 4.51 1: 2.40

Onc 7A 19.53 18.23 3.47 5.19 4.51 0.00 5.48 6.85 5.32 1: 2.85 0.00 0.00 1:0 8.33 1: 4.38 1: 2.34

Onc 7P 19.39 12.32 3.53 5.19 4.53 0.00 5.14 4.65 5.30 1: 4.17 0.00 0.00 1:0 5.28 1: 4.67 1: 3.67

Peds 7A 7.09 5.40 3.33 5.97 4.98 0.00 6.00 2.24 4.82 1: 3.17 0.00 0.00 1:0 2.70 1: 4.00 1: 2.63

Peds 7P 7.06 5.02 3.38 6.20 5.50 0.00 5.83 2.30 4.37 1: 3.07 0.00 0.00 1:0 2.44 1: 4.12 1: 2.89

PICU 7A 2.67 2.69 4.00 9.13 8.95 0.00 10.39 2.01 2.68 1: 1.33 0.00 0.00 1:0 2.33 1: 2.31 1: 1.14

PICU 7P 2.50 2.37 4.15 10.20 10.15 0.00 12.01 2.00 2.36 1: 1.25 0.00 0.00 1:0 2.37 1: 2.00 1: 1.06



Rolling Indicators DetailThe Rolling Indicators Detail report is a unit specific report that provides a detailed record of classifications where rolling indicators have been saved without changes. The report includes the patient name, location, and hours of classification time that rolling indicators have been in effect without change. The number of classifications and the percentage of classifications without a change to the rolling indicators is provided.

Key Features

Unit specific listing of classifications with no change to the rolling indicators.

Provides the percentage of classifications with no change to the rolling indicators.

Report can be generated by shift and/or by day for a defined date range.



Rolling Indicators SummaryThe Rolling Indicator Usage Summary report can be printed for one unit or multiple units to provide a summary of the number of classifications with rolling indicators without a change. The number and hours of classifications using rolling indicators without a change, the total number of classifications and the percentage of classifications with rolling indicators without a change are shown.

Key Features

Displays the number of classifications with no change to the rolling indicators and the hours of classification with no change.

Unit specific listing of data and totals for all units within the reporting group.




Staffing AnalysisThe Staffing Analysis report provides actual and scheduled staffing data by Job Title, recommended staffing by Job Skill, and the variances between actual, scheduled, and recommended staffing for direct care providers. This report can be used to compare actual and scheduled staffing by Job Title to evaluate opportunities to improve scheduling practices and to evaluate actual and recommended staffing.

Key Features

Staffing displayed in hours or number of staff.

Average actual and scheduled staffing by Job Title for direct care providers.

Actual and scheduled staffing data is displayed by shift based on entry of staffing data. If a unit has defined 7A and 7P as the primary shifts and enters staffing data for a D shift, all three shifts show on this report.

Staffing Analysis - In Staff


Unit: Med Surg

Job Title Code

7A

Sch Act

7P

Sch Act

NUD 0.00 0.00

RN 0.30 8.79 0.23 5.99

NUS 0.78 0.88

LPN 0.03 1.68 0.03 1.11

NA1 0.24 0.41

NA2 0.32 0.96

UA I 0.02 0.03

OA/MT 0.00 0.00 0.00 0.00

Sitter 0.00 0.00

Shift

Job Skill

7A

Rec

7P

Rec

Mgmt 0.00 0.00

RN 9.74 6.19

LPN 0.93 1.59

NA 0.93 1.59

OA/MT 0.00 0.00

Sitters 0.00 0.00

Shift

Job Skill

7A

R-S R-A A-S

7P

R-S R-A A-S

Mgmt 0.00 0.00 0.00 0.00 0.00 0.00

RN 9.44 0.18 9.26 5.95 -0.68 6.64

LPN 0.89 -0.76 1.65 1.56 0.48 1.08

NA 0.91 0.37 0.54 1.56 0.22 1.34

Scheduled and Actual Staffing

Recommended Staffing

Variances




Staffing by Hour by Day of WeekThe Staffing by Hour by Day of Week report provides a comparison of average daily recommended and actual direct staff by hour of day by day of week. Hourly variance between recommended actual staffing is displayed, along with 24 hour totals and average hourly data. The report provides the option to include recommended staffing without minimum staffing; when this option is selected the variance between recommended staffing without minimums and actual staffing is also displayed. Another option is to display average data by weekday and weekend; data by hour for all valid days within the date range is displayed with all options.

Key Features

Display of staffing data by hour of day and day of week for analysis.

Variance between actual and recommended staffing.

Option to display recommended staffing without minimum staffing included.

Option to display data for weekdays and weekends for comparative analysis.



7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 0 1 2 3 4 5 6 Total Avg/HrRec Staff 11.1 11.2 10.5 11.2 11.7 9.2 10.0 8.8 7.9 8.7 8.3 8.3 8.4 8.4 8.3 8.3 8.0 8.0 8.0 8.0 8.5 8.5 8.5 8.5 216.4 9.0Act Staff 11.1 11.1 11.1 11.1 11.1 11.1 11.1 11.1 8.1 8.1 8.1 8.1 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 217.1 9.0Rec Staff - Act 0.0 0.1 -0.6 0.1 0.6 -1.9 -1.1 -2.3 -0.2 0.6 0.2 0.2 0.4 0.3 0.3 0.3 0.0 0.0 0.0 0.0 0.5 0.5 0.5 0.5 -0.7 0.0Rec Staff 9.4 9.4 9.4 10.9 12.4 12.4 12.6 13.1 13.0 12.3 12.9 12.7 11.5 11.7 12.0 12.1 11.7 11.7 11.7 11.7 11.8 11.8 11.8 11.8 281.9 11.7Act Staff 9.5 9.5 9.5 9.5 9.5 9.5 9.5 9.5 13.3 13.3 13.3 13.3 13.9 13.9 13.9 13.9 11.1 11.1 11.1 11.1 11.1 11.1 11.1 11.1 274.0 11.4Rec Staff - Act -0.1 -0.1 -0.1 1.4 2.9 2.9 3.1 3.6 -0.3 -1.0 -0.4 -0.7 -2.4 -2.3 -1.9 -1.8 0.6 0.6 0.6 0.6 0.7 0.7 0.7 0.7 7.9 0.3Rec Staff 12.9 12.9 12.9 12.9 14.0 13.9 13.6 13.8 14.9 13.8 14.5 14.2 12.6 12.6 12.6 12.6 11.9 11.9 12.0 12.3 11.7 11.7 11.7 11.7 310.0 12.9Act Staff 13.1 13.1 13.1 13.1 13.1 13.1 13.1 13.1 11.5 11.5 11.5 11.5 11.9 11.9 11.9 11.9 11.3 11.3 11.3 11.3 11.3 11.3 11.3 11.3 288.4 12.0Rec Staff - Act -0.2 -0.2 -0.2 -0.2 0.9 0.8 0.5 0.7 3.4 2.4 3.1 2.7 0.7 0.7 0.7 0.7 0.6 0.6 0.7 1.0 0.4 0.4 0.4 0.4 21.6 0.9Rec Staff 13.0 13.0 13.0 13.7 13.8 13.5 13.4 15.0 12.9 11.6 12.3 12.5 13.0 12.7 12.4 11.9 11.9 11.9 11.9 11.9 11.9 11.9 11.9 12.4 303.9 12.7Act Staff 13.7 13.7 13.7 13.7 13.7 13.7 13.7 13.7 12.4 12.4 12.4 12.4 12.4 12.4 12.4 12.4 11.2 11.2 11.2 11.2 11.2 11.2 11.2 11.2 298.6 12.4Rec Staff - Act -0.7 -0.7 -0.7 0.0 0.1 -0.2 -0.3 1.3 0.5 -0.9 -0.1 0.1 0.6 0.3 0.0 -0.5 0.8 0.8 0.8 0.8 0.8 0.8 0.8 1.3 5.3 0.2Rec Staff 13.2 12.7 13.1 12.3 14.0 11.3 10.9 10.4 11.0 10.8 10.5 10.5 10.6 9.9 9.9 9.9 9.9 9.9 9.9 9.9 10.3 10.3 10.3 10.3 262.0 10.9Act Staff 13.1 13.1 13.1 13.1 13.1 13.1 13.1 13.1 11.9 11.9 11.9 11.9 9.3 9.3 9.3 9.3 9.9 9.9 9.9 9.9 9.9 9.9 9.9 9.9 268.6 11.2Rec Staff - Act 0.1 -0.4 0.0 -0.8 0.9 -1.7 -2.2 -2.7 -0.8 -1.1 -1.4 -1.4 1.3 0.7 0.7 0.7 0.0 0.0 0.0 0.0 0.4 0.4 0.4 0.4 -6.6 -0.3Rec Staff 11.6 11.6 11.6 12.5 10.5 11.9 11.8 10.5 11.2 9.7 10.3 11.0 9.5 11.2 9.7 9.4 10.3 10.8 10.6 10.6 10.1 10.1 10.1 10.1 256.3 10.7Act Staff 11.3 11.3 11.3 11.3 11.3 11.3 11.3 11.3 9.5 9.5 9.5 9.5 10.7 10.7 10.7 10.7 10.2 10.2 10.2 10.2 10.2 10.2 10.2 10.2 253.0 10.5Rec Staff - Act 0.3 0.3 0.3 1.2 -0.8 0.6 0.5 -0.8 1.6 0.2 0.7 1.4 -1.2 0.5 -1.0 -1.3 0.0 0.5 0.4 0.4 -0.2 -0.2 -0.2 -0.2 3.3 0.1Rec Staff 12.3 12.3 12.3 12.3 12.6 11.9 12.2 12.6 10.4 10.3 9.6 9.6 8.5 8.5 8.8 9.3 10.3 9.8 9.8 9.8 10.0 10.0 10.0 10.0 253.3 10.6Act Staff 11.2 11.2 11.2 11.2 11.2 11.2 11.2 11.2 11.3 11.3 11.3 11.3 8.2 8.2 8.2 8.2 8.1 8.1 8.1 8.1 8.1 8.1 8.1 8.1 232.3 9.7Rec Staff - Act 1.1 1.1 1.1 1.1 1.5 0.8 1.0 1.5 -0.9 -1.0 -1.7 -1.7 0.3 0.3 0.6 1.1 2.2 1.7 1.7 1.7 1.9 1.9 1.9 1.9 21.0 0.9

Rec Staff 12.0 11.9 12.0 12.5 12.9 12.6 12.5 12.6 12.6 11.6 12.1 12.2 11.4 11.6 11.3 11.2 11.1 11.2 11.2 11.3 11.2 11.2 11.2 11.3 1413.9 11.8Act Staff 12.1 12.1 12.1 12.1 12.1 12.1 12.1 12.1 11.7 11.7 11.7 11.7 11.6 11.6 11.6 11.6 10.7 10.7 10.7 10.7 10.7 10.7 10.7 10.7 1382.6 11.5Rec Staff - Act -0.1 -0.2 -0.1 0.3 0.8 0.5 0.3 0.4 0.9 -0.1 0.4 0.4 -0.2 0.0 -0.3 -0.4 0.4 0.5 0.5 0.6 0.4 0.4 0.4 0.5 31.3 0.3Rec Staff 11.7 11.7 11.4 11.8 12.2 10.6 11.1 10.7 9.2 9.5 8.9 8.9 8.5 8.4 8.6 8.8 9.2 8.9 8.9 8.9 9.2 9.2 9.2 9.2 469.7 9.8Act Staff 11.1 11.1 11.1 11.1 11.1 11.1 11.1 11.1 9.7 9.7 9.7 9.7 8.1 8.1 8.1 8.1 8.1 8.1 8.1 8.1 8.1 8.1 8.1 8.1 449.4 9.4Rec Staff - Act 0.6 0.6 0.3 0.6 1.0 -0.5 0.0 -0.4 -0.5 -0.2 -0.8 -0.8 0.3 0.3 0.5 0.7 1.1 0.9 0.9 0.9 1.2 1.2 1.2 1.2 20.3 0.4

Rec Staff 11.93 11.87 11.84 12.27 12.72 12.04 12.08 12.03 11.63 11.03 11.19 11.24 10.59 10.70 10.54 10.51 10.58 10.58 10.56 10.61 10.62 10.62 10.62 10.69 1883.61 11.21Act Staff 11.85 11.85 11.85 11.85 11.85 11.85 11.85 11.85 11.15 11.15 11.15 11.15 10.63 10.63 10.63 10.63 9.97 9.97 9.97 9.97 9.97 9.97 9.97 9.97 1832.00 10.90Rec Staff - Act 0.07 0.01 -0.02 0.42 0.86 0.19 0.23 0.18 0.47 -0.13 0.04 0.09 -0.03 0.08 -0.08 -0.11 0.61 0.61 0.59 0.64 0.65 0.65 0.65 0.72 51.61 0.31

Week-day

Week-end

All Days

Mon

Tue

Wed

Thu

Fri

Sat

Staffing by Hour by Day of WeekQuadraMed Medical Center

Date: 3/1 to 3/7Unit: Ortho

Hour of Day

Sun

AcuityPlus Page: 1 Run Date: 3/9



Staffing by MIS GuidelinesThe Staffing by MIS Guidelines report is designed for Canadian Clients who are required to report staffing data by defined categories to government agencies. This report displays actual staffing in minutes by defined service categories. The options for display of data include: actual staffing only, actual staffing based on defined distribution by age groupings, and by actual and recommended staffing.

Key Features


Actual staffing in minutes for defined service categories.

Actual staffing in minutes for defined service categories and age categories.

Actual and recommended staffing for defined service categories.



Staffing by MIS Guideline Components - Actual Only - By Age Group

7A 7P0 0 0 0 0 0 0

Sub-Totals

Unit Totals

57372 6375 0

229487 25499 0

45475 5053 0

181899 20211 0

114274

457095

7A 7P

Research 11474 1275 0 9095 1011 0 22855

7A 7P

Teaching/Inservice 11474 1275 0 9095 1011 0 22855

7A 7P

Facility/Community/Professional Activities 11474 1275 0 9095 1011 0 22855

7A 7P

Functional Centre Activities 22949 2550 0 18190 2021 0 45709

7A 7P0 0 0 0 0 0 0

Sub-Totals 172115 19124 0 136424 15158 0 342821

7A 7P0 0 0 0 0 0 0

7A 7P

Consultation and Collaboration 57372 6375 0 45475 5053 0 114274

7A 7P

Therapeutic Intervention 57372 6375 0 45475 5053 0 114274

7A

Adult Adoles-cent

New-born

7P

Adult Adoles-cent

New-born

Total

Assessment 57372 6375 0 45475 5053 0 114274


Unit: Med Surg Adult = 90% Adolescent = 10% Newborn = 0%Date Range: 9/1/05 To 9/30/05

Page 1 of 1Note: Direct Staff reported in minutes



Staffing NotesThe Staffing Notes report displays comments entered in the Staffing Notes feature, allowing documentation to be maintained regarding variances between recommended staffing and actual staffing and the evaluation of the outcome of the variances. In the Staffing Notes feature, comments can be entered as free text or selected from a drop-down list. This report displays the date, shift if applicable, the comment, the author of the comment, and editor of the comment.

Key Features

Displays user comments regarding evaluation of staffing and the impact on patient outcomes.

Report data can be grouped by unit or by unit group.



Med SurgFrom 9/1/2005 to 9/30/2005

Staffing NotesQuadraMed Medical Center

Date Shift Created By Edited By Notes9/1/2005 7A Student nurses on unitQuadraMed, Expert9/6/2005 7A Manager in staffingQuadraMed, Expert9/18/2005 7P Staff expertise and experience facilitated staffing with fewer RNs; No adverse eventsQuadraMed, Expert9/30/2005 7A Additional staff to facilitate RNs attending manditory education classes on new equipment - 1

hour classQuadraMed, Expert

Total notes for this unit: 4



Staffing PercentagesThe Staffing Percentages report display the scheduled, recommended, and actual staffing for the direct and non-direct staff in percentages. The report facilitates analysis of a unit’s skill and shift distribution goal sets providing data to compare scheduled, recommended, and actual staffing by skill and shift.

Staffing Percentages report options:

The report can be generated by unit or for a unit group.

24 Hour Totals provides the average percentages of direct, non-direct and total scheduled, recommended, and actual staff by job skill.

Report by shift-all shifts provides the average percentages of direct, non-direct, and total scheduled, recommended, and actual staff by job skill for all primary shifts.

Report by shift provides the average percentages of direct, non-direct and total scheduled, recommended, and actual staff by job skill for the selected shift.

Key Features

User defined date range for summary of data.

Staffing data presented in percentages.



Staffing Percentages - By Skill Level, By Shift

QuadraMed Medical CenterDate: 9/1/05 To 9/30/05

Scheduled Staffing Recommended Staffing Actual Staffing

ShiftShift

Length Skill Dir N-Dir Total Dir N-Dir Total Dir N-Dir Total

7A 12.00 Mgmt 0% 0% 0% 0% 25% 4% 0% 10% 2%

12.00 RN 0% 0% 0% 84% 0% 72% 81% 0% 68%

12.00 LPN 0% 0% 0% 8% 0% 7% 14% 0% 12%

12.00 NA 0% 0% 0% 8% 0% 7% 5% 0% 4%

12.00 OA/MT 0% 0% 0% 0% 75% 11% 0% 76% 12%

12.00 Sitters 0% 0% 0% 0% 0% 0% 0% 14% 2%

% Dir/NDir 0% 0% 0% 85% 15% 100% 85% 15% 100%

% by Shift 0% 0% 0% 55% 81% 58% 56% 77% 58%

7P 12.00 Mgmt 0% 0% 0% 0% 0% 0% 0% 0% 0%

12.00 RN 0% 0% 0% 66% 0% 63% 73% 0% 69%

12.00 LPN 0% 0% 0% 17% 0% 16% 12% 0% 11%

12.00 NA 0% 0% 0% 17% 0% 16% 15% 0% 14%

12.00 OA/MT 0% 0% 0% 0% 100% 5% 0% 63% 4%

12.00 Sitters 0% 0% 0% 0% 0% 0% 0% 37% 2%

% Dir/NDir 0% 0% 0% 95% 5% 100% 94% 6% 100%

% by Shift 0% 0% 0% 45% 19% 42% 44% 23% 42%

Unit: Med Surg



Staffing Ratios

The Staffing Ratios report displays data for one unit by shift. Data includes LOS adjusted census; acuity; recommended and actual average RN and licensed staff per hour; target ratio staffing for RN and Licensed staff; and staff to patient ratios for RNs, Licensed staff, and all direct staff.

Licensed staff typically includes RNs and LPNs. Skill consolidations are assigned to job titles in System Parameters. The target ratio for RNs and Licensed staff is entered in the Shift Definition table in System Parameters.

Key Features


User defined date range for summary of data.

Comparison of ratio staffing based on patient need driven recommended staff, actual staff defined and target ratios.

CalculationsLOS Adjusted Census – (Sum of the classified patient hours divided by the shift length) divided by days of valid data.

Acuity – Classification workload normalized for 24 hours divided by LOS adjusted census. Normalized for 24 hours means the relative acuity value for 24 hours is used for each 8 hour period to determine acuity. For example: A type II patient is on the unit the entire shift: RAV = 1 and the LOS adjusted census = 1, thus acuity is 1/1 = 1.

Select to display data for one shift for a single unit or for multiple units. Each shift is a separate report.

Select to display data by shift for one unit



Average RN Staff/Hr:

Recommended – Sum of result for each patient type: ((((Workload by patient type time THPWI) * RN skill distribution by patient type) divided by days of valid data) divided by shift length)

Actual – (Sum of actual RN staff for date range in hours divided by days of valid data) divided by shift length)

Ratio Target – LOS adjusted census divided by RN to patient ratio defined in system setup.

Average Licensed Staff/Hr:

Recommended – Sum of result for each patient type: ((((Workload by patient type time THPWI) * RN skill distribution by patient type) divided by days of valid data) divided by shift length) + Sum of result for each patient type: ((((Workload by patient type time THPWI) * other licensed staff(LPN) skill distribution by patient type) divided by days of valid data) divided by shift length)

Actual – (Sum of actual RN and other licensed staff(LPN) staff for date range in hours divided by days of valid data) divided by shift length)

Ratio Target – LOS adjusted census divided by licensed staff to patient ratio defined in system setup.

Staff-to-Patient-Ratios:

RN to Patient:

Recommended – LOS adjusted census divided by recommended RNs per hour. The result is displayed as 1 (one RN) : (to) result (patients).

Actual – LOS adjusted census divided by actual RNs per hour. The result is displayed as 1 (one RN) : (to) result (patients).

Ratio Target – As defined in System Parameters

Licensed Staff to Patient:

Recommended: LOS adjusted census divided by recommended licensed staff per hour. The result is displayed as 1 (one licensed staff) : (to) result (patients).



Unit Detail Staffing Ratio


Med Surg

Staffing Staff-to-Patient Ratios

Avg RN Staff / Hr Avg Licensed Staff / Hr RN to Patient Licensed Staff to Patient Tot Dir Staff toPatient

LOS AdjCen

Acuity Rec Act RatioTrg

Rec Act RatioTrg

Rec Act RatioTrg

Rec Act RatioTrg

Rec Act

7A 29.30 1.51 9.74 9.56 7.32 10.66 11.25 5.86 1: 3.0 1: 3.1 1: 4.0 1: 2.7 1: 2.6 1: 5.0 1: 2.5 1: 2.5

7P 30.25 1.63 6.19 6.87 7.56 7.78 7.98 6.05 1: 4.9 1: 4.4 1: 4.0 1: 3.9 1: 3.8 1: 5.0 1: 3.2 1: 3.2

Average 29.77 1.57 7.96 8.22 7.44 9.22 9.61 5.95 1: 3.7 1: 3.6 1: 4.0 1: 3.2 1: 3.1 1: 5.0 1: 2.8 1: 2.8



Staffing Recommendation ComparisonsThe Staffing Recommendation Comparisons report is designed to provide a comparison of recommended staffing with an alternative approach to recommended staffing. Recommended and/or alternative staffing can be based on patient type, complexity of care (complexity module required), ratio staffing based on patient type skill distribution (ratio module required), or ratio staffing based on complexity skill distribution (complexity and ratio modules required).

Data is presented by day, by shift with job skills in staff or hours; and averaged by shift by skill. The percentage of staff is shown by job skill.

Key Features


Ability to compare two different approaches to recommended staffing.

Ability to view data by day or in averages.



Staffing Recommendation Comparisons by Day in Staff


Unit: 4STH7/1/2005

Rec

Pt Type Cmplx

7/2/2005

Rec

Pt Type Cmplx

7/3/2005

Rec

Pt Type Cmplx

7/4/2005

Rec

Pt Type Cmplx

7/5/2005

Rec

Pt Type Cmplx

7/6/2005

Rec

Pt Type Cmplx

RN 8.73 8.88 9.12 9.12 7.57 7.57 5.05 4.33 6.02 5.77 7.29 7.34

LPN 2.74 2.15 0.87 0.87 0.72 0.72 1.87 1.91 2.00 1.72 2.30 1.85

NA 1.70 2.14 0.87 0.87 0.72 0.72 1.55 2.23 1.20 1.73 1.32 1.71

7A Subtotal 13.17 13.17 10.85 10.85 9.01 9.01 8.47 8.47 9.22 9.22 10.90 10.90

RN 8.40 9.14 4.37 4.37 4.41 4.41 4.07 3.71 5.94 6.49 5.91 6.27

LPN 2.49 1.47 1.12 1.12 1.13 1.13 1.43 1.39 1.76 0.96 1.74 1.20

NA 1.18 1.47 1.12 1.12 1.13 1.13 1.08 1.48 0.61 0.86 0.78 0.97

7P Subtotal 12.07 12.07 6.62 6.62 6.68 6.68 6.58 6.58 8.31 8.31 8.43 8.43

Total 25.24 25.24 17.47 17.47 15.68 15.68 15.05 15.05 17.53 17.53 19.34 19.34



Staffing Recommendation Comparisons in Staff


Unit: 4STH

Job Skill Code Rec by Patient Type % Rec by Complexity of Care %

7A RN 7.29 71.03 % 7.17 69.80 %

LPN 1.75 17.03 % 1.54 14.96 %

NA 1.23 11.94 % 1.57 15.25 %

Subtotal -- 10.27 100.00 % 10.27 100.00 %

Job Skill Code Rec by Patient Type % Rec by Complexity of Care %

7P RN 5.52 67.97 % 5.73 70.62 %

LPN 1.61 19.88 % 1.21 14.95 %

NA 0.99 12.15 % 1.17 14.43 %

Subtotal -- 8.12 100.00 % 8.12 100.00 %

24Hr Total Job Skill Code Rec by Patient Type % Rec by Complexity of Care %

RN 12.81 69.68 % 12.90 70.16 %

LPN 3.36 18.29 % 2.75 14.95 %

NA 2.21 12.03 % 2.74 14.89 %

Total -- 18.38 100.00 % 18.38 100.00 %



Staffing VarianceThe Staffing Variance reports provide the variances between scheduled, recommended, actual and budgeted staffing for direct and non-direct care hours or number of staff. It may be used by all levels of management to facilitate the analysis of overall staffing by unit or job skill level and shift for each unit. The date range is user defined.

The Staffing Variance Detail report provides multiple options for the display of data. Reports can be printed by unit or by unit group, by 24 hour average, by shift for all shifts, or by shift for selected shift. Additionally, the report options define if the report will include the staffing totals, staffing variances, or both.

Staffing totals includes scheduled, recommended, and actual staffing on average per day for selected date range.

Staffing variances includes the variance between recommended and actual, recommended and scheduled, and scheduled and actual staffing.

The Staffing Variance Summary report provides total staffing information for direct and non-direct staff categories using midnight census, LOS adjusted census, or classification census to calculate budgeted staff. Budgeted staff is based on the BHPPD entered for the direct and non-direct staff for each unit in System Parameters. The comparisons are as follows:

The Totals in Staff option displays the total scheduled, recommended, actual, and budgeted staffing.

The Variances in Staff option displays the variances between scheduled, recommended, actual, and budgeted staff.

Key Features

Variance information can be viewed for several units on one report or by job skill level for each unit.

Provides summarized data for all units in selected unit group.



Staffing Variance Detail - By Skill

Med Surg


Scheduled Staffing Recommended Staffing Actual Staffing

Shift Shift Length Skill Dir N-Dir Total Dir N-Dir Total Dir N-Dir Total

7A 12.00 Mgmt 0.00 0.02 0.02 0.00 0.49 0.49 0.00 0.22 0.22

12.00 RN 0.30 0.00 0.30 9.74 0.00 9.74 9.56 0.00 9.56

12.00 LPN 0.03 0.00 0.03 0.93 0.00 0.93 1.68 0.00 1.68

12.00 NA 0.02 0.02 0.03 0.93 0.00 0.93 0.56 0.00 0.56

12.00 OA/MT 0.00 0.05 0.05 0.00 1.49 1.49 0.00 1.63 1.63

12.00 Sitters 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.31 0.31

Shift Total 0.35 0.09 0.44 11.59 1.98 13.57 11.80 2.16 13.96

7P 12.00 Mgmt 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

12.00 RN 0.23 0.00 0.23 6.19 0.00 6.19 6.87 0.00 6.87

12.00 LPN 0.03 0.00 0.03 1.59 0.00 1.59 1.11 0.00 1.11

12.00 NA 0.03 0.03 0.07 1.59 0.00 1.59 1.38 0.00 1.38

12.00 OA/MT 0.00 0.02 0.02 0.00 0.46 0.46 0.00 0.39 0.39

12.00 Sitters 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.23 0.23

Shift Total 0.30 0.05 0.35 9.38 0.46 9.83 9.36 0.63 9.98

Unit Total 0.65 0.14 0.79 20.97 2.43 23.40 21.16 2.79 23.95



Staffing Variance Detail - By Shift and Skill

Med Surg


Recommended - Actual Variance Recommended - Scheduled Variance Scheduled - Actual Variance

Shift Shift Length Skill Dir N-Dir Total Dir N-Dir Total Dir N-Dir Total

7A 12.00 Mgmt 0.00 0.27 0.27 0.00 0.47 0.47 0.00 -0.20 -0.20

12.00 RN 0.18 0.00 0.18 9.44 0.00 9.44 -9.26 0.00 -9.26

12.00 LPN -0.76 0.00 -0.76 0.89 0.00 0.89 -1.65 0.00 -1.65

12.00 NA 0.37 0.00 0.37 0.91 -0.02 0.89 -0.54 0.02 -0.53

12.00 OA/MT 0.00 -0.14 -0.14 0.00 1.44 1.44 0.00 -1.58 -1.58

12.00 Sitters 0.00 -0.31 -0.31 0.00 0.00 0.00 0.00 -0.31 -0.31

Shift Total -0.21 -0.18 -0.39 11.24 1.89 13.13 -11.45 -2.07 -13.52

7P 12.00 Mgmt 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

12.00 RN -0.68 0.00 -0.68 5.95 0.00 5.95 -6.64 0.00 -6.64

12.00 LPN 0.48 0.00 0.48 1.56 0.00 1.56 -1.08 0.00 -1.08

12.00 NA 0.22 0.00 0.22 1.56 -0.03 1.53 -1.34 0.03 -1.31

12.00 OA/MT 0.00 0.06 0.06 0.00 0.44 0.44 0.00 -0.38 -0.38

12.00 Sitters 0.00 -0.23 -0.23 0.00 0.00 0.00 0.00 -0.23 -0.23

Shift Total 0.02 -0.17 -0.15 9.08 0.41 9.48 -9.06 -0.58 -9.63

Unit Total -0.19 -0.35 -0.55 20.32 2.29 22.61 -20.51 -2.65 -23.16



Staffing Variance Summary - By Unit


Note: Data crosses more than 1 effective date range

Note: Budget in Mn Census

Scheduled Staffing Recommended Staffing Actual Staffing Budget Staffing

Facility Unit Dir N-Dir Total Dir N-Dir Total Dir N-Dir Total Dir N-Dir Total

QMC Med Surg 0.00 0.00 0.00 20.97 2.43 23.40 21.16 2.79 23.95 22.24 2.63 24.87

QMC MH 0.00 0.00 0.00 7.49 2.00 9.49 10.10 4.38 14.48 7.35 2.77 10.11

QMC Ortho 0.00 0.00 0.00 16.73 2.60 19.33 16.47 2.59 19.06 18.35 2.75 21.10

QMC Med 0.00 0.00 0.00 16.04 3.00 19.04 17.04 2.36 19.40 16.31 2.00 18.31

QMC Surg 0.00 0.00 0.00 11.86 2.33 14.20 12.29 1.99 14.28 12.57 1.81 14.38

QMC MSICU 0.00 0.00 0.00 9.47 1.50 10.97 15.07 2.37 17.44 9.11 1.15 10.26

QMC CVICU 0.00 0.00 0.00 4.05 1.86 5.91 10.99 1.78 12.78 4.45 0.89 5.34

QMC Med SD 0.00 0.00 0.00 24.82 9.59 34.41 29.14 9.39 38.52 25.21 8.61 33.82

QMC Neuro 0.00 0.00 0.00 19.62 3.22 22.84 20.33 7.31 27.64 19.02 3.83 22.84

QMC NICU 0.00 0.00 0.00 35.27 5.31 40.57 35.09 4.94 40.04 33.74 5.89 39.63

QMC Onc 0.00 0.00 0.00 13.21 2.34 15.55 15.02 1.95 16.97 12.71 2.57 15.29

QMC Peds 0.00 0.00 0.00 5.27 2.16 7.43 5.87 2.25 8.12 5.43 1.70 7.13

QMC PICU 0.00 0.00 0.00 4.06 1.67 5.73 5.12 0.85 5.96 4.51 1.23 5.74

Total 0.00 0.00 0.00 188.88 40.00 228.88 213.68 44.95 258.63 191.00 37.84 228.84



Staffing Variance Summary - By Unit




Recommended - ActualVariance

Recommended - BudgetVariance

Actual - Budget Variance Recommended - ScheduledVariance

Facility Unit Dir N-Dir Total Dir N-Dir Total Dir N-Dir Total Dir N-Dir Total

QMC Med Surg -0.19 -0.35 -0.55 -1.28 -0.20 -1.47 -1.08 0.16 -0.93 20.97 2.43 23.40

QMC MH -2.60 -2.38 -4.99 0.15 -0.77 -0.62 2.75 1.62 4.36 7.49 2.00 9.49

QMC Ortho 0.26 0.01 0.27 -1.62 -0.15 -1.77 -1.88 -0.16 -2.04 16.73 2.60 19.33

QMC Med -0.99 0.64 -0.35 -0.27 1.00 0.73 0.73 0.36 1.09 16.04 3.00 19.04

QMC Surg -0.43 0.35 -0.08 -0.71 0.52 -0.18 -0.28 0.18 -0.11 11.86 2.33 14.20

QMC MSICU -5.60 -0.87 -6.47 0.36 0.35 0.71 5.96 1.22 7.18 9.47 1.50 10.97

QMC CVICU -6.94 0.07 -6.87 -0.40 0.96 0.56 6.54 0.89 7.43 4.05 1.86 5.91

QMC Med SD -4.31 0.20 -4.11 -0.38 0.97 0.59 3.93 0.77 4.70 24.82 9.59 34.41

QMC Neuro -0.71 -4.09 -4.80 0.60 -0.60 0.00 1.32 3.49 4.80 19.62 3.22 22.84

QMC NICU 0.18 0.36 0.54 1.52 -0.58 0.94 1.35 -0.95 0.40 35.27 5.31 40.57

QMC Onc -1.81 0.39 -1.42 0.50 -0.24 0.26 2.31 -0.63 1.68 13.21 2.34 15.55

QMC Peds -0.60 -0.09 -0.69 -0.15 0.45 0.30 0.44 0.55 0.99 5.27 2.16 7.43

QMC PICU -1.06 0.82 -0.23 -0.45 0.44 -0.01 0.61 -0.39 0.22 4.06 1.67 5.73

Total -24.81 -4.95 -29.75 -2.13 2.16 0.03 22.68 7.11 29.79 188.88 40.00 228.88



Treatment Area WorkloadThe Treatment Area Workload report provides the number of patients by type, percent of total unit census, workload, the percentage of total unit workload, acuity, complexity, if applicable, and average LOS for each treatment area. Patients not assigned to a treatment area during the classification process are defaulted to the None category.

A unit specific option is available in System Parameters to make the selection of a treatment area mandatory for each classification. If this option is set to yes, the user is not able to save a classification without first selecting a treatment area.

The treatment area of ‘none’ is a default treatment area assigned to patients that do not have a treatment area selected during the classification process. This category cannot be selected by a user.

Key Features


Percentage of unit workload for each treatment area.

Acuity for each treatment area.

LOS for patients in each treatment area.

Patient type distribution for each treatment area.

Complexity of care for each treatment area, if applicable.



Treatment Area Workload


Date: 9/1/05 to 9/30/05Med Surg

Volume by Patient Type % of Unit Tx Area % of Unit Avg

I II III IV V VI All Census Wkld Wkld Acuity Cmplx LOS

Cardiac

Tx Area Total 0.00 15.41 53.48 17.76 1.00 0.00 87.65 -- -- -- -- -- --

Avg/Day 0.00 0.51 1.78 0.59 0.03 0.00 2.92 10 % 4.61 10 % 1.58 2.50 3.51

% 0 % 18 % 61 % 20 % 1 % 0 % 100 % -- -- -- -- -- --

Diabetic

Tx Area Total 0.00 7.03 24.67 6.85 0.00 0.00 38.56 -- -- -- -- -- --

Avg/Day 0.00 0.23 0.82 0.23 0.00 0.00 1.29 4 % 1.99 4 % 1.55 2.72 3.86

% 0 % 18 % 64 % 18 % 0 % 0 % 100 % -- -- -- -- -- --

None

Tx Area Total 0.44 136.78 474.81 154.96 0.00 0.00 766.98 -- -- -- -- -- --

Avg/Day 0.01 4.56 15.83 5.17 0.00 0.00 25.57 86 % 39.82 86 % 1.56 2.63 2.95

% 0 % 18 % 62 % 20 % 0 % 0 % 100 % -- -- -- -- -- --

Unit Totals 0.44 159.22 552.96 179.57 1.00 0.00 893.19 -- -- -- -- -- --

Avg/Day 0.01 5.31 18.43 5.99 0.03 0.00 29.77 100 % 46.42 100 % 1.56 2.62 3.03

% 0 % 18 % 62 % 20 % 0 % 0 % 100 % -- -- -- -- -- --

Unit:Days of Data: 30



Unclassified Patient DetailThe Unclassified Patient Detail report is a unit specific report that provides a detailed record of patients that have not been classified during the specified timeframe. The report includes patient name, location, account number, start date and time, end date and time, and hours of unclassified time. The summary data includes the unique patient actual census, total hours for actual patient census, the number of unclassified patients, the number of unclassified hours, and the percentage of unclassified hours.

The following report options are available:

Include discharged/transferred patients only – When this option is selected, only transferred and discharged patients are included in the report.

Must classify every shift – When this option is selected, any patient not classified during the shift will be reported as unclassified. Available only if shift-based classification is in use.

Key Features

Unit specific display listing unclassified patients.

Percentage of unclassified patient hours.

Data displayed for entire 24 hour period (for units with primary shifts other than a 24 hour shift, the report can also display data by shift for a specific shift and by shift for all shifts).



Location Patient Name Ending Date/TimeStart Date/TimeAccount Number Hours

Jones, Judy710 A 9/9/2005 5:32:00 AM29225185392429 9/9/2005 7:00:00 AM 1.5Smith, Alan720 A 9/12/2005 12:46:00 PM29425761812329 9/13/2005 7:00:00 AM 18.2Jones, Anita730 A 9/16/2005 10:12:00 AM27815319082027 9/17/2005 7:00:00 AM 20.8Smith, Joan727 A 9/18/2005 6:16:00 AM00625956797500 9/18/2005 7:00:00 AM 0.7Jones, Marie733 A 9/29/2005 5:40:00 AM01725851125501 9/29/2005 7:00:00 AM 1.3Smith, Homer732 A 9/29/2005 6:32:00 AM22725801935422 9/29/2005 7:00:00 AM 0.5

Unclassified Patient Detail


Ortho (QuadraMed Medical Center)Unit:

278

43.0

6# Unclassified Patients:

Total Actual Census:

# Unclassified Hours:

% Unclassified Hours:

Total Hours: 17,756.4

0%



Unclassified Patient SummaryThe Unclassified Patient Summary report can be printed for one unit or multiple units to provide a summary of the number of unclassified patient hours, percentage of unclassified patient hours, total number of patient hours on the unit, and the actual census (unique number of patients).

The following report options are available:

Include discharged/transferred patients only – When this option is selected, only transferred and discharged patients are included in the report.

Must classify every shift – When this option is selected, any patient not classified during the shift will be reported as unclassified. Available only if shift-based classification is in use.

Key Features

Unit specific display listing number of unclassified patients, hours, and percentage of unclassified hours.

Total patient hours and unique patient actual census displays for each unit and for all units in the report.

Data displayed for entire 24 hour period (for units with primary shifts other than a 24 hour shift, the report can also display data by shift for a specific shift and by shift for all shifts).

5Med Surg 0%117.0 83761,828.711MH 0%51.7 11113,452.324Ortho 1%253.3 76449,906.150Med 1%393.6 70759,725.637Surg 1%240.7 51838,519.612MSICU 1%73.7 16211,327.06CVICU 1%44.4 835,346.449Med SD 0%289.8 91260,047.741Neuro 0%260.7 55654,666.016NICU 0%102.9 19682,671.619Onc 1%194.4 32538,574.429Peds 2%342.6 31915,713.424PICU 3%163.2 1015,488.4

Totals 323 2,528.0 5,5911% 497,267.2

Actual Census% Hours # Hours

Unclassified Patient Summary


UnitPatients # Hours

Unclassified Total



Unit Monthly TrendThe Unit Monthly Trend report provides a month-by-month summary of workload, acuity, com-plexity, if applicable, staffing, and productivity information. Staffing and productivity statistics are reported as direct and total. The report also provides trend and fiscal year-to-date averages for the reported statistics. As with many of the system reports, you may select the data to be displayed in averages or totals, and staff or hours. You can select the HPPD for budgeted, recommended, and actual staffing calculations using either the LOS adjusted census or the midnight census. This is two page report, with options to print by page.

Key Features

Identification of productivity trends for the past year.

Identification of seasonal workload fluctuations.


Unit Monthly Trend Report Calculations

Days of Data – Total number of days of data included in the report. This report uses only valid days of data; this is days with both classification and actual staffing data.

Class Census – Total number of patients classified / days of data.

LOS Adjusted Census – [Sum of (Total length of stay for all patients in a 24 hour period / 24 hours)] / days of data.

WI – Total Workload Index / days of data.

Acuity – Total Workload / LOS adjusted census.

Complexity – (Sum of individual complexity type x (LOS / 24)) / LOS adjusted census.

Direct Staffing:

Recommended – Total number of recommended direct care staff / days of data.

Actual – Total number of actual direct care staff / days of data.

Budget – Total number of budgeted direct care staff / days of data.

Total Staffing:




Recommended – (Total number of recommended direct + non-direct care staff) / days of data.

Actual – (Total number of actual direct + non-direct care staff) / days of data.

Budgeted – (Total number of budgeted direct + non-direct care staff) / days of data.

Direct Care Staff:

Rec HPWI – Total recommended direct staff for the unit / total workload.

Actual HPWI – Total actual direct staff in hours / total workload.

% Productivity – (Total recommended direct staff / total actual direct staff) x 100.

Rec HPPD – Total recommended direct staff hours / midnight census or LOS adjusted census.

Actual HPPD – Total actual direct staff / midnight census or LOS adjusted census.

Budget HPPD – As defined in System Parameters.

Total Staff:

Rec HPWI – (Total recommended direct + non-direct staff for the unit) / total workload.

Actual HPWI – (Total actual direct + non-direct staff for the unit) / total workload.

% Productivity – [(Total recommended direct + non-direct staff)/(Total actual direct + non-direct staff)] x 100.

Rec HPPD – (Total recommended direct + non-direct hours) / midnight census or LOS adjusted census.

Actual HPPD – (Total actual direct + non-direct hours) / midnight census or LOS adjusted census.

Budget HPPD – As defined in System Parameters.




Med Surg

QuadraMed Medical CenterDate: 10/1/04 to 9/30/05FY Start Date: 1/1/2005


Days

of Class LOS Direct Staffing Total Staffing

Year Month Data Census Adj Cen Mn Cen WI Acuity Cmplx Rec Actual Budget Rec Actual Budget

2004 Oct 31 37.29 27.97 28.48 44.31 1.58 2.78 20.01 21.63 20.89 22.36 24.28 23.36

2004 Nov 30 36.97 27.31 27.83 43.86 1.61 2.86 19.81 21.51 20.41 22.24 24.16 22.82

2004 Dec 31 36.19 26.08 26.32 40.96 1.57 2.75 18.50 19.87 19.30 20.95 22.47 21.58

2005 Jan 31 40.45 29.87 30.55 46.57 1.56 2.75 21.04 22.12 22.40 23.39 24.57 25.05

2005 Feb 28 41.29 30.44 30.89 47.78 1.57 2.77 21.58 22.67 22.65 23.99 25.02 25.33

2005 Mar 31 41.87 30.51 31.10 48.06 1.58 2.78 21.71 23.02 22.80 24.15 25.57 25.50

2005 Apr 30 36.70 26.88 27.30 43.55 1.62 2.84 19.67 20.72 20.02 22.05 23.52 22.39

2005 May 31 37.55 27.79 28.23 44.20 1.59 2.81 19.96 21.43 20.70 22.36 24.01 23.15

2005 Jun 30 39.80 29.32 29.77 45.87 1.56 2.71 20.72 21.83 21.83 23.15 24.57 24.41

2005 Jul 31 36.23 26.49 26.81 41.99 1.59 2.76 18.97 20.09 19.66 21.32 22.22 21.98

2005 Aug 31 38.03 27.71 28.19 44.20 1.59 2.77 19.96 21.04 20.68 22.41 23.89 23.12

2005 Sep 30 39.80 29.77 30.33 46.42 1.56 2.62 20.97 21.16 22.24 23.40 23.95 24.87

TrendAverage 365 38.49 28.33 28.80 44.79 1.58 2.77 20.23 21.42 21.12 22.64 24.01 23.62

FYAverage 273 39.06 28.74 29.22 45.38 1.58 2.76 20.50 21.56 21.43 22.90 24.14 23.96



Med Surg



Days Direct Total

of Class LOS Rec Actual % Rec Actual Budget Rec Actual % Rec Actual Budget

Year Month Data Census Adj Cen Mn Cen WI Acuity Cmplx HPWI HPWI Prod HPPD HPPD HPPD HPWI HPWI Prod HPPD HPPD HPPD

2004 Oct 31 37.29 27.97 28.48 44.31 1.58 2.78 5.42 5.86 93 % 8.43 9.11 8.80 6.06 6.58 92 % 9.42 10.23 9.84

2004 Nov 30 36.97 27.31 27.83 43.86 1.61 2.86 5.42 5.89 92 % 8.54 9.28 8.80 6.09 6.61 92 % 9.59 10.42 9.84

2004 Dec 31 36.19 26.08 26.32 40.96 1.57 2.75 5.42 5.82 93 % 8.43 9.06 8.80 6.14 6.58 93 % 9.55 10.24 9.84

2005 Jan 31 40.45 29.87 30.55 46.57 1.56 2.75 5.42 5.70 95 % 8.26 8.69 8.80 6.03 6.33 95 % 9.19 9.65 9.84

2005 Feb 28 41.29 30.44 30.89 47.78 1.57 2.77 5.42 5.69 95 % 8.38 8.81 8.80 6.02 6.28 96 % 9.32 9.72 9.84

2005 Mar 31 41.87 30.51 31.10 48.06 1.58 2.78 5.42 5.75 94 % 8.38 8.88 8.80 6.03 6.39 94 % 9.32 9.87 9.84

2005 Apr 30 36.70 26.88 27.30 43.55 1.62 2.84 5.42 5.71 95 % 8.65 9.11 8.80 6.08 6.48 94 % 9.69 10.34 9.84

2005 May 31 37.55 27.79 28.23 44.20 1.59 2.81 5.42 5.82 93 % 8.49 9.11 8.80 6.07 6.52 93 % 9.51 10.21 9.84

2005 Jun 30 39.80 29.32 29.77 45.87 1.56 2.71 5.42 5.71 95 % 8.35 8.80 8.80 6.06 6.43 94 % 9.33 9.90 9.84

2005 Jul 31 36.23 26.49 26.81 41.99 1.59 2.76 5.42 5.74 94 % 8.49 8.99 8.80 6.09 6.35 96 % 9.54 9.95 9.84

2005 Aug 31 38.03 27.71 28.19 44.20 1.59 2.77 5.42 5.71 95 % 8.50 8.95 8.80 6.08 6.48 94 % 9.54 10.17 9.84

2005 Sep 30 39.80 29.77 30.33 46.42 1.56 2.62 5.42 5.47 99 % 8.29 8.37 8.80 6.05 6.19 98 % 9.26 9.47 9.84

TrendAvg 365 38.49 28.33 28.80 44.79 1.58 2.77 5.42 5.74 94 % 8.43 8.92 8.80 6.06 6.43 94 % 9.43 10.00 9.84

FY Avg 273 39.06 28.74 29.22 45.38 1.58 2.76 5.42 5.70 95 % 8.42 8.85 8.80 6.06 6.38 95 % 9.40 9.91 9.84



Unit Performance SummaryThe Unit Performance Summary report displays staffing, percent RN, and productivity indices. Data is average daily data presented by month with period-to-date and year-to-date summaries. This report is designed to facilitate analysis of data over time, facilitating analysis of meeting productivity goals, system changes, and seasonal changes.

Key Features

Provides monthly productivity data for analysis.

Facilitates comparison of recommended and actual hours per workload index and hours per patient day.



Unit: Med Surg



PRODUCTIVITY


SKILL MIX

Actual %RN

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD FY



20.89 20.41 19.30 22.40 22.65 22.80 20.02 20.70 21.83 19.66 20.68 22.24 21.12 21.4319.82 19.52 18.32 20.83 21.40 21.54 19.48 19.83 26.31 19.23 21.47 21.20 20.73 21.2421.72 21.51 19.86 22.12 22.67 23.02 20.72 21.43 21.54 20.09 21.04 21.16 21.40 21.53-1.91 -2.00 -1.54 -1.30 -1.28 -1.48 -1.24 -1.60 4.76 -0.85 0.43 0.04 -0.67 -0.28

5.42 5.42 5.42 5.42 5.42 5.42 5.42 5.42 6.89 5.50 5.84 5.49 5.59 5.655.94 5.98 5.88 5.76 5.74 5.79 5.76 5.86 5.64 5.74 5.72 5.48 5.77 5.728.35 8.41 8.35 8.18 8.31 8.31 8.56 8.43 10.60 8.61 9.14 8.39 8.64 8.729.15 9.28 9.06 8.69 8.81 8.88 9.11 9.11 8.69 8.99 8.95 8.37 8.92 8.84

77.5 79.3 78.8 77.7 77.4 76.2 74.9 73.6 74.7 73.3 75.9 77.6 76.4 75.7

Unit Performance Summary - In StaffDate: 10/1/2004 to 9/30/2005



Unit Period DetailThe Unit Period Detail report is used to evaluate workload and productivity data by day, by day of week, or by month at the unit level. This report provides detailed data on patient type distribution, census, workload, acuity, complexity, if applicable, staffing, and productivity. The report can have the HPPD for budget, recommended, and actual staff calculated by either the LOS Adjusted Census or the midnight census.

Key Features


Report can be generated by day, by day of week, or by month.

Report displays the complexity of care score, if applicable.

Report includes unit specific display of staffing data in hours or number of staff.

Census (classification, LOS Adjusted, and midnight), acuity, complexity, and workload information are detailed.

Budgeted, recommended, and actual staffing is shown.

Productivity indices (HPWI, and HPPD) for both direct and non-direct staffing are shown.

Recommended hours per workload index (RHPWI) are shown.

When the selected date range crosses two or more effective date ranges, the period-to-date (PTD) column is based on the following:

Direct Staff:

THPWI – most current target is shown.

Budget Staff = Sum of budgeted direct care hours for all days of valid data / total midnight or LOS adjusted census.

RHPWI = Recommended direct hours of care / workload.

BHPPD – most current hours are shown.

RHPPD = Sum of the recommended direct hours of care / midnight or LOS adjusted census.

Non-Direct Staff:

Budget Staff = Total budgeted non-direct care hours / total midnight or LOS adjusted census.

RHPWI = recommended non-direct hours of care / workload.

BHPPD – most current hours are shown.

RHPPD = Sum of the recommended non-direct hours of care / midnight or LOS adjusted census.



Unit Period Detail Report Calculations

Workload:

Patient Types – Number of patients by type.

Classification Census – Number of patients classified.

LOS Adjusted Census – The total number of patient LOS hours / 24 hours.

Midnight Census – The number of patients as counted at midnight.

Workload:

Acuity – Workload Index / LOS Adjusted Census.

Complexity – (Sum of individual complexity type x (LOS / 24)) / LOS adjusted census

Staffing:

Direct Staffing:

Budget – Budget HPPD for direct care givers x midnight census or LOS Adjusted Census.

Sum over all shifts ((Total Type I patients length of stay on each shift / specific shift length) x (specific shift distribution percentage) x methodology specific relative acuity value)

+ Sum over all shifts ((Total Type II patients length of stay on each shift / specific shift length) x (specific shift distribution percentage) x methodology specific relative acuity value)

+ Sum over all shifts ((Total Type III patients length of stay on each shift / specific shift length) x (specific shift distribution percentage) x methodology specific relative acuity value)

+ Sum over all shifts ((Total Type IV patients length of stay on each shift / specific shift length) x (specific shift distribution percentage) x methodology specific relative acuity value)

+ Sum over all shifts ((Total Type V patients length of stay on each shift / specific shift length) x (specific shift distribution percentage) x methodology specific relative acuity value)

+ Sum over all shifts ((Total Type VI patients length of stay on each shift / specific shift length) x (specific shift distribution percentage) x methodology specific relative acuity value)



Recommended:

Actual – The number of direct care staff actually working on the unit in the 24 hour time period.

AHPWI – Actual staff in hours / workload index.

RHPWI (Recommended hours per workload index) – Recommended direct staff hours divided by workload index.

Non-Direct Staffing:

Budget – Budget HPPD for non-direct caregivers x midnight census or LOS Adjusted Census.

Recommended – The number of non-direct care givers as defined in the System Parameters; this may include staff recommended based on census.

Actual – The number of non-direct care staff actually working on the unit in the 24 hour time period.

AHPWI – Non-direct staffing hours / workload index.

RHPWI (Recommended hours per workload index) – Recommended non-direct staff hours divided by workload index.

Sum over all shifts ((Total Type I patients workload by shift x target hour per workload index) x shift specific percent for each direct care skill level for a Type I)

+ Sum over all shifts ((Total Type II patients workload by shift x target hour per workload index) x shift specific percent for each direct care skill level for a Type II)

+ Sum over all shifts ((Total Type III patients workload by shift x target hour per workload index) x shift specific percent for each direct care skill level for a Type III)

+ Sum over all shifts ((Total Type IV patients workload by shift x target hour per workload index) x shift specific percent for each direct care skill level for a Type IV)

+ Sum over all shifts ((Total Type V patients workload by shift x target hour per workload index) x shift specific percent for each direct care skill level for a Type V)

+ Sum over all shifts ((Total Type VI patients workload by shift x target hour per workload index) x shift specific percent for each direct care skill level for a Type VI)




Productivity:

Budget HPPD:

Direct – As defined by unit.

Non-Direct – As defined by unit.

Total – Sum of the direct and non-direct HPPD.

Actual HPPD:

Direct – Actual direct care staff in hours / midnight census or LOS adjusted census.

Non-Direct – Actual non-direct care staff in hours / midnight census or LOS Adjusted Census.

Total – Total Actual staff in hours / midnight census or LOS Adjusted Census.

Recommended HPPD:

Direct – Recommended direct care staff in hours / midnight census or LOS Adjusted Census.

Non-Direct – Recommended non-direct care staff in hours / midnight census or LOS Adjusted Census.

Total – Total recommended staff in hours / midnight census or LOS Adjusted Census.

PTD (Period-to-date): Average data for the selected date range.

Calculations are for the daily report.



Unit Period Detail In Staff


Unit: Med Surg

FY Start Date:

Sun

09/04/05

Mon

09/05/05

Tue

09/06/05

Wed

09/07/05

Thu

09/08/05

Fri

09/09/05

Sat

09/10/05

Sun

09/11/05

Mon

09/12/05

Tue

09/13/05

Wed

09/14/05

Thu

09/15/05

Fri

09/16/05

Sat

09/17/05 PTD YTD

I - C

II - C

III - C

IV - C

V - C

VI

3.42

13.44

5.39

0.76

2.26

--

3.07

14.89

0.38

1.58

0.00

--

5.06

10.04

2.00

0.89

5.26

--

1.82

4.75

11.09

7.94

1.98

--

4.37

9.86

3.69

10.37

1.00

--

4.35

8.73

4.12

7.44

6.62

--

1.26

13.73

5.85

6.39

0.00

--

4.61

12.00

6.00

2.00

2.00

--

4.87

8.26

3.64

8.21

2.59

--

3.33

9.38

5.87

7.31

5.57

--

2.00

17.48

5.80

7.95

0.00

--

3.76

16.64

6.00

6.64

0.00

--

4.50

13.22

5.65

2.62

7.02

--

8.00

11.06

5.42

4.00

0.70

--

3.89 3.69

11.68 10.78

5.07 6.25

5.29 4.21

2.50 3.67

-- --

Act ClassCensus

Los AdjCensus

Mn Cen

WI

Acuity

Cmplx

THPWI

Dir Staffing

Budget

Rec

Actual

AHPWI

RHPWI

N-Dir Staff

Budget

Rec

Actual

AHPWI

RHPWI

Bud HPPD

Dir

N-Dir

Total

Act HPPD

Dir

N-Dir

Total

Rec HPPD

Dir

N-Dir

Total

30.00

25.27

25.00

38.90

1.54

2.41

5.42

18.33

17.57

16.56

5.11

5.42

2.17

1.33

1.98

0.61

0.41

8.80

1.04

9.84

7.95

0.95

8.90

8.43

0.64

9.07

29.00

19.92

18.00

29.33

1.47

2.02

5.42

13.20

13.25

12.46

5.10

5.42

1.56

2.83

1.42

0.58

1.16

8.80

1.04

9.84

8.31

0.94

9.25

8.83

1.89

10.72

32.00

23.25

26.00

34.21

1.47

2.62

5.42

19.07

15.45

16.21

5.69

5.42

2.25

2.83

1.42

0.50

0.99

8.80

1.04

9.84

7.48

0.65

8.13

7.13

1.31

8.44

40.00

27.57

28.00

44.60

1.62

3.13

5.42

20.53

20.14

20.33

5.47

5.42

2.43

2.83

3.19

0.86

0.76

8.80

1.04

9.84

8.71

1.37

10.08

8.63

1.21

9.85

41.00

29.29

29.00

46.68

1.59

2.79

5.42

21.27

21.08

22.04

5.67

5.42

2.51

2.83

2.25

0.58

0.73

8.80

1.04

9.84

9.12

0.93

10.05

8.72

1.17

9.90

43.00

31.26

32.00

54.39

1.74

3.10

5.42

23.47

24.57

24.42

5.39

5.42

2.77

2.83

2.44

0.54

0.63

8.80

1.04

9.84

9.16

0.91

10.07

9.21

1.06

10.27

36.00

27.23

26.00

41.49

1.52

2.64

5.42

19.07

18.74

18.71

5.41

5.42

2.25

1.33

3.23

0.93

0.39

8.80

1.04

9.84

8.63

1.49

10.12

8.65

0.62

9.26

28.00

26.61

26.00

38.14

1.43

2.43

5.42

19.07

17.23

16.85

5.30

5.42

2.25

1.33

4.08

1.28

0.42

8.80

1.04

9.84

7.78

1.88

9.66

7.95

0.62

8.57

40.00

27.57

29.00

45.59

1.65

2.83

5.42

21.27

20.59

23.08

6.08

5.42

2.51

2.83

2.48

0.65

0.75

8.80

1.04

9.84

9.55

1.03

10.58

8.52

1.17

9.69

43.00

31.46

34.00

51.88

1.65

3.08

5.42

24.93

23.43

23.56

5.45

5.42

2.95

2.83

3.02

0.70

0.66

8.80

1.04

9.84

8.32

1.07

9.38

8.27

1.00

9.27

42.00

33.22

34.00

52.43

1.58

2.59

5.42

24.93

23.68

24.90

5.70

5.42

2.95

2.83

1.90

0.43

0.65

8.80

1.04

9.84

8.79

0.67

9.46

8.36

1.00

9.36

42.00

33.04

34.00

49.46

1.50

2.47

5.42

24.93

22.34

23.13

5.61

5.42

2.95

2.83

2.23

0.54

0.69

8.80

1.04

9.84

8.16

0.79

8.95

7.88

1.00

8.88

48.00

33.01

35.00

51.72

1.57

2.83

5.42

25.67

23.36

23.38

5.42

5.42

3.03

2.83

1.85

0.43

0.66

8.80

1.04

9.84

8.01

0.64

8.65

8.01

0.97

8.98

37.00

29.18

27.00

40.85

1.40

2.26

5.42

19.80

18.45

20.48

6.02

5.42

2.34

1.33

1.88

0.55

0.39

8.80

1.04

9.84

9.10

0.83

9.94

8.20

0.59

8.79

37.93 38.91

28.42 28.60

28.79 29.06

44.26 45.22

1.56 1.58

2.68 2.77

5.42 5.42

21.11 21.31

19.99 20.42

20.44 21.55

5.54 5.72

5.42 5.42

2.49 2.52

2.40 2.40

2.38 2.55

0.65 0.68

0.65 0.64

8.80 8.80

1.04 1.04

9.84 9.84

8.52 8.90

0.99 1.05

9.51 9.95

8.33 8.43

1.00 0.99

9.34 9.42

1/1/2005

WinPFS Report Version 6.0. Page 1 of 1 Run Date:


12/11/2005 01:51:41 PM





Unit: Med Surg10

2004

Oct

112004

Nov

122004

Dec

12005

Jan

22005

Feb

32005

Mar

42005

Apr

52005

May

62005

Jun

72005

Jul

82005

Aug

92005

Sep PTD YTD

I

II

III

IV

V

VI

0.02

4.31

17.37

6.21

0.07

0.00

0.00

4.23

16.15

6.84

0.10

0.00

0.04

4.29

16.13

5.63

0.00

0.00

0.00

5.64

17.71

6.49

0.02

0.00

0.01

5.50

18.15

6.77

0.01

0.00

0.01

5.07

18.65

6.78

0.00

0.00

0.00

3.47

16.56

6.82

0.02

0.00

0.01

4.77

16.23

6.78

0.00

0.00

0.11

5.23

17.69

6.27

0.01

0.00

0.00

4.71

15.55

6.21

0.01

0.00

0.00

4.21

17.11

6.36

0.03

0.00

0.01

5.31

18.43

5.99

0.03

0.00

0.02 0.02

4.72 4.88

17.13 17.33

6.43 6.50

0.03 0.02

0.00 0.00

Act ClassCensus

Los AdjCensus

Mn Cen

WI

Acuity

Cmplx

THPWI

Dir Staffing

Budget

Rec

Actual

AHPWI

RHPWI

N-Dir Staff

Budget

Rec

Actual

AHPWI

RHPWI

Bud HPPD

Dir

N-Dir

Total

Act HPPD

Dir

N-Dir

Total

Rec HPPD

Dir

N-Dir

Total

37.29

27.97

28.48

44.31

1.58

2.78

5.42

20.89

20.01

21.63

5.86

5.42

2.47

2.35

2.65

0.72

0.64

8.80

1.04

9.84

9.11

1.12

10.23

8.43

0.99

9.42

36.97

27.31

27.83

43.86

1.61

2.86

5.42

20.41

19.81

21.51

5.89

5.42

2.41

2.43

2.64

0.72

0.67

8.80

1.04

9.84

9.28

1.14

10.42

8.54

1.05

9.59

36.19

26.08

26.32

40.96

1.57

2.75

5.42

19.30

18.50

19.87

5.82

5.42

2.28

2.45

2.60

0.76

0.72

8.80

1.04

9.84

9.06

1.19

10.24

8.43

1.12

9.55

40.45

29.87

30.55

46.57

1.56

2.75

5.42

22.40

21.04

22.12

5.70

5.42

2.65

2.35

2.45

0.63

0.61

8.80

1.04

9.84

8.69

0.96

9.65

8.26

0.92

9.19

41.29

30.44

30.89

47.78

1.57

2.77

5.42

22.65

21.58

22.67

5.69

5.42

2.68

2.40

2.35

0.59

0.60

8.80

1.04

9.84

8.81

0.91

9.72

8.38

0.93

9.32

41.87

30.51

31.10

48.06

1.58

2.78

5.42

22.80

21.71

23.02

5.75

5.42

2.70

2.45

2.55

0.64

0.61

8.80

1.04

9.84

8.88

0.98

9.87

8.38

0.94

9.32

36.70

26.88

27.30

43.55

1.62

2.84

5.42

20.02

19.67

20.72

5.71

5.42

2.37

2.38

2.81

0.77

0.66

8.80

1.04

9.84

9.11

1.23

10.34

8.65

1.05

9.69

37.55

27.79

28.23

44.20

1.59

2.81

5.42

20.70

19.96

21.43

5.82

5.42

2.45

2.40

2.57

0.70

0.65

8.80

1.04

9.84

9.11

1.09

10.21

8.49

1.02

9.51

39.80

29.32

29.77

45.87

1.56

2.71

5.42

21.83

20.72

21.83

5.71

5.42

2.58

2.43

2.74

0.72

0.64

8.80

1.04

9.84

8.80

1.10

9.90

8.35

0.98

9.33

36.23

26.49

26.81

41.99

1.59

2.76

5.42

19.66

18.97

20.09

5.74

5.42

2.32

2.35

2.13

0.61

0.67

8.80

1.04

9.84

8.99

0.95

9.95

8.49

1.05

9.54

38.03

27.71

28.19

44.20

1.59

2.77

5.42

20.68

19.96

21.04

5.71

5.42

2.44

2.45

2.85

0.77

0.66

8.80

1.04

9.84

8.95

1.21

10.17

8.50

1.04

9.54

39.80

29.77

30.33

46.42

1.56

2.62

5.42

22.24

20.97

21.16

5.47

5.42

2.63

2.43

2.79

0.72

0.63

8.80

1.04

9.84

8.37

1.10

9.47

8.29

0.96

9.26

38.49 39.06

28.33 28.74

28.80 29.22

44.79 45.38

1.58 1.58

2.77 2.76

5.42 5.42

21.12 21.43

20.23 20.50

21.42 21.56

5.74 5.70

5.42 5.42

2.50 2.53

2.41 2.40

2.60 2.58

0.70 0.68

0.64 0.64

8.80 8.80

1.04 1.04

9.84 9.84

8.92 8.85

1.08 1.06

10.00 9.91

8.43 8.42

1.00 0.99

9.43 9.40


FY Start Date: 1/1/2005



Unit Period Detail In Staff - By Day of Week


Unit: Med SurgMon

Days(13)

Tue

Days(13)

Wed

Days(13)

Thu

Days(13)

Fri

Days(14)

Sat

Days(13)

Sun

Days(13)

Weekday Weekend PTD YTD

Days(66) Days(26) Days(92) Days(273)

I

II

III

IV

V

VI

0.00

4.71

11.64

9.85

0.03

0.00

0.00

3.83

17.15

8.99

0.00

0.00

0.02

2.81

21.10

7.13

0.08

0.00

0.00

5.43

19.85

5.04

0.00

0.00

0.00

4.75

16.02

8.39

0.00

0.00

0.02

4.14

19.30

1.77

0.08

0.00

0.00

7.50

14.12

1.98

0.00

0.00

0.00 0.01 0.01 0.02

4.31 5.82 4.74 4.88

17.14 16.71 17.02 17.33

7.89 1.88 6.19 6.50

0.02 0.04 0.03 0.02

0.00 0.00 0.00 0.00

Act Class Census

Los Adj Census

Mn Cen

WI

Acuity

Cmplx

THPWI

Direct Staffing

Budget

Rec

Actual

AHPWI

RHPWI

Non Dir Staffing

Budget

Rec

Actual

AHPWI

RHPWI

Budget HPPD

Dir

N-Dir

Total

Act HPPD

Dir

N-Dir

Total

Rec HPPD

Dir

N-Dir

Total

38.15

26.23

27.54

44.10

1.68

3.01

5.42

20.19

19.92

19.94

5.43

5.42

2.39

2.83

2.76

0.75

0.77

8.80

1.04

9.84

8.69

1.20

9.89

8.68

1.23

9.91

40.54

29.97

31.92

49.39

1.65

2.96

5.42

23.41

22.31

22.40

5.44

5.42

2.77

2.83

2.90

0.71

0.69

8.80

1.04

9.84

8.42

1.09

9.51

8.38

1.07

9.45

41.85

31.14

31.46

50.73

1.63

2.86

5.42

23.07

22.91

22.87

5.41

5.42

2.73

2.83

2.82

0.67

0.67

8.80

1.04

9.84

8.72

1.08

9.80

8.74

1.08

9.82

41.08

30.32

30.69

46.44

1.53

2.57

5.42

22.51

20.98

22.26

5.75

5.42

2.66

2.83

3.04

0.79

0.73

8.80

1.04

9.84

8.70

1.19

9.89

8.20

1.11

9.31

42.79

29.16

29.71

47.54

1.63

2.87

5.42

21.79

21.47

22.66

5.72

5.42

2.58

2.83

2.75

0.70

0.72

8.80

1.04

9.84

9.15

1.11

10.27

8.67

1.14

9.81

33.00

25.30

24.38

37.59

1.49

2.43

5.42

17.88

16.98

19.00

6.07

5.42

2.11

1.33

1.86

0.59

0.43

8.80

1.04

9.84

9.35

0.91

10.26

8.35

0.66

9.01

28.23

23.60

23.15

33.23

1.41

2.17

5.42

16.98

15.01

16.01

5.78

5.42

2.01

1.33

1.95

0.70

0.48

8.80

1.04

9.84

8.30

1.01

9.31

7.78

0.69

8.47

40.91 30.62 38.00 39.06

29.36 24.45 27.97 28.74

30.26 23.77 28.42 29.22

47.64 35.41 44.18 45.38

1.62 1.45 1.58 1.58

2.85 2.30 2.72 2.76

5.42 5.42 5.42 5.42

22.19 17.43 20.84 21.43

21.52 15.99 19.95 20.50

22.04 17.50 20.76 21.56

5.55 5.93 5.64 5.70

5.42 5.42 5.42 5.42

2.62 2.06 2.46 2.53

2.83 1.33 2.41 2.40

2.86 1.90 2.59 2.58

0.72 0.65 0.70 0.68

0.71 0.45 0.65 0.64

8.80 8.80 8.80 8.80

1.04 1.04 1.04 1.04

9.84 9.84 9.84 9.84

8.74 8.84 8.76 8.85

1.13 0.96 1.09 1.06

9.87 9.80 9.86 9.91

8.53 8.07 8.42 8.42

1.12 0.67 1.02 0.99

9.66 8.75 9.44 9.40



12/11/2005 01:41:58 PM



Unit Period Detail by ShiftThe Unit Period Detail by Shift report provides shift specific data on patient type distribution, complexity of care type, if applicable, actual census, classification census, LOS census, workload, acuity, and actual and recommended staffing and RHPWI. Data is displayed by day or by month with a period-to-date summary.

Key Features


Report can be generated by day or by month.

Display of data by shift.

Classification and LOS Census, acuity, complexity, and workload information detailed.

Unit specific display of staffing data in hours or numbers of staff.





Unit: Med Surg10

2004

Oct

112004

Nov

122004

Dec

12005

Jan

22005

Feb

32005

Mar

42005

Apr

52005

May

62005

Jun

72005

Jul

82005

Aug

92005

Sep PTD YTD

I

II

III

IV

V

VI

0.02

4.31

17.37

6.21

0.07

0.00

0.00

4.23

16.15

6.84

0.10

0.00

0.04

4.29

16.13

5.63

0.00

0.00

0.00

5.64

17.71

6.49

0.02

0.00

0.01

5.50

18.15

6.77

0.01

0.00

0.01

5.07

18.65

6.78

0.00

0.00

0.00

3.47

16.56

6.82

0.02

0.00

0.01

4.77

16.23

6.78

0.00

0.00

0.11

5.23

17.69

6.27

0.01

0.00

0.00

4.71

15.55

6.21

0.01

0.00

0.00

4.21

17.11

6.36

0.03

0.00

0.01

5.31

18.43

5.99

0.03

0.00

0.02 0.02

4.72 4.88

17.13 17.33

6.43 6.50

0.03 0.02

0.00 0.00

Act ClassCensus

Los AdjCensus

Mn Cen

WI

Acuity

Cmplx

THPWI

Dir Staffing

Budget

Rec

Actual

AHPWI

RHPWI

N-Dir Staff

Budget

Rec

Actual

AHPWI

RHPWI

Bud HPPD

Dir

N-Dir

Total

Act HPPD

Dir

N-Dir

Total

Rec HPPD

Dir

N-Dir

Total

37.29

27.97

28.48

44.31

1.58

2.78

5.42

20.89

20.01

21.63

5.86

5.42

2.47

2.35

2.65

0.72

0.64

8.80

1.04

9.84

9.11

1.12

10.23

8.43

0.99

9.42

36.97

27.31

27.83

43.86

1.61

2.86

5.42

20.41

19.81

21.51

5.89

5.42

2.41

2.43

2.64

0.72

0.67

8.80

1.04

9.84

9.28

1.14

10.42

8.54

1.05

9.59

36.19

26.08

26.32

40.96

1.57

2.75

5.42

19.30

18.50

19.87

5.82

5.42

2.28

2.45

2.60

0.76

0.72

8.80

1.04

9.84

9.06

1.19

10.24

8.43

1.12

9.55

40.45

29.87

30.55

46.57

1.56

2.75

5.42

22.40

21.04

22.12

5.70

5.42

2.65

2.35

2.45

0.63

0.61

8.80

1.04

9.84

8.69

0.96

9.65

8.26

0.92

9.19

41.29

30.44

30.89

47.78

1.57

2.77

5.42

22.65

21.58

22.67

5.69

5.42

2.68

2.40

2.35

0.59

0.60

8.80

1.04

9.84

8.81

0.91

9.72

8.38

0.93

9.32

41.87

30.51

31.10

48.06

1.58

2.78

5.42

22.80

21.71

23.02

5.75

5.42

2.70

2.45

2.55

0.64

0.61

8.80

1.04

9.84

8.88

0.98

9.87

8.38

0.94

9.32

36.70

26.88

27.30

43.55

1.62

2.84

5.42

20.02

19.67

20.72

5.71

5.42

2.37

2.38

2.81

0.77

0.66

8.80

1.04

9.84

9.11

1.23

10.34

8.65

1.05

9.69

37.55

27.79

28.23

44.20

1.59

2.81

5.42

20.70

19.96

21.43

5.82

5.42

2.45

2.40

2.57

0.70

0.65

8.80

1.04

9.84

9.11

1.09

10.21

8.49

1.02

9.51

39.80

29.32

29.77

45.87

1.56

2.71

5.42

21.83

20.72

21.83

5.71

5.42

2.58

2.43

2.74

0.72

0.64

8.80

1.04

9.84

8.80

1.10

9.90

8.35

0.98

9.33

36.23

26.49

26.81

41.99

1.59

2.76

5.42

19.66

18.97

20.09

5.74

5.42

2.32

2.35

2.13

0.61

0.67

8.80

1.04

9.84

8.99

0.95

9.95

8.49

1.05

9.54

38.03

27.71

28.19

44.20

1.59

2.77

5.42

20.68

19.96

21.04

5.71

5.42

2.44

2.45

2.85

0.77

0.66

8.80

1.04

9.84

8.95

1.21

10.17

8.50

1.04

9.54

39.80

29.77

30.33

46.42

1.56

2.62

5.42

22.24

20.97

21.16

5.47

5.42

2.63

2.43

2.79

0.72

0.63

8.80

1.04

9.84

8.37

1.10

9.47

8.29

0.96

9.26

38.49 39.06

28.33 28.74

28.80 29.22

44.79 45.38

1.58 1.58

2.77 2.76

5.42 5.42

21.12 21.43

20.23 20.50

21.42 21.56

5.74 5.70

5.42 5.42

2.50 2.53

2.41 2.40

2.60 2.58

0.70 0.68

0.64 0.64

8.80 8.80

1.04 1.04

9.84 9.84

8.92 8.85

1.08 1.06

10.00 9.91

8.43 8.42

1.00 0.99

9.43 9.40





12/11/2005 01:53:22 PM



Unit Period Detail by Shift and Day - In Staff



Unit: Med Surg Note: Data crosses more than 1 effective date range10

2004

Oct

112004

Nov

122004

Dec

12005

Jan

22005

Feb

32005

Mar

42005

Apr

52005

May

62005

Jun

72005

Jul

82005

Aug

92005

Sep PTD YTD

7A I

II

III

IV

V

VI

Act Census

Cl CensusShift LOS

CnWI

Acuity

Cmplx

Rec Dir

Rec N-Dir

Rec Total

RHPWI

Act Dir

Act N-Dir

Act Total

0.03

5.25

17.70

4.40

0.05

0.00

35.52

35.13

27.43

25.26

1.53

2.60

11.41

1.90

13.31

5.42

11.97

1.70

13.67

0.00

5.20

16.71

4.70

0.10

0.00

35.07

34.23

26.71

24.82

1.55

2.63

11.21

1.98

13.19

5.42

11.88

1.81

13.69

0.05

5.21

16.68

3.78

0.01

0.00

35.13

33.81

25.71

23.38

1.52

2.53

10.56

1.99

12.55

5.42

11.11

2.02

13.13

0.01

6.70

18.18

4.35

0.02

0.00

38.52

37.65

29.25

26.42

1.51

2.54

11.93

1.90

13.83

5.42

12.06

1.71

13.77

0.02

6.31

18.82

4.79

0.01

0.00

39.32

38.36

29.96

27.37

1.52

2.59

12.36

1.95

14.32

5.42

12.27

1.63

13.90

0.02

5.97

19.32

4.66

0.00

0.00

39.81

38.77

29.97

27.41

1.52

2.57

12.38

1.99

14.37

5.42

12.46

1.92

14.38

0.00

4.22

17.30

4.87

0.02

0.00

35.33

34.37

26.41

24.86

1.57

2.64

11.23

1.93

13.16

5.42

11.36

2.22

13.58

0.01

5.59

16.89

4.83

0.01

0.00

35.74

35.00

27.33

25.17

1.54

2.60

11.37

1.95

13.32

5.42

11.96

1.96

13.92

0.15

6.10

18.26

4.31

0.02

0.00

37.33

36.20

28.84

25.28

1.51

2.51

11.42

1.98

13.39

5.42

12.15

2.07

14.22

0.00

5.65

16.02

4.46

0.03

0.00

33.97

33.32

26.16

23.21

1.53

2.56

10.48

1.90

12.39

5.42

11.16

1.73

12.89

0.00

5.02

17.55

4.63

0.03

0.00

35.58

34.84

27.23

24.41

1.55

2.59

11.03

1.99

13.01

5.42

11.85

2.03

13.88

0.03

6.12

18.95

4.17

0.03

0.00

37.43

36.40

29.30

25.66

1.51

2.45

11.59

1.98

13.57

5.42

11.80

2.16

13.96

0.03 0.03

5.61 5.74

17.69 17.91

4.49 4.56

0.03 0.02

0.00 0.00

36.54 36.98

35.65 36.08

27.84 28.25

25.25 25.51

1.53 1.53

2.57 1.28

11.41 11.52

1.95 1.95

13.36 13.48

5.42 5.42

11.83 11.89

1.91 1.94

13.75 13.83

7P I

II

III

IV

V

VI

Act Census

Cl CensusShift LOS

CnWI

Acuity

Cmplx

Rec Dir

Rec N-Dir

Rec Total

RHPWI

Act Dir

Act N-Dir

Act Total

0.00

3.37

17.05

8.01

0.09

0.00

28.74

2.45

28.51

19.05

1.67

2.96

8.60

0.45

9.05

5.42

9.67

0.95

10.62

0.00

3.25

15.58

8.97

0.10

0.00

28.40

2.90

27.92

19.04

1.70

3.09

8.60

0.46

9.05

5.42

9.63

0.84

10.47

0.03

3.37

15.58

7.48

0.00

0.00

27.81

2.48

26.45

17.58

1.66

2.95

7.94

0.46

8.40

5.42

8.76

0.58

9.34

0.00

4.58

17.23

8.64

0.03

0.00

31.06

3.06

30.48

20.16

1.65

2.96

9.10

0.45

9.55

5.42

10.06

0.74

10.81

0.00

4.69

17.47

8.75

0.00

0.00

31.68

3.07

30.92

20.41

1.65

2.95

9.22

0.45

9.67

5.42

10.41

0.72

11.12

0.01

4.17

17.97

8.91

0.00

0.00

32.06

3.19

31.06

20.65

1.66

2.98

9.33

0.46

9.78

5.42

10.56

0.63

11.19

0.00

2.72

15.83

8.77

0.03

0.00

27.90

2.33

27.35

18.69

1.71

3.04

8.44

0.45

8.89

5.42

9.36

0.59

9.95

0.00

3.96

15.57

8.72

0.00

0.00

28.84

2.71

28.25

19.02

1.68

3.02

8.59

0.45

9.04

5.42

9.47

0.61

10.09

0.07

4.37

17.12

8.23

0.00

0.00

30.67

3.63

29.79

20.59

1.65

2.91

9.30

0.46

9.76

5.42

9.68

0.67

10.35

0.00

3.77

15.08

7.97

0.00

0.00

27.94

3.00

26.82

18.78

1.67

2.95

8.48

0.45

8.93

5.42

8.92

0.40

9.33

0.00

3.41

16.67

8.08

0.03

0.00

29.13

3.35

28.20

19.79

1.67

2.95

8.94

0.46

9.40

5.42

9.19

0.81

10.00

0.00

4.50

17.92

7.80

0.03

0.00

31.20

3.53

30.25

20.76

1.63

2.79

9.38

0.46

9.83

5.42

9.36

0.63

9.98

0.01 0.01

3.84 4.01

16.58 16.75

8.36 8.43

0.03 0.01

0.00 0.00

29.60 30.04

2.98 3.10

28.82 29.22

19.53 19.87

1.67 1.66

2.96 1.47

8.82 8.97

0.45 0.45

9.28 9.42

5.42 5.42

9.58 9.66

0.68 0.64

10.26 10.31




Unit StatisticsThe Unit Statistics report provides a comparison of budget, target, and actual parameters for monitoring productivity, budget, and cost. The data displayed on the report is based on budget, target, minimum and maximum ranges, and actual parameters, if applicable, including admissions, LOS adjusted census, midnight census, patient days, workload, LOS, acuity, complexity, direct and non-direct HPPD, and direct and non-direct HPWI. Staffing data displays by budget, recommended and actual budget includes average daily direct, non-direct and total staff; direct, non-direct and total dollars per patient day; direct, non-direct and total dollars per workload index; and direct and non-direct dollars. Variance data is also shown.

Key Features

Ability to monitor budget and actual patient days and LOS.

Ability to monitor productivity, budget, and labor costs.

Variance data to facilitate data analysis.



Unit Statistics

Date: 7/1/05 to 9/30/05


Unit: Med Surg

Statistics

Adms LOS AdjCen

Mn Cen PatientDays

WI LOS Acuity Cmplx Dir HPPD N-Dir HPPD Dir HPWI N-Dir HPWI

Budget -- -- -- 10220 44.80 -- -- -- 8.80 1.04 -- --

Minimum -- -- -- -- 40.32 -- 1.44 -- -- -- 4.88 --

Maximum -- -- -- -- 49.28 -- 1.76 -- -- -- 5.96 --

Target/Rec -- -- -- -- 44.80 -- 1.60 -- 8.42 1.02 5.42 0.65

Actual 8.93 27.97 28.42 7978 44.18 3.08 1.58 2.72 8.76 1.09 5.64 0.70

StaffDir Staff N-Dir Staff Total Staff D $/PD ND $/PD $/PD D $/WI ND $/WI $/WI Dir $ NDir $

Budget 20.53 2.43 22.96 -- -- -- -- -- -- -- --

Rec 19.95 2.41 22.36 $251.02 $16.02 $267.03 $161.50 $10.30 $171.80 $7,134.91 $455.26

Actual 20.76 2.59 23.34 $261.01 $15.63 $276.64 $167.92 $10.06 $177.98 $7,418.93 $444.39

VarianceDir Staff N-Dir Staff Total Staff D $/PD ND $/PD $/PD D $/WI ND $/WI $/WI Dir $ NDir $

R - B -0.58 -0.02 -0.60 -- -- -- -- -- -- -- --

A - B 0.22 0.16 0.38 -- -- -- -- -- -- -- --

R - A -0.80 -0.18 -0.98 -$9.99 $0.38 -$9.61 -$6.43 $0.25 -$6.18 -$284.02 $10.87




WI Measurement SummaryThe Workload Measurement Summary report provides classification, LOS and midnight census, acuity, complexity, if applicable, recommended and actual staffing, and productivity summaries for a specified date or date range. This report can be generated for one unit or multiple units. When generated for multiple units, a summary of data for all units is provided.

Key Features


User defined date ranges for summarizing data.

Days of data included in the report is displayed for each unit.

Staffing data may be reported in hours or number of staff.

Target acuity available for easy comparison to actual acuity.

Reporting of both direct and non-direct care hours.

Comparative productivity data (HPWI, HPPD).

Workload Measurement Summary Calculations

THPWI:

Unit – As defined by unit in System Parameters.

Workload:

Sum over all shifts ((Total Type I patients length of stay on each shift / specific shift length) x (specific shift distribution percentage) x methodology specific relative acuity value)

+ Sum over all shifts ((Total Type II patients length of stay on each shift / specific shift length) x (specific shift distribution percentage) x methodology specific relative acuity value)

+ Sum over all shifts ((Total Type III patients length of stay on each shift / specific shift length) x (specific shift distribution percentage) x methodology specific relative acuity value)

+ Sum over all shifts ((Total Type IV patients length of stay on each shift / specific shift length) x (specific shift distribution percentage) x methodology specific relative acuity value)



Days of data:

Unit – Total number of days of data with both classification and actual staffing data.

Actual Class Census:

Unit – Total number of patients classified / days of data.

All Units – Total number of patients classified on each unit / days of data.

LOS Adjusted Census:

Unit – (Total number of patient LOS hours (all patients, all days) / 24 hours) / days of data.

All Units – (Total number of patient LOS hours (for all units) / 24 hours) / days of data.

Midnight Census:

Unit – The number of patients as counted at midnight / days of data.

All Units – Total number of patients at midnight on each unit / days of data.

Target Acuity:

Unit – As defined by the unit.

Actual Acuity:

Unit – Sum of workload for all days of data / sum of number of LOS Adjusted Census for all days of data.

All Units – Sum of workload for all days for each unit / sum of number of patients for all days for each unit.

Complexity – (Sum of individual complexity type x (LOS / 24)) / LOS adjusted census.

+ Sum over all shifts ((Total Type V patients length of stay on each shift / specific shift length) x (specific shift distribution percentage) x methodology specific relative acuity value)

+ Sum over all shifts ((Total Type VI patients length of stay on each shift / specific shift length) x (specific shift distribution percentage) x methodology specific relative acuity value)



Recommended Staffing:

Unit2:

Direct Hours = (The sum of the workload x THPWI (Target Hours Per Workload Index) x the shift distribution percentage for specific patient type) divided by the shift length = Hourly Recommended Staff by Shift. Sum of LOS by patient type by shift x recommended staff by hour for each specific shift x skill distribution for specific shift.

Non-Direct Hours = (Sum of recommended staffing from unit tables for non-direct hours) / days of data.

Total Hours = (Recommended direct hours + recommended non-direct hours) / days of data.

All Units:

Direct Hours = Sum of recommended direct hours for each unit / days of data.

Non-Direct hours = Sum of non-direct hours for each unit / days of data.

Total Hours = (Total direct hours + total non-direct hours) / days of data.

Actual Staffing:

Unit:

Direct Hours = Sum of actual hours for direct caregivers / days of data.

Non-Direct Hours = Sum of actual hours for non-direct staff / days of data.

Total Hours = (Total actual direct staff + total actual non-direct staff) / days of data.

All Units:

Direct Hours = Sum of total direct staff for each unit / days of data.

Non-Direct Hours = Sum of total non-direct staff for each unit / days of data.

Total Hours = (Total direct staff + total non-direct staff) / days of data.

Actual HPWI:

Unit:

Direct Hours = Sum of actual direct hours for all days of data / sum of workload for all days of data.

Non- Direct Hours = Sum of actual non-direct hours for all days of data / sum of workload for all days of data.

Total Hours = (Actual direct hours + non-direct hours for all days of data) / sum of workload for all days of data.



All Units:

Direct Hours = Sum of actual direct hours for each unit for all days of data / sum of workload for each unit for each day of data.

Non-Direct Hours = Sum of actual non-direct hours for each unit for all days of data / sum of workload for each unit for all days of data.

Total Hours = (Total actual direct + non-direct hours for each unit for all days of data) / sum of workload for all units for all days of data.

Actual HPPD:

Unit:

Direct Hours = Sum of actual direct hours for all days of data / sum of number of midnight census/LOS adjusted census for all days of data.

Non- Direct Hours = Sum of actual non-direct hours for all days of data / sum of midnight census/LOS adjusted census for all days of data.

Total Hours = (Actual direct hours + non-direct hours for all days of data) / sum of midnight census/LOS adjusted census for all days of data.

All Units:

Direct Hours = Sum of actual direct hours for each unit for all days of data / sum of midnight census/LOS adjusted census for each unit for each day of data.

Non-Direct Hours = Sum of actual non-direct hours for each unit for all days of data / sum of midnight census/LOS adjusted census for each unit for all days of data.

Total Hours = (Total actual direct + non-direct hours for each unit for all days of data) / sum of midnight census/LOS adjusted census for all units for all days of data.



Workload Measurement Summary In Staff

Date: 7/1/05 to 9/30/05Note: Data crosses more than one effective date range


Unit: Med Surg THPWI: 5.42 Workload: 44.18 Days of Data: 92

ActualClass

Census

LOSAdjustedCensus

MnCensus

TargetAcuity

ActualAcuity

Cmplx Rec StaffDir

Rec StaffN-Dir

Rec StaffTotal

ActualStaff Dir

ActualStaff N-Dir

ActualStaff Total

38.00 27.97 28.42 1.60 1.58 2.72 19.95 2.41 22.36 20.76 2.59 23.34

HPWI 5.42 0.65 6.07 5.64 0.70 6.34

HPPD 8.42 1.02 9.44 8.76 1.09 9.86

Unit: Ortho THPWI: 5.38 Workload: 34.16 Days of Data: 92

ActualClass

Census

LOSAdjustedCensus

MnCensus

TargetAcuity

ActualAcuity

Cmplx Rec StaffDir

Rec StaffN-Dir

Rec StaffTotal

ActualStaff Dir

ActualStaff N-Dir

ActualStaff Total

31.22 22.51 22.66 1.58 1.52 3.04 15.32 2.58 17.89 15.63 2.68 18.31

HPWI 5.38 0.90 6.28 5.49 0.94 6.43

HPPD 8.11 1.36 9.47 8.28 1.42 9.70

Unit: Onc THPWI: 5.19 Workload: 27.1 Days of Data: 92

ActualClass

Census

LOSAdjustedCensus

MnCensus

TargetAcuity

ActualAcuity

Cmplx Rec StaffDir

Rec StaffN-Dir

Rec StaffTotal

ActualStaff Dir

ActualStaff N-Dir

ActualStaff Total

20.71 17.42 17.37 1.49 1.56 3.55 11.72 2.32 14.05 13.70 1.86 15.56

HPWI 5.19 1.03 6.22 6.06 0.82 6.89

HPPD 8.10 1.61 9.70 9.46 1.29 10.75

Unit Totals Workload 105.45 Days ofData

92

ActualClass

Census

LOSAdjustedCensus

MnCensus

TargetAcuity

ActualAcuity Cmplx

Rec StaffDir

Rec StaffN-Dir

Rec StaffTotal

ActualStaff Dir

ActualStaff N-Dir

ActualStaff Total

Total 89.92 67.90 68.46 -- 1.55 3.04 46.99 7.31 54.30 50.08 7.13 57.21

HPWI 5.35 0.83 6.18 5.70 0.81 6.51

HPPD 8.24 1.28 9.52 8.78 1.25 10.03




Workload AnalysisThe Workload Analysis report provides summarized information to evaluate the impact of the additional procedure and ADT events on acuity; and the impact of the additional procedure, ADT events, and other workload category on recommended staffing. The report provides the workload and recommended staffing for procedure workload, ADT events, and the other workload category. The target, patient type, classification, and total acuity are displayed. Additionally, the target HPWI and recommended HPWI are provided for analysis.

This report will provide recommended staffing for procedures when the procedures are set to No to include in recommended staffing if the generate alternate staffing approach is the same as the recommended staffing approach and the option to include all procedures and ADT workload in alternate staffing is set to Yes.

Key Features


Provides data to determine the impact of the additional workload on unit acuity.

Provides data to determine the recommended staffing associated with the additional workload.

Provides the target and recommended HPWI.

Staffing can be in hours or numbers.

The staff equivalent hours defaults to the equivalent hours in system parameters and can be changed.



Workload Analysis


Date: 9/21/2007 to 9/21/2007

Alternate Staffing - In Staff

Med Surg 1.60 3.49 3.72 2.30 5.63 0.32 0.20 8.45 5.42 5.58 1.13 2.54 0.17 0.09 3.93

Totals 1.60 3.49 3.72 2.30 5.63 0.32 0.20 8.45 5.42 5.58 1.13 2.54 0.17 0.09 3.93

Acuity Workload Recommended Staff

Unit Target Class Overall Class Proc ADT Other Total THPWI RHPWI Class Proc ADT Other Total



Workload Analysis by DOW by HourThe Workload Analysis by Hour of Day by Day of Week report displays the census and workload by hour by day of week. This report facilitates the analysis of average census and workload over the 24-hour period to determine opportunities for improving the matching of resources with workload. This report is only available for users with a manual or automatic ADT method for data input.

Key Features


Provides hourly data by day of week for analysis.

Provides data for analysis of matching staffing with workload.



Workload Analysis By Day of Week by Hour - Weekday

Med Surg


Hr of Day Mon

Cl Cen WI

Tue

Cl Cen WI

Wed

Cl Cen WI

Thu

Cl Cen WI

Fri

Cl Cen WI

7.00 24.54 1.46 28.54 1.76 32.35 2.01 32.14 1.88 30.86 1.83

8.00 24.56 1.46 28.50 1.76 32.35 2.01 32.19 1.89 30.86 1.83

9.00 24.62 1.47 28.44 1.76 32.31 2.01 32.15 1.89 30.70 1.83

10.00 24.64 1.50 27.91 1.74 32.02 2.00 31.51 1.86 29.45 1.78

11.00 24.81 1.57 27.05 1.73 31.07 1.98 29.95 1.79 28.31 1.77

12.00 24.94 1.63 27.09 1.79 30.85 1.99 29.74 1.80 28.44 1.83

13.00 24.79 1.68 27.08 1.82 30.76 2.03 29.97 1.86 27.70 1.83

14.00 24.09 1.69 27.23 1.86 29.77 2.01 29.95 1.88 27.00 1.83

15.00 24.37 1.76 27.92 1.95 29.73 2.03 29.14 1.87 26.75 1.86

16.00 24.79 1.82 28.67 2.04 29.66 2.05 28.54 1.86 27.35 1.94

17.00 25.44 1.89 29.26 2.11 29.77 2.09 28.06 1.84 27.77 1.99

18.00 26.10 1.96 29.80 2.16 30.05 2.12 28.34 1.87 28.08 2.02

19.00 26.28 1.98 30.36 2.20 29.96 2.11 28.54 1.89 28.69 2.07

20.00 26.78 2.02 31.03 2.25 30.51 2.16 29.13 1.94 29.04 2.09

21.00 27.18 2.05 31.41 2.28 30.75 2.18 29.70 1.98 29.21 2.11

22.00 27.27 2.06 31.63 2.30 30.98 2.20 30.28 2.03 29.31 2.12

23.00 27.39 2.07 31.79 2.31 31.28 2.23 30.61 2.05 29.62 2.14

0.00 27.57 2.08 31.89 2.32 31.56 2.25 30.78 2.06 29.83 2.15

1.00 27.86 2.10 32.12 2.34 31.64 2.25 30.94 2.07 29.93 2.16

2.00 28.13 2.12 32.25 2.35 31.83 2.27 31.04 2.08 30.08 2.17

3.00 28.23 2.13 32.31 2.36 31.92 2.27 31.20 2.09 30.14 2.17

4.00 28.23 2.13 32.31 2.36 32.06 2.28 31.23 2.09 30.24 2.18

5.00 28.31 2.13 32.31 2.36 32.08 2.28 31.23 2.09 30.29 2.18

6.00 28.51 2.14 32.31 2.36 32.08 2.28 31.23 2.09 30.32 2.18

Total

Avg/Hr

38.15 44.91

26.23 44.91

40.54 50.23

29.97 50.23

41.85 51.12

31.14 51.12

41.08 46.79

30.32 46.79

42.79 48.08

29.16 48.08



Workload Analysis By Day of Week by Hour - Weekend

Med Surg


Hr of Day Sat

Cl Cen WI

Sun

Cl Cen WI

7.00 30.11 1.79 25.08 1.44

8.00 30.15 1.80 25.08 1.44

9.00 30.10 1.80 25.10 1.44

10.00 29.41 1.76 24.90 1.43

11.00 27.70 1.68 24.51 1.42

12.00 25.97 1.59 24.24 1.41

13.00 24.76 1.53 23.74 1.38

14.00 24.01 1.49 23.12 1.35

15.00 23.81 1.48 22.60 1.33

16.00 23.69 1.47 22.38 1.32

17.00 23.37 1.45 22.27 1.32

18.00 23.27 1.45 22.31 1.32

19.00 23.14 1.44 22.46 1.33

20.00 23.51 1.46 22.62 1.34

21.00 23.85 1.48 22.70 1.34

22.00 24.07 1.50 22.77 1.35

23.00 24.20 1.51 22.96 1.36

0.00 24.24 1.51 23.17 1.37

1.00 24.27 1.51 23.53 1.39

2.00 24.49 1.53 23.85 1.41

3.00 24.69 1.54 24.11 1.43

4.00 24.69 1.54 24.24 1.44

5.00 24.77 1.55 24.31 1.44

6.00 24.97 1.56 24.38 1.45

Total

Avg/Hr

33.00 37.41

25.30 37.41

28.23 33.24

23.60 33.24



Workload by Hour of DayThe Workload by Hour of Day report displays the census, workload, complexity if applicable, acuity, and recommended and actual direct and non-direct staff in hours and in hours per workload index. This report facilitates the analysis of average census and workload over the 24-hour period to determine opportunities for improving the matching of resources with workload. Workload reflected on this report is weighted by the shift distribution goal set defined for each unit within the software. This report is only available with a manual or automatic ADT method for data input.

Key Features


Provides hourly data for analysis.

Provides data for analysis of matching staffing with workload.



Workload By Hour of Day

Date: 7/1/05 to 9/30/05


Med Surg

HourStarted Cl Cen WI Acuity Cmplx

7.00 29.11 1.74 1.67 2.28

8.00 29.12 1.74 1.67 2.29

9.00 29.08 1.74 1.67 2.29

10.00 28.56 1.73 1.68 2.32

11.00 27.64 1.71 1.72 2.40

12.00 27.34 1.72 1.75 2.48

13.00 26.98 1.73 1.79 2.56

14.00 26.46 1.73 1.82 2.64

15.00 26.34 1.75 1.85 2.72

16.00 26.45 1.79 1.88 2.79

17.00 26.58 1.81 1.90 2.84

18.00 26.86 1.84 1.91 2.86

19.00 27.08 1.86 1.39 2.87

20.00 27.53 1.90 1.39 2.88

21.00 27.84 1.92 1.39 2.89

22.00 28.06 1.94 1.39 2.90

23.00 28.28 1.95 1.39 2.90

0.00 28.45 1.96 1.39 2.90

1.00 28.63 1.98 1.39 2.90

2.00 28.83 1.99 1.39 2.90

3.00 28.96 2.00 1.39 2.90

4.00 29.02 2.00 1.39 2.90

5.00 29.05 2.01 1.39 2.90

6.00 29.13 2.01 1.39 2.90

Total 9.08 44.18 1.58 2.72

Avg/Hr 27.97 1.84 1.58 2.72

Recommended Staffing Actual Staffing Actual Hours per Workload

Dir N-Dir Dir N-Dir Dir N-Dir Total

10.95 1.96 11.60 1.97 6.66 1.13 7.80

10.96 1.96 11.60 1.97 6.65 1.13 7.78

10.96 1.96 11.60 1.97 6.65 1.13 7.79

10.86 1.96 11.60 1.97 6.72 1.14 7.86

10.73 1.96 11.60 1.97 6.80 1.16 7.96

10.82 1.96 11.60 1.97 6.74 1.15 7.89

10.88 1.96 11.60 1.97 6.70 1.14 7.84

10.89 1.96 11.60 1.97 6.70 1.14 7.84

11.03 1.96 11.60 1.97 6.61 1.12 7.74

11.25 1.96 11.60 1.97 6.49 1.10 7.59

11.41 1.96 11.60 1.97 6.39 1.09 7.48

11.60 1.96 11.60 1.97 6.29 1.07 7.36

8.48 0.45 9.15 0.61 4.91 0.33 5.24

8.63 0.45 9.15 0.61 4.83 0.32 5.15

8.74 0.45 9.15 0.61 4.77 0.32 5.09

8.82 0.45 9.15 0.61 4.72 0.32 5.04

8.89 0.45 9.15 0.61 4.69 0.31 5.00

8.94 0.45 9.15 0.61 4.66 0.31 4.97

9.01 0.45 9.15 0.61 4.63 0.31 4.94

9.07 0.45 9.15 0.61 4.60 0.31 4.90

9.11 0.45 9.15 0.61 4.58 0.31 4.88

9.13 0.45 9.15 0.61 4.57 0.31 4.87

9.14 0.45 9.15 0.61 4.56 0.31 4.87

9.16 0.45 9.15 0.61 4.55 0.31 4.85

239.46 28.91 249.09 31.04 5.59 0.70 6.28

9.98 1.20 10.38 1.29 5.59 0.70 6.28




Define SVH factor.

Calculate average daily coverage, SVH replacement factor, and annual FTEs.

Calculate percent budgeted staff by personnel category and by shift.

Define the process of budgeting using QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System data.

OverviewManagers are aware that resources such as time, commitment, money, supplies, and humans are generally not as available or plentiful as might be desired. Resources are finite and need to be judiciously used and allocated. Therefore, effective budgeting skills are essential.

The patient care department budget is almost exclusively related to resource consumption costs, including salaries, supplies, and equipment, and is traditionally perceived as an expense rather than an investment. This presumption consistently puts managers in a defensive position. They must compete aggressively with other departments for a fair share of limited resources. Success in such competition takes preparation, information, and a clear strategy.

The personnel budget generally represents the greatest expenditure for a patient care cost center (unit). It is also the part of the budget over which the manager has the most control. Within the personnel budget, FTEs, positions, and employment costs are identified. It is important to understand the concept of Full Time Equivalent (FTE) and to differentiate between that and position. Other budgeting concepts that the manager must understand are that of direct versus non-direct staff, Hours Per Patient Day (HPPD), Hours Per Patient Visit (HPPV) replacement factors, and productive and non-productive time.



DefinitionsFull Time Equivalent (FTE)

A Full Time Equivalent (FTE) is a conversion of hours to a standard base of one employee paid for 8 hours a day, 5 days a week, 52 weeks a year:

8 hours/day x 5 days/week x 52 weeks/year = 2080 hours; or

2080 hours / 8 hours/day = 260 shifts/year.

In some organizations, the standard work week is determined to be other than 40 hours (the equivalent of five 8-hour days). For example, in many hospitals the standard work week is 37.5 hours or five 7.5-hour days. In this instance, the standard FTE is 1950 hours, as follows:

7.5 hours/day x 5 days/week x 52 weeks/year = 1950 hours; or 1950 hours / 7.5 hours/day = 260 shifts/year.

Note the total hours in the second example are fewer, but the total shifts remain the same.

Another variation that may affect the definition of an FTE is the employee who works seven 10-hour days in a 2-week period. The calculation is as follows:

10 hours/day x 7 days/2 weeks x 26 periods/year = 1820; or


One other common variation of the definition of an FTE is the employee who works six or seven 12-hour shifts in a 2-week period. Examples follow:





In these examples, note how both the total hours and the number of shifts are affected by the variation in the definition of the standard.

In identifying the appropriate calculation for an FTE in an organization, it is important to describe the full-time employee in terms of total hours paid. The personnel and payroll policies of the organization generally determine the definition of an FTE.

Position

A position is one job for one person, regardless of the number of hours that person works. Personnel reports generally describe positions by job category and regularly worked hours (full time, part time, or per diem). Position control, vacancy, and turnover reports are also generated using positions.

See Sample Replacement Factor Calculations on page 383 for examples of replacement factor calculations.



Multiple part time positions (within the same job class) may equate to one FTE. That is one position may be an employee who works 3 days per week and another position may be an employee who works 2 days per week.

Direct Staff

The hours for direct staff tend to fluctuate based on the workload. That is, caregivers whose numbers are increased or decreased in relation to the level of workload. They may often be referred to as the direct care providers and are generally in the job categories of RN, LPN, and NA.

Non-Direct Staff

The hours for non-direct staff do not fluctuate based on workload, for example, the Unit Manager and clerk. In some instances their numbers may fluctuate by census.

Hours Per Patient Day (HPPD)

Those hours budgeted, targeted or available for each patient each day within a clinical service or patient care area. Often, the HPPD will be reported as a total, which includes both the direct and non-direct staff. If the HPPD is reported as direct, this would include only the hours provided by the direct staff. An organization may budget a medical patient day at 7.50 hours and a critical care patient day at 21.00 hours, reflecting the total budgeted hours per patient day. Simply put, each patient, regardless of need has been allocated 7.50 hours or 21.00 hours of staff resources in a 24-hour period. The direct HPPD is often more meaningful when assessing levels of productivity. The calculation involves first determining the total budgeted annual hours and deducting the non-direct staff hours. The number of budgeted patient days is required.

Example

Budgeted Patient Days = 9125

Total HPPD = 7.50

Non-Direct Staff = 1 Manager 5 days/week and 2 Secretaries 7 days/week: (3 staff/day x 5 days = 120 hours/week, and 2 staff/day x 2 days = 32 hours/week)

9125 patient days x 7.50 HPPD = 68437.50 total staff hours budgeted

Total Non-Direct Staff Hours: (120 hours/week + 32 hours/week) x 52 weeks = 7904 hours

68437.50 - 7904 = 60533.5 direct staff hours

60533.5 / 9125 = 6.63 direct HPPD

8 Hours/day x 3 days/week x 52 weeks/year = 1, 248 hours

+ 8 Hours/day x 2 days/week x 52 weeks/year = 832 hours

2, 080 hours



Replacement Factor

The replacement factor is that portion of a full time equivalent required to replace an employee for earned (benefit) time off for which they receive pay and to cover the days which a standard FTE does not work. That is, an organization that operates seven days per week, as do hospitals and their patient care units, must provide staffing seven days per week, 52 weeks per year (2912 hours) The average employee or one FTE equates to only 2080 hours per year. Using the example of the standard FTE represented by the 40-hour work week (8 hours/day x 5 days/week); an additional 2 days per week must be staffed. The weekend replacement may be calculated as follows:

8 hours/day x 2 days/week x 52 weeks/year = 832 hours/year

832 hours/year / 2080 hours/year = 0.4

Therefore, for each FTE employee an additional 0.4 FTE is required to cover the 2 days per week that the full time employee is not scheduled to work in order to cover the 7-day work week.

Additionally, employees are allotted time off for which they are paid as benefit time. This generally includes sick, vacation, holiday, and mandatory education time. It is often referred to as Paid Time Off (PTO). A replacement for anticipated time off must also be determined and planned for in the budgeting process. If, for example, an employee earned 240 hours of benefit time (PTO) annually, and they were an FTE defined by 2080 hours, they would only work 1840 hours (2080 - 240). The portion of the FTE required to replace for the 240 hours is 0.13 (240 / 1840). Therefore, adding 1.0 to each of the factors and multiplying the “weekend” replacement by the PTO replacement determines the total replacement factor:

(1.0 + 0.4) x (1.0 + 0.13) = 1.58.

Simply stated, each full time equivalent requires another 0.58 (0.6) FTE to cover or replace days off. This is the equivalent of approximately 3 days per week.

Productive Time

Often referred to as worked time, productive time includes straight time and overtime.

Nonproductive Time

This is time that the employee does not work, but for which she/he is paid benefit time. It generally includes sick, vacation, holiday and other paid, non-worked time.

Implications for ManagersIn order to prepare and manage the budget for a patient care unit, the manager must be familiar with the financial structure and reporting systems of the organization and with the data reported through these systems. The data is analyzed in conjunction with other known factors to define operational goals and to predict levels of activity and resource utilization.

See Sample Replacement Factor Calculations on page 383 for examples of replacement factor calculations.



The labor resource budget identifies full time equivalents and positions. Workload is the basis for quantifying the productive hours required, as well as allocating these hours by shift and skill category. Determining coverage requirements for non-productive time is based on historical data and organizational policies. These hours are added to the productive hours to determine total required FTEs. Additionally, fixed staff requirements to maintain the unit and support the variable staff are identified and incorporated into the total budget.

The salary budget includes expenses for regular salaries, differentials and premiums, fringe benefits, and related employment costs.

The AcuityPlus system provides a means of tracking actual performance against budgetary goals and responding to that information on a concurrent basis. The system provides for the input of several budget parameters and reports these values for the specified time period along with the actual performance values.

The ongoing and trend data related to the patient mix and workload provides information that may be used to justify/support budget to actual performance variances. It further provides valuable information to assist with preparation of future budgets.

Budgeting Procedure1. Obtain unit specific budgeted daily census.

This information is most often obtained from the hospital finance department. Volume projections may be defined in terms of budgeted patient days or percent occupancy, these numbers can easily be translated into budgeted daily census.

2. Develop unit specific projected average overall acuity. Evaluation of the projected overall acuity includes:

Examining the accuracy of historical average overall acuities by reviewing patient classification monitoring scores, accuracy and completeness of activity classifications, and feedback from other system control mechanisms.

Considering projected changes in overall acuity that may result from new services to be provided, shifts in patient populations, etc.

Making adjustments in projected overall acuity if needed based on these findings.

3. Calculate the budgeted workload index.

Multiply the budgeted daily census times the projected overall acuity. If workload fluctuation is significant, you may choose to utilize an adjusted workload index for budgeting, for example, the workload index at the 70th or 80th percentile rather than the projected average (see Workload Fluctuation Analysis on page 387).



4. Select the target HPWI for budgeting.

A variety of philosophical, financial and quality issues must be addressed before final selection of a budgeted target HPWI.

Compare historic target HPWI against actual HPWI for each unit and the hospital in total.

Identify units consistently outside the target range and examine factors that may be contributing to this, for example, low census, minimum staffing requirements, geographic constraints, unit management issues, etc.

Compare current quality of care with desired level of quality of care.

Examine financial constraints, feasibility, and effects of budgeting at various target HPWIs before making a final selection.

5. Review and adjust staffing parameters.

Examine current philosophy and goals for shift and personnel mix based on acuity.

Review target allocation parameters versus using actual historic data.

Examine constraints, feasibility, and effects of budgeting using various staffing parameters.

Compare each unit’s staffing parameters with similar units in the National Database.

6. Calculate the budget.

Use the attached worksheets to calculate the direct staff requirements for each patient care unit.

Determine the replacement factor for sick, vacation, holiday, and weekends (see Calculating a Replacement Factor on page 380) and apply by skill level to calculate total variable nursing FTE requirements. Consider including a replacement factor for education and orientation.

Once the budgeted variable caregivers are determined, add any fixed FTE requirements, such as, Unit Manager, Unit Secretary, Monitor Technician, etc.

Compare the total number of budgeted FTEs to the current number of budgeted positions and adjust if necessary. Examine constraints, feasibility and effects of projected budget changes.



Unit Labor Resource Budget Worksheet Unit: Date:

1. Budgeted Census x Budgeted (Targeted) Overall Acuity

= Budgeted Workload (WI)

x =

2. Budgeted WI x Target HPWI = Total Direct Care Hours per 24 hours

x =

3. NCH/24 hours / 8 (hours per shift) = Total number of direct staff for 24 hours

/ =

4. Total Direct Staff / 24 Hours x % / Shift Goal = Total Direct Staff for Each 8-Hour Shift

Total Staff x % Days = Staff on Days

Total Staff x % Evenings = Staff on Evenings

Total Staff x % Nights = Staff on Nights

5. Direct Staff / Shift x % / Skill Category Goal = Direct Staff / Skill Category / Shift

Days: x % RN = RN Days

x % LPN = LPN Days

x % NA = NA Days

x % Other = Other Days

Eves: x % RN = RN Evenings

x % LPN = LPN Evenings

x % NA = NA Evenings

x % Other = Other Evenings

Nights: x % RN = RN Nights

x % LPN = LPN Nights

x % NA = NA Nights

x % Other = Other Nights

6. Total Direct Staff / Skill x SVHW Factor* = Total FTEs / Skill Category

Total RN (all shifts) x SVHW = RN FTEs

Total LPN (all shifts) x SVHW = LPN FTEs



* SVHW = Sick / Vacation / Holiday / Weekend Factor (may also include replacement for education and orientation time).

Total NA (all shifts) x SVHW = NA FTEs

Total Other (all shifts) x SVHW = Other FTEs

7. Total Direct Care FTEs =

8. Add Non Direct FTE requirement (calculate SVHW* for skill category, as appropriate):

Unit Manager

Unit Secretaries

Monitor Technicians

9. Total FTEs =



Unit Labor Resource Budget Worksheet Example:Unit: 2 East Date: October 2007



30.0 x 1.10 = 33.0


33.0 x 5.50 = 181.5


181.5 / 8 = 22.7


Total Staff 22.7 x 38 % Days = 8.6 Staff on Days

Total Staff 22.7 x 33 % Evenings = 7.5 Staff on Evenings

Total Staff 22.7 x 29 % Nights = 6.6 Staff on Nights


Days: 8.6 x 56 % RN = 4.8 RN Days

8.6 x 22 % LPN = 1.8 LPN Days

8.6 x 22 % NA = 1.8 NA Days


Eves: 7.5 x 50 % RN = 3.8 RN Evenings

7.5 x 25 % LPN = 1.9 LPN Evenings

7.5 x 25 % NA = 1.9 NA Evenings


Nights: 6.6 x 57 % RN = 3.8 RN Nights

6.6 x 14 % LPN = 0.9 LPN Nights

6.6 x 29 % NA = 1.9 NA Nights



Total RN (all shifts) 12.4 x 1.58 SVHW = 19.6 RN FTEs

Total LPN (all shifts) 4.6 x 1.58 SVHW = 7.3 LPN FTEs




Calculating a Replacement FactorThe replacement factor includes all the non-productive time and days off allocated to employees. Multiplying the number of employees required each day by the replacement factor determines the number of FTEs needed. Items that may be included in the replacement factor are:

Days Off

Vacation

Holidays

Sick Time

Education

Orientation*

* A factor for orientation should be included in the overall replacement factor, as the first two to eight weeks of employment are often considered non-productive, and therefore not included in the actual hours per patient day and actual hours per workload index.

Total NA (all shifts) 5.6 x 1.58 SVHW = 8.8 NA FTEs


7. Total Direct Care FTEs = 35.7


Unit Manager 1.0

Unit Secretaries 3.2

Monitor Technicians

9. Total FTEs = 39.9



Calculations1. Replacement for time off:

Number of Days per Week / Number of Days Worked

Examples:

a. 40 Hour Work Week / 8 Hours per Day = 5 DaysTotal Days per Week = 7 Days7 / 5 = 1.40

b. 36 Hour Work Week / 12 Hours per Day = 3 DaysTotal Days per Week = 7 Days7 / 3 = 2.33

c. 80 Hours Worked per 2 Weeks / (6) 12 Hour Shifts = 6.67 DaysTotal Days per 2 Weeks = 14 Days14 / 6.67 = 2.10

d. 40 Hours Worked per Week / 10 Hour Shifts = 4 DaysTotal Days per Week = 7 Days7 / 4 = 1.75

2. Replacement for benefit factors: Hours of Benefit Time / (Total Hours Worked - Benefit Hours)

Examples:

Benefits (All 8 Hour Days):

a. 40 Hours/Week (8-Hour Shifts) x 52 Weeks = 2080 Hours per Year312 / (2080 - 312) = 0.176 or 0.18

b. 36 Hours/Week (12-Hour Shifts) x 52 Weeks = 1872 Hours per Year312 / (1872 - 312) = 0.20

Vacation - 15 Days/Year = 120 HoursSick Time - 12 Days/Year = 96 HoursHolidays - 10 Days/Year = 80 HoursEducation - 2 Days/Year = 16 HoursTotal = 312 Hours



c. 80 Hours/2 Weeks [(6) 12 Hour and (1) 8-Hour Shift] x 52 Weeks = 2080 Hours per Year312 / (2080 - 312) = 0.176 or 0.18

3. Replacement for Orientation:12% Turnover Rate400 EmployeesAverage of 4 Weeks Orientation = 20 Days x 8 Hours = 160 Hours per Person % Turnover x (# Employees x Hours of Orientation/Person) / # of Employees

0.12 x (400 x 160) / 400 = 19.2 Hours per Employee

This time can be allocated per employee and replaced as a benefit factor or placed in a separate unit budget for the department. If placed in a nursing department budget, the total hours [0.12 x (400 x 160) = 7680] would be budgeted. If budgeted to each nursing unit, it would be calculated as a benefit factor of 19.2 hours per employee.

Per Employee Example: Hours of Orientation per Employee / (Standard FTE Hours - Orientation Hours)

a. 40 Hours/Week 8-Hour Shifts = 2080 Hours per Year (Standard FTE)19.2 / (2080 - 19.2) = .009 or .01

b. 36 Hours/Week 12 - Hour Shifts = 1872 Hours per Year (Standard FTE)19.2 / (1872 - 19.2) = .01

c. 80 Hours/2 Weeks [(6) 12 Hour and (1) 8-Hour Shift) x 52 Weeks = 2080 Hours per Year19.2 / (2080 - 19.2) = .009 or .01

4. Total Replacement factor: (1 + Benefit Factor + Orientation Factor) x Days Off Factor

Examples:

a. 40 Hours per Week (8-Hour Shifts)(1 + 0.18 + 0.01) x 1.4 = 1.666 or 1.67

b. 36 Hours per Week (12-Hour Shifts)(1 + 0.20 + 0.01) x 2.33 = 2.819 or 2.82

c. 80 Hours per 2 Weeks [(6) 12-Hour Shifts and (1) 8-Hour Shift]

Replacement factor for 10-hour shifts is the same as for 8-hour shifts.

Replacement factor for 10-hour shifts is the same as for 8 hour shifts.



(1 + 0.18 + 0.01) x 2.10 = 2.499 or 2.50

d. 40 Hours per Week (10-Hour Shifts)

(1 + 0.18 + 0.01) x 1.75 = 2.083 or 2.08

5. Replacement Factor for 12 Hour Weekend Shifts:

Example:

Work 48 of 52 Weekends per Year

Total Weekend Days = 52 x 2 = 104

Total Worked Days = 48 x 2 = 96

Total Worked Hours = 96 x 12 = 1152

Replacement Time Off: 104 / 96 = 1.08

Benefit Factor: 64 / (1152-64) = .058 or .06

Orientation: No Time Budgeted

Total Replacement Factor = (1 + 0.06) x 1.08 = 1.14

If you use weekend staff, the replacement factor for your other employees is different for the number of days off calculation, as there are fewer days to replace this staff.

Sample Replacement Factor Calculations

Sample 1

1. Sum the hours of sick, vacation, and holiday benefits for the unit’s average employee for one year:

2. Divide total SVH hours by the standard hours for 1.0 FTE (2080) minus the benefit hours.

Benefits: Vacation 4 Days/Year = 32 HoursHoliday 4 Days/Year = 32 HoursSick NoneEducation NoneTotal 64 Hours

12 Sick Days x 8 Hours = 9610 Vacation Days x 8 Hours = 808 Holidays x 8 Hours = 64Total 240 Hours



240 / (2080 - 240) = .13

3. Add the SVH benefit factor to 1.0 FTE to compute the SVH replacement factor.

1.0 + .13 = 1.13 SVH Replacement Factor

Sample 2(Used when provided a percent benefit or to calculate the percent benefit per employee)

1. Same as step one in Sample 1.

2. To calculate the percent benefit, divide total SVH benefit hours by 1.0 FTEs hours.

240 / 2080 = 0.115 or 11.5% SVH Benefit Factor

3. Calculate the SVH replacement factor.

1.0 / (1.0 - .115) = 1.13 SVH Replacement Factor

The above samples do not include a weekend replacement. To reflect the weekend replacement in the Total replacement, the SVH Factor is multiplied by 1.4.


Appendix A Variable Staffing Calculations

Patient classification is generally performed one time per day, on the day shift, and staffing is projected for the following 24-hour period based on the daily workload measure. There are occasions when the change in census and/or workload from one shift to the next is significant enough to warrant an adjustment to the recommended staff level. The following technique provides a guideline for making the staffing adjustment.

1. Calculate the hours of care recommended for one unit of workload on each shift. Use the Target Hours Per Workload Index (THPWI) and the recommended/desired shift distribution.

If the THPWI is 5.50 and the shift distribution is 42% days, 34% evenings, and 24% nights; then one unit of workload (WI) should receive the following amount of care for each shift:

Days 42% x 5.5 = 2.31 or 2.3 hours

Evenings 34% x 5.5 = 1.87 or 1.9 hours

Nights 24% x 5.5 = 1.32 or 1.3 hours

2. Determine the amount of workload one 8-hour caregiver can manage:

Days: 8 Hours / 2.3 Hrs/WI = 3.5 WI (or 3.5 type II patients)

Evenings: 8 Hours / 1.9 Hrs/WI = 4.2 WI

Nights: 8 Hours / 1.3 Hrs/WI = 6.2 WI

Therefore, a change in workload of 3.5 units from classification until days, the next day, would justify a change in staffing of one 8-hour caregiver. A change in workload of 4.2 units from classification until evenings and/or a change in workload of 6.2 units until nights would justify a similar change in staffing for nights. Since most units have a mix of patients of varying types, it is necessary to translate the number of workload units into a number of patients. This is done using the unit’s expected acuity and is calculated as follows in step 3.

3. Translate the WI into number of patients. Use the target/expected acuity.

Expected Acuity = 1.25

Days: 3.5 WI /1.25 = 2.9 patients



Evenings: 4.2 WI / 1.25 = 3.4 patients

Nights: 6.2 WI / 1.25 = 5.0 patients

Therefore, a change in census of 3 patients (2.9) from classification until days, the next day, would justify a change in staffing of one 8-hour care provider. A change in census of 3.4 patients from classification until evenings and/or a change in census of 5 patients until nights would justify a similar change in staffing.

Using this technique, where the average census is 30 with a range between 20 and 40, a sample staffing grid be:

Acuity 1.25 THPWI 5.5 %D 42% %E 34% %N 24%TOTAL

CENSUS WI REC HOURS STAFFING

20 25.0 137.50 7 6 4 17

21 26.3 144.38 8 6 4 18

22 27.5 151.25 8 6 5 19

23 28.8 158.13 8 7 5 20

24 30.0 165.00 9 7 5 21

25 31.3 171.88 9 7 5 21

26 32.5 178.75 9 8 5 22

27 33.8 185.63 10 8 6 23

28 35.0 192.50 10 8 6 24

29 36.3 199.38 10 8 6 25

30 37.5 206.25 11 9 6 26

31 38.8 213.13 11 9 6 27

32 40.0 220.00 12 9 7 28

33 41.3 226.88 12 10 7 28

34 42.5 233.75 12 10 7 29

35 43.8 240.63 13 10 7 30

36 45.0 247.50 13 11 7 31

37 46.3 254.38 13 11 8 32

38 47.5 261.25 14 11 8 33

39 48.8 268.13 14 11 8 34

40 50.0 275.00 14 12 8 34



OverviewThe AcuityPlus system data can be used to plan the direct staff labor budget and predict the required FTEs to meet patient care needs. The calculations are generated using historic average workload and the target hours per workload index. Some units, however, demonstrate such extreme and frequent workload fluctuation that budgeting for an average workload may put them at risk of being able to contain variable staff costs within the budgeted level. The concept of units being at risk is illustrated here:



Unit A demonstrates minimum workload fluctuation around the average. Minimum staffing constraints occasionally occur, but generally the unit should be able to flex staffing from day to day to match workload requirements. This type of a workload pattern is usually presented on patient care units that have somewhat predictable patterns of admission, discharge, and acuity. Over time, the unit should be able to meet budgetary staffing projections if the mean workload remains fairly constant. In general, this type of workload pattern is seen on most medical, surgical, and long-term care units, such as, rehabilitation, and skilled nursing units.

Unit B demonstrates more dramatic workload fluctuation from the average. Minimum staffing constraints may significantly affect the unit’s ability to react to decreases in workload, thereby, raising labor costs. Sudden, unpredictable increases in workload may necessitate using overtime hours, float, or agency coverage to meet the required staffing levels. This type of a workload pattern is reflective of units with unpredictable changes in census and/or acuity. The units are at risk for exceeding their budget due to the inability to consistently flex staffing levels with workload changes. Any unit where census and acuity fluctuate may be budgetarily at risk. Common examples of units at risk are post-partum, nursery, critical care, and short-stay surgical units.

Using 100 consecutive days of workload data, it is relatively easy to analyze a unit’s degree of workload fluctuation. The Workload Index (WI) for each of the 100 days is ranked from lowest to highest, and workload is identified at the various percentiles (20th, 50th, 80th). Units demonstrating a variance between high workload, represented by the 80th percentile, and low workload of 30% or greater, represented by the 20th percentile, tend to be budgetarily at risk. The percent variance in workload is calculated as follows:

% Variance = WI at the 80th percentile - WI at the 20th percentile x 100%

WI at the 80th percentile



Note that the formula for calculating the percent variance in workload ignores the extremes of workload indices greater than the 80th percentile or less than the 20th percentile. Calculations are based on those values that fall closer to the median as demonstrated in the normal workload distribution curve below:

Units identified as at risk may be budgeted for a higher than average workload. However, their staffing target should remain the same. Since the workload on risk level units is unstable and somewhat unpredictable, they need dollars budgeted for those times when they must staff above the workload requirements (minimum staffing) or when the workload is significantly greater than the average (workload fluctuation). The degree of risk that is budgeted for these units is dependent on:

The ability to flex staff in these units;

The ability to minimize workload fluctuation; and

Financial constraints.

Increased flexibility in floating staff between units could decrease the total risk of going over budget. Cross-training, sharing of staff during a shift, and an on call system could allow for higher staffing patterns with appropriately trained nurses available if the need arose.

In order to minimize workload fluctuations, a process to control patient placement could be considered. If this combining is not feasible due to specialty areas, then combining patient populations should be considered when workload decreases significantly in one or more units. This has the potential for representing a major cost savings. Combining patient populations at pre-defined times would allow for staffing some units at a maximum productivity versus keeping all units open at minimum staffing levels, decreasing productivity, and escalating costs.

The ultimate factor in how much to budget for workload fluctuation depends on the bottom line. Some hospitals will budget and staff Risk Level Units at the 50th percentile (average) of workload; and budget float pool or agency FTEs represented by the difference in staffing requirements from the 50th percentile to the 80th percentile of workload.



Any combination of risk level budgeting is appropriate if it meets the needs of the patient care division and meets budgetary constraints. If FTEs are reallocated from other units to allow for risk level budgeting, in effect that is taking real staffing needs from one unit to allow for the potential workload fluctuation on risk level units. The cost benefit of such a decision must be considered, as well as the overall resulting quality of care on all patient care units. In such a situation, policies should define when risk level staff must be available to float back to the other units to meet real staffing requirements.


AcuityPlus™Inpatient Coordinator Guide Appendix B Workload Fluctuation Analysis

Historical Workload Fluctuation Analysis Worksheet

UNIT% VARIANCE (80-20)/80

20TH 50TH 70TH 75TH 80TH 85TH 100TH

WI STAFF WI STAFF WI STAFF WI STAFF WI STAFF WI STAFF WI STAFF


AcuityPlus™Inpatient Coordinator Guide Appendix B Workload Fluctuation Analysis

Historical Workload Fluctuation Analysis ExampleDate Range: 6/9 - 9/17 (100 days) Target Hours Per Workload Index = 5.0

UNIT

PERCENTILE OF RISK

20TH 50TH 80TH 85TH 100TH VARIANCE*

WI DAILY STAFF

WI DAILY STAFF

WI DAILY STAFF

WI DAILY STAFF

WI DAILY STAFF

1A 25.8 16.1 33.1 20.7 39.7 24.8 42.2 26.4 52.0 32.5 35%

1B 30.2 18.9 34.2 21.4 42.5 26.6 44.1 27.6 52.2 32.6 29%

1C 15.2 9.5 21.3 13.3 24.5 15.3 24.5 15.3 27.9 17.4 38%

2A 13.1 8.2 16.3 10.2 19.8 12.4 20.6 12.9 23.6 14.8 34%

2B 63.7 39.8 84.5 52.8 93.0 58.1 96.2 60.1 108.7 67.9 31%

2C 12.2 7.6 19.2 12.0 24.5 15.3 25.1 15.7 31.3 19.6 50%

3A 6.1 3.8 10.1 6.3 13.9 8.7 15.7 9.8 21.1 13.2 56%

Totals 166.3 103.9 218.7 136.7 257.9 161.2 268.4 167.8 316.8 198 35%

* % Variance = WI at the 80th percentile - WI at the 20th percentile x 100%

WI at the 80th percentile



OverviewSome staff perform activities/procedures on and/or off the unit that may impact the overall unit workload and staffing requirements. Typically these activities/procedures are not related to direct patient care and therefore unaccounted for in workload measurement via patient classification. When this occurs, units may want to quantify time required for these activities to determine significance to the overall staffing requirement. One means of quantifying such time is to maintain activity logs for a designated data collection period. Following are some activity log examples and the steps to consideration when undertaking this means of data collection.

1. Identify the activities/procedures for which staff time will be quantified and create an Activity Log for each activity/procedure for which data collection is to occur. A sample Activity Log form follows on page 396; it should be revised as necessary to capture the data necessary to the specific activity time quantification. Depending on the volume of the activity/procedure, it may be necessary to have a log form for each day during the collection period. Typical data to capture on the activity log is:

Unit identification and data collection period

Name/description of activity/procedure

Date of occurrence

Patient identification

Time activity/procedure started

Time activity/procedure ended

Total time, generally recorded in minutes, for each occurrence (end time and start time)

Caregiver identification (it may be helpful to evaluate the skill level typically engaged in the activity/procedure)

2. Compile the activities/procedures data to get the total amount of time spent during the data collection period for each activity. Transfer the information to the Activity Log Summary. A sample Log Summary follows on page 397 and can be adapted to accommodate the organizational needs, for example, all activities for a single unit on one summary sheet or one activity for all units on a summary sheet. Typical summary information should include:



Unit identification

Name of activity/procedure

Data collection period

Total time recorded for each activity

Number of occurrences of each activity

Average number of hours per day (24-hours) per activity

Impact on Target Hours per Workload Index and/or FTEs



Activity Log WorksheetActivity: ___________________________________________________________________

Unit: _________________ Data Collection Period: ____________________________

DATE PATIENT ID TIME STARTED TIME ENDED TOTAL TIME CAREGIVER



Sample Activity LogActivity: Administration of Chemotherapy on Other Units

Unit: Oncology Data Collection Period: February 1 – 28, 2006 (28 days)

Total Occurrences: 23 Total Time: 1253 minutes

DATE UNIT TIME STARTED TIME ENDED TOTAL TIME CAREGIVER

02/01 2N 09:00 09:45 45 min. RN

02/01 2N 18:00 19:10 70 min. RN

02/02 2N 08:45 09:30 45 min RN

02/02 5E 09:30 10:45 75 min RN

02/03 5E 09:00 09:55 55 min RN

02/04 5E 08:50 09:30 40 min RN

02/06 2N 11:00 11:20 20 min RN

02/07 2N 10:55 11:30 35 min RN

02/10 5E 15:00 15:45 45 min RN

02/11 5E 06:00 06:55 55 min RN

02/12 5E 07:00 08:00 60 min RN

02/13 5E 06:45 07:20 35 min RN

02/14 5E 07:10 07:55 35 min RN

02/19 2N 10:00 10:35 35 min RN

02/20 2N 10:15 10:58 43 min RN

02/21 2N 09:55 10:40 45 min RN

02/25 2N 12:30 02:00 90 min RN

02/26 2N 11:45 13:00 75 min RN

02/26 5E 16:40 18:05 85 min RN

02/27 2N 11:50 12:10 20 min RN

02/27 5E 14:00 14:50 50 min RN

02/28 Pedi 13:20 15:30 130 min RN

02/28 5E 17:00 18:05 65 min RN


AcuityPlus™Inpatient Coordinator Guide Appendix C Activity Logs

Sample Activity Log Summary

1. Total time for all occurrences of the activity during the collection period as recorded on the Activity Log.

2. Total number of occurrences of the activity during the collection period.

3. Average Time per Occurrence = Total Time / Number of Occurrences.

4. Average Time per Day = Total Time / Number of Days in data collection period.

5. Impact on THPWI = Average Time per Day in Hours / Budgeted Workload Index [example uses a Budget Workload Index of 32].

6. Impact on FTEs = (Average Time per Day x 365 days) / 2080 (standard FTE hours).

UNIT ACTIVITYDATA COLLECTION PERIOD

TOTAL TIME1 NUMBER OF OCCURRENCES2

AVERAGE TIME PER OCCURRENCE3

AVERAGE TIME PER DAY (24 HOURS)4

IMPACT ON THPWI5

IMPACT ON FTES6

Onc Chemo Admin on Other Units

02/01 – 02/28 (28 days)

1253 minutes 23 54.48 min. (0.91 hr.)

44.75 min. (0.75 hr.)

.023 HPWI 0.132 FTE


AcuityPlus™Inpatient Coordinator Guide Appendix C Activity Logs

Activity Log Summary Worksheet

1. Total time for all occurrences of the activity during the collection period as recorded on the Activity Log.

2. Total number of occurrences of the activity during the collection period.

3. Average Time per Occurrence = Total Time / Number of Occurrences.

4. Average Time per Day = Total Time / Number of Days in data collection period.

5. Impact on THPWI = Average Time per Day in Hours / Budgeted Workload Index.

6. Impact on FTEs = (Average Time per Day x 365 days) / 2080 (standard FTE hours).

UNIT ACTIVITYDATA COLLECTION PERIOD

TOTAL TIME1 NUMBER OF OCCURRENCES2

AVERAGE TIME PER OCCURRENCE3

AVERAGE TIME PER DAY (24 HOURS)4

IMPACT ON THPWI5

IMPACT ON FTES6



OverviewThe following worksheets are for use during the implementation and ongoing maintenance of the QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System.

Scheduled/Actual Staffing on page 400

Patient Classification Monitoring Report on page 401

Unit Monitoring Summary on page 402

Hospital Monitoring Summary (Acuity Reliability) on page 403

Paid to Actual Staff Analysis Worksheet on page 404

Target Hours Per Workload Index Analysis on page 405

Shift Distribution by Patient Type on page 406

Skill Distribution by Patient Type by Shift on page 406

Shift Distribution and Skill Mix Worksheet on page 407

Testing Shift and Skill Distribution Goals on page 409

Unit Labor Resource Budget Worksheet on page 415



Scheduled/Actual Staffing

Scheduled Staff

Actual Staff

Unit: Date:

SHIFT JOB TITLES

Other:

SHIFT JOB TITLES

Other:


AcuityPlus™Inpatient Coordinator Guide Appendix D Worksheets

Patient Classification Monitoring Report

Unit: ___________ Date: __________________ Census: __________________ Number of Patients Monitored:__________________

Signature: ______________________________________________

I. Check for the following and circle the appropriate response: III. Calculate Patient Type Reliability Percent: ______________%

All patients classified? Yes No (No. of patients correctly classified / total no. of patients in sample) x 100%

II. Record classification information: Patient Type List Indicators by Number

Room # Patient Name Staff Monitor Overuse Under use Comments

1

2

3

4

5

6

7

8

9

10

IV. Narrative Summary (Actions):

V. Time Started: ______________ Time Completed: ______________ Total Time: ________________



Unit Monitoring SummaryUnit: ___________________

PERIOD ENDING % RELIABILITY SUMMARY – INDICATORS OVER/UNDER USED, ACTIONS



Hospital Monitoring Summary (Acuity Reliability)

Unit ↓ Period Ending → Average

Period Average



Paid to Actual Staff Analysis WorksheetDate Range: ______________________

An acceptable variance is 2% or less.

UNIT (A) PAID STAFF (B) ACTUAL STAFF (C) VARIANCE (D) % VARIANCE

Hospital


AcuityPlus™Inpatient Coordinator Guide Appendix D Worksheets

Target Hours Per Workload Index Analysis

UNIT CENSUS ACUITY WI DAILY STAFFING AT THFWI[ ] [ ] [ ]

ACTUAL STAFF

BUDGET STAFF

AHPPD BHPPD AHPWI BHPWI



Shift Distribution by Patient Type

Skill Distribution by Patient Type by ShiftShift: _________________

Shift: _________________

SHIFTPATIENT TYPE

I II III IV V VI

I II III IV V VI

RN

LPN

NA

I II III IV V VI

RN

LPN

NA



Shift: _________________

Shift Distribution and Skill Mix WorksheetUnit: __________________

Shift Distribution

I II III IV V VI

RN

LPN

NA

I II III IV V VI TOTAL

Cens/Type

Acuity

Workload

Hrs/24

I II III IV V VI

Day

Evening

Night



Skill Mix

Shift: _________________

Shift: _________________

Shift: _________________

I II III IV V VI

RN

LPN

NA

I II III IV V VI

RN

LPN

NA

I II III IV V VI

RN

LPN

NA



Testing Shift and Skill Distribution GoalsThe goal sets may be tested prior to entry into the QUADRAMED AcuityPlus Productivity, Benchmarking and Outcomes System. Instructions follow for performing manual calculations. These calculations simulate the software algorithm. They demonstrate how closely the goal sets will recommend the desired staffing levels based on the current workload.

1. Using the workload per patient type from step 5 of Developing Shift Distribution and Skill Mix Goals on page 164 and the goal sets for shift distribution defined in step 7 of Developing Shift Distribution and Skill Mix Goals on page 164, calculate the amount of workload per patient type that is allocated to each shift.

2. Calculate the percent of staff hours that will be recommended for each shift:

Total WI for Shift / Total Unit Workload (sum of workload by patient type as calculated in step 5 of Developing Shift Distribution and Skill Mix Goals on page 164).

Shift 1: __________________

Shift 2: __________________

Patient Type WI % Shift 1

I x =

II x =

III x =

IV x =

V x =


Total WI / = x 100% =


I x =

II x =

III x =

IV x =

V x =


Total WI / = x 100% =



Shift 3: __________________

Shift 4: __________________

3. Follow the above procedure to test the skill mix goal set.

Shift 1: __________________

RN


I x =

II x =

III x =

IV x =

V x =


Total WI / = x 100% =


I x =

II x =

III x =

IV x =

V x =


Total WI / = x 100% =

Patient Type WI % RN

I x =

II x =

III x =

IV x =

V x =





LPN

NA

Shift 2: __________________

RN

Patient Type WI % LPN

I x =

II x =

III x =

IV x =

V x =



Patient Type WI % NA

I x =

II x =

III x =

IV x =

V x =




I x =

II x =

III x =

IV x =

V x =





LPN

NA

Shift 3: __________________

RN


I x =

II x =

III x =

IV x =

V x =




I x =

II x =

III x =

IV x =

V x =




I x =

II x =

III x =

IV x =

V x =





LPN

NA

Shift 4: __________________

RN


I x =

II x =

III x =

IV x =

V x =




I x =

II x =

III x =

IV x =

V x =




I x =

II x =

III x =

IV x =

V x =





LPN

NA

4. Compare the calculated outcomes to the budgeted and actual staff distributions. Make revisions to the goal sets as necessary.


I x =

II x =

III x =

IV x =

V x =




I x =

II x =

III x =

IV x =

V x =





Unit Labor Resource Budget WorksheetUnit: Date:



x =


x =


/ =


Total Staff x % Days = Staff on Days

Total Staff x % Evenings = Staff on Evenings

Total Staff x % Nights = Staff on Nights


Days: x % RN = RN Days

x % LPN = LPN Days

x % NA = NA Days


Eves: x % RN = RN Evenings

x % LPN = LPN Evenings

x % NA = NA Evenings


Nights: x % RN = RN Nights

x % LPN = LPN Nights

x % NA = NA Nights



Total RN (all shifts) x SVHW = RN FTEs

Total LPN (all shifts) x SVHW = LPN FTEs




Total NA (all shifts) x SVHW = NA FTEs


7. Total Direct Care FTEs =


Unit Manager

Unit Secretaries

Monitor Technicians

9. Total FTEs =



The following information is needed to accurately set up the AcuityPlus system. The forms that follow may be used to facilitate data collection and translation of information into the correct format for entry into the system.

Enterprise – The healthcare corporation name and information.

Facility – The hospital name and information.

Job Skill/Job Titles – The Job Skills and Job Titles are established for the entire enterprise. The job skills define the categories for recommended staff and are used to define the direct and non-direct care categories for the system reports. The job titles also define the categories for actual staff entry. The sequence of the job skills and the job titles in the software determines the order in which they appear on the reports. See Job Skill/Job Title example and worksheet that follow.



Job Skills and Titles

Job Skill/Job Title Example

Job Skill/Job Title Worksheet

JOB TITLE ↓JOB SKILL

NM RN LPN TECH US

NM X

RN1 X

RN-Oriented X

LPN X

Tech 1 X

Tech 2 X

US X

JOB SKILL

JOB TITLE ↓



Day DefinitionsDefine the parameters for setting up staffing for each day of the week. Different days of the week can use the same staffing parameters. For example:

All days – where all seven days of the week have the same parameters.

M-F – where the weekdays have the same parameters.

S-S – where the weekend days have the same parameters.

Shift DefinitionThe following parameters are required for each day definition defined:

Name.

Description.

Start and end time.

Paid and non-paid time for each shift.

JOB SKILL

JOB TITLE ↓



It is recommended that a universal name is used on all units for like shifts; for example, Day for 7:00 AM - 3:00 PM; Eve for 3:00 PM - 11:00 PM.; Noc for 11:00 PM - 7:00 AM.

Shift Definition ExampleUnit: Med/Surg

Day Definition: M-F

Shift Definition WorksheetUnit: _______________

Day Definition: ____________

SHIFT NAME DESCRIPTION START TIME FINISH TIME PAID HOURS UNPAID HOURS

Day 7a-3:00p 7:00:00 AM 15:00:00 PM 8 0

Eve 3p-11:00p 3:00:00 PM 22:00:00 PM 8 0

Noc 11p-7:00a 11:00:00 PM 7:00:00 AM 8 0

SHIFT NAME DESCRIPTION START TIME FINISH TIME PAID HOURS UNPAID HOURS



Shift Distribution and Skill DistributionFor shift and skill distribution define the following. See the example below and use the worksheet on page 423 for your organization’s shift and skill distribution.

Define the percentage of care by shift for each patient type. This is the percentage of care on each shift for the direct care providers.

Define the percentage of care by shift by direct care provider by shift for each patient type.

Shift and Skill Distribution ExampleUnit: Med/Surg

Day Definition: M-F

Shift Distribution:

Skill Distribution

Shift: Day

SHIFTPATIENT TYPE

I II III IV V VI

Day 46 45 42 35 34 34

Eve 33 33 33 33 33 33

Noc 24 22 25 22 33 33

JOB SKILLPATIENT TYPE

I II III IV V VI

RN 50 60 65 70 80 90

LPN 25 20 20 15 0 0

NA 25 20 15 15 20 10



Shift: Eve

Shift: Noc


I II III IV V VI

RN 50 60 65 70 80 90

LPN 25 20 20 15 0 0

NA 25 20 15 15 20 10


I II III IV V VI

RN 50 60 65 70 80 90

LPN 25 20 20 15 0 0

NA 25 20 15 15 20 10



Shift and Skill Distribution WorksheetUnit: ____________________Day Definition: ________________

Shift Distribution

Skill Distribution

Shift: ____________________________

Shift: ____________________________

SHIFTPATIENT TYPE

I II III IV V VI


I II III IV V VI


I II III IV V VI



Shift: ____________________________

Staffing ParametersThis table is used to define the staffing parameters for the job skills on each unit. The average wage field is calculated from the Job Title Parameters table. See the example and worksheet that follow.

Staffing Parameters Example

Shift: Day


I II III IV V VI

Parameters must be defined for each shift.

Unit: Med/Surg Day Definition: M-F

JOB SKILL

AVERAGE WAGE

DC% VARIABLEADJUSTED BY

MINIMUM ADDITIONAL

DC HRS

NON-DC HRS

DC HRSNON-DC HRS

NM $35.00 0% N None 0 8 0 0

RN $21.00 100% Y HPWI 16 0 0 0

LPN $19.00 100% Y HPWI 0 0 0 0

TECH $12.00 100% Y HPWI 0 0 0 0

US $10.00 0% Y Census 0 0 0 0



Shift: Eve

Shift: Noc

JOB SKILL

AVERAGE WAGE


MINIMUM ADDITIONAL

DC HRS

NON-DC HRS

DC HRSNON-DC HRS

RN $25.00 100% Y HPWI 16 0 0 0

LPN $21.00 100% Y HPWI 0 0 0 0

TECH $14.00 100% Y HPWI 0 0 0 0

US $12.00 0% Y Census 0 0 0 0

JOB SKILL

AVERAGE WAGE


MINIMUM ADDITIONAL

DC HRS

NON-DC HRS

DC HRSNON-DC HRS

RN $29.00 100% Y HPWI 16 0 0 0

LPN $23.00 100% Y HPWI 0 0 0 0

TECH $16.00 100% Y HPWI 0 0 0 0

US $14.00 0% Y Census 0 0 0 0



Staffing Parameters Worksheet

Shift: _______________________

Shift: _______________________

Unit: Day Definition:

JOB SKILLAVERAGE WAGE


MINIMUM ADDITIONAL

DC HRS

NON-DC HRS

DC HRSNON-DC HRS



MINIMUM ADDITIONAL

DC HRS

NON-DC HRS

DC HRSNON-DC HRS



Shift: _______________________

Job Title ParametersThis table is used to define the parameters for the specific job titles on each unit. Parameters must be defined for each shift. See Job Title Parameter Example and Worksheet.

Shift: Day



MINIMUM ADDITIONAL

DC HRS

NON-DC HRS

DC HRSNON-DC HRS

Unit: Med/Surg Day Definition: M-F

JOB TITLE DIRECT CARE % HOURLY WAGE

NM 0% $35.00

RN1 100% $27.00

RN-Orientee 100% $25.00

LPN 100% $19.00

Tech1 100% $12.00

Tech2 100% $14.00

US 0% $10.00



Job Title Worksheet

Shift: ________________________

Shift: ________________________

Shift: ________________________

Unit: Day Definition:






Staffing by CensusThis table is used for job skills defined as variable by census. In this table, you define the upper end of the census range for the associated recommended hours.

Staffing By Census Example

Staffing By Census Worksheet

Midnight CensusThis table expands automatically when patients have been classified. It is a data entry table where data can be entered either through an interface or manually.

Treatment AreasThis table is used to define subsets of populations on the unit. Reports are available to evaluate data in the defined treatment areas.

JOB SKILL HIGH VALUE RECOMMENDED HOURS

US 3 0

US 30 24

JOB SKILL HIGH VALUE RECOMMENDED HOURS




Treatment Area Example

Unit: _______________________

Treatment Area Worksheet

Unit: _______________________

Weekly ScheduleThis table is completed to assign the defined day definition to the specific day of the week.

Weekly Schedule Example

UNIT AREA CODE DESCRIPTION

SD Step Down

UNIT AREA CODE DESCRIPTION

PARAMETER VALUE

Name Med/Surg

Sunday M-F

Monday M-F

Tuesday M-F

Wednesday M-F

Thursday M-F

Friday M-F

Saturday M-F



Weekly Schedule Workload Worksheet PARAMETER VALUE

Name

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday



Use of the Data Retrieval FormThe Data Retrieval Form is to be filled out for a seven day period of time.

This form should be completed as accurately as possible since this is an integral part of the information needed to implement the QUADRAMED Patient Classification System.

Each unit fills out a separate sheet accurately for each 24-hour period, labeling each sheet properly for unit and date.

A simple hash mark is all that is needed to indicate that an activity occurs. The Project Coordinator completes further number retrieval.

Explanation of seven points of information:

If you have any questions please call the Nursing Office at ____________________.

Forms will be picked up __________________.

DATA ELEMENT EXPLANATION

Known Admission The hour timeframe the unit is actually notified of an admission.

Arrival Admissions The hour timeframe that a patient actually arrives on the floor.

Discharge The hour timeframe that a patient actually leaves the nursing unit. This includes routine discharge, AMA, expires, or AWOL (estimate the time the patient left the unit).

To O.R. The hour timeframe the patient actually leaves the unit to go to O.R.

From O.R. The hour timeframe the patient actually returns from the O.R.

To Procedure Actual hour timeframe that the patient leaves the unit for examinations, tests, or any procedures that occurs off the unit that may cause the patient to change type upon return, for example, cardiac cath.

From Procedure Actual hour timeframe that the patient returns from the procedure to the unit.



Data Retrieval FormStart 12 Midnight, Sat/Sun: _________ Complete 12 Midnight, Sat/Sun: ___________Unit: ______________________ Date: ______________________

*Procedures: angiograms, cardiac caths., pacemaker insertions, etc.

TIMEADMISSION AND TRANSFER IN TO

O.R.FROM O.R. TO PROCEDURES* FROM PROCEDURES*

KNOWN ARRIVE DISCHARGE

1 AM

2 AM

3 AM

4 AM

5 AM

6 AM

7 AM

8 AM

9 AM

10 AM

11 AM

12 PM

1 PM

2 PM

3 PM

4 PM

5 PM

6 PM

7 PM

8 PM

9 PM

10 PM

11 PM

12 AM



Compile Data and Complete the Data Summary Form1. Each study unit should have seven completed data retrieval forms, each representing one

24-hour period.

2. Total the following:

a. The number of events or “hash marks” for the entire hospital under each of the points of information, Admissions, Discharges, etc., for each of the hours within a 24-hour period.

b. The number of all events under each of the seven points of information.

3. Calculate the cumulative totals and cumulative percentage within each box on the Data Summary Form. This is accomplished by:

a. Sequentially adding the number of events for each hour onto the total from the previous hour.

b. Calculating this new cumulative total for each hour as a percentage of the total for the 24-hour period.

Example:

If you have any questions, please call your Nurse Consultant.

TIME ADMISSION KNOWN

1 AM 2 1.5% Between 12 midnight and 1 AM there were two known admissions representing 1.5% of the total (2 / 130)

2 AM 5 3.8% Between 1 AM and 2 AM there were three known admissions. When added to the previous two, there are now five known admissions representing 3.8% of the total (5 / 130)

3 AM 10 13% There were five more known admissions in the next hour.

12 AM 130 100% The last box always show 100% and the total of all events


AcuityPlus™Inpatient Coordinator Guide Appendix F Determination of Classification Time

Data Summary Form

TIME

ADMISSION & TRANSFER IN CUMULATIVE DISCHARGE CUMULATIVE

TO O.R. CUMULATIVE

FROM O.R. CUMULATIVE

TO PROCEDURES* CUMULATIVE

FROM PROCEDURES* CUMULATIVEKNOWN ARRIVE

TOTAL % TOTAL % TOTAL % TOTAL % TOTAL % TOTAL % TOTAL %

1 AM

2 AM

3 AM

4 AM

5 AM

6 AM

7 AM

8 AM

9 AM

10 AM

11 AM

12 PM

1 PM

2 PM

3 PM

4 PM

5 PM


AcuityPlus™Inpatient Coordinator Guide Appendix F Determination of Classification Time

* Procedures: anogiogram, cardiac cath, pacemaker insertion, etc.

6 PM

7 PM

8 PM

9 PM

10 PM

11 PM

12 AM

TIME

ADMISSION & TRANSFER IN CUMULATIVE DISCHARGE CUMULATIVE

TO O.R. CUMULATIVE

FROM O.R. CUMULATIVE

TO PROCEDURES* CUMULATIVE

FROM PROCEDURES* CUMULATIVEKNOWN ARRIVE

TOTAL % TOTAL % TOTAL % TOTAL % TOTAL % TOTAL % TOTAL %


Appendix G Educational Sheets

Implementation Summary

QuadraMed’s Approach to Patient Acuity and Staffing

Inpatient Methodology Acuity and Point Range

Calculation Summary

Workload Measurement Key Concepts

System Control Summary

Patient Classification and Indicators Overview

System Staffing Framework Summary

Staffing Framework Parameters


Nursing Activities Included in THPWI



Implementation SummaryApproximately Eight Month Process

Individualized Project Plan

On/Off Site Professional Consultation

Unlimited Phone Support

Active Client Participation

Designated Coordinator

Committee Directed

Staff Involvement

Centralized Education

Methodology Workshop

Software Education Seminar

Client Support Coverage

Toll Free Hotline: 877-823-7263

Weekdays: 8:30 AM - 5:00 PM EST



QuadraMed’s Approach to Patient Acuity and Staffing

A patient has the same needs regardless of location.

Each unit/hospital has its own unique mix of patients and acuity.

Each hospital environment is uniquely different from other hospitals.

There is a measurable relationship between staffing, costs, and quality.



Inpatient Methodology Acuity and Point Range

Workload Index =

Acuity = Workload Index (Weighted Census)/ LOS Adjusted Census

TYPE I II III IV V VI

NCH/24 0-4 4-7 7-10 10-14 14-20 20+

Acuity 0.7 1.0 1.5 2.3 3.1 4.6

Point Range 0-17 18-36 37-56 57-79 80-104 105+

Sum over all shifts ((Total Type I patients’ length of stay on each shift ÷ specific shift length) x (specific shift distribution percentage) x 0.7)

+ Sum over all shifts ((Total Type II patients’ length of stay on each shift ÷ specific shift length) x (specific shift distribution percentage) x 1.0)

+ Sum over all shifts ((Total Type III patients’ length of stay on each shift ÷ specific shift length) x (specific shift distribution percentage) x 1.5)

+ Sum over all shifts ((Total Type IV patients’ length of stay on each shift ÷ specific shift length) x (specific shift distribution percentage) x 2.3)

+ Sum over all shifts ((Total Type V patients’ length of stay on each shift ÷ specific shift length) x (specific shift distribution percentage) x 3.1)

+ Sum over all shifts ((Total Type VI patients’ length of stay on each shift ÷ specific shift length) x (specific shift distribution percentage) x 4.6)



Calculation SummaryWorkload Index (WI) = Census x Acuity

Summing over all shifts ((total LOS on each shift by Patient Type / specific shift length) x (specific shift distribution percentage)) x relative value (acuity) for the category

Procedure Workload =Total Procedure Hours

THPWI

LOS Adjusted Census =Total LOS for all classified patients

24 hours

Unit Classification Acuity =

Classification Workload Index

LOS Adjusted Census

Unit Overall AcuityTotal Workload

LOS Adjusted Census

Recommended Staff = Workload Index x THPWI

HPDD = HPWI x Acuity

BHPPD =# of Budgeted Staff x Shift Length

Budgeted Census

AHPPD =# of Actual Direct Staff Hours


AHPWI =# of Actual Direct Staff Hours

WI

RHPPD =# of Recommended Staff Hours


RHPWI =# of Recommended Staff Hours

WI



Workload Measurement Key ConceptsWorkload Index – A census, weighted according to patient mix.

Obtained by – Summing over all shifts ((Total Length of Stay on each shift by Patient Type divided by the specific shift length) x (the specific shift distribution percentage)) x the relative value (acuity) for the category.

Acuity – Represents the average patient mix or the workload of an individual patient.

Obtained by – Dividing the Sum of Individual Patient Acuities by the Classification Census.

Hours Per Workload Index – Productivity index that corrects for patient mix.

Obtained by – Dividing number of available care hours by the Workload Index.

LOS Adjusted Census – Represents the equivalent number of 24-hour patients.



System Control Summary

Census

MN - CLS Census Analysis (2% Hospital Wide or ≤ 1 Patient/Unit)

Guidelines for Classification

Daily Classification Census Verification

Acuity

Daily Reporting/Review of Acuity

Acuity Target Ranges (Flagging System)

Classification Monitoring (90 - 100% Reliability)

Staffing

Actual to Paid Worked Hours Analysis (2%)



Patient Classification and Indicators Overview

Patient classification is a process in which critical indicators are used to objectively categorize patients.

Classification process:

A daily assessment of patient care needs

Critical indicators:

Describe patient need for care

Statistically weighted based on ability to predict overall care requirement

Sum of weights places patients into one of six categories

Six categories:

Predictive of relative requirements for care



System Staffing Framework Summary

Hours Per Unit of Workload (HPWI)

Value representing ratio of staffing per unit of workload

Shift Distribution Parameter

Percent of care delivered by shift per patient type

Skill Mix Parameter

Percent of care delivered by skill level per patient type



Staffing Framework ParametersQualityHours Per Workload Index

% of Care by ShiftShift Distribution Parameter

% of Care by RNSkill Distribution Parameter

StaffingMin Max

Target Range

Day Eve Night

Acuity

Acuity




Philosophy Related to Patient Care Delivery

Care Delivery Modality

Financial Resources and Constraints

Quality of Care

Physician Practices

Skill Mix

Minimum Staffing

Nursing Leadership

Roles and Responsibilities

Staff Experience and Staff Stability

Unit Size/Layout

Workload Fluctuation

Support Services



Nursing Activities Included in THPWIDirect Nursing Care

Indirect Nursing Care, such as counting narcotics

Charting, such as checking MD orders

Reporting, such as shift-to-shift

Administrative, such as staff meetings

Personnel Education, on or off unit

Personal/Non-productive, such as breaks

Patient Support Activities, involves interface with support services

Transportation

Unit Management

Housekeeping

Dietary


Index

AActivity Detail 210activity logs

overview 393sample 396sample summary 397summary worksheet 398worksheet 395

Activity Recommended Hours by Hour of Day 212

Activity Summary 214Activity Workload Analysis 217Actual and Recommended HPWI Trend

Graph 220Actual and Scheduled Staffing by Shift reports 225Actual Staffing by Hour of Day report 223acuity

about 32, 95calculating 35expected range 96monitoring patient classification 97reliability testing 100summary 124

Acuity/Complexity Trend Graph 228assessment 60

Bbed allocation 155beds, number of 155budget management

definitions 372implications for managers 374objectives 371overview 371procedure 375

Budget Recommended and Actual Productivity report 231

Ccare delivery practices 157census

about 94data input, on-line 94data input, patient classification import 95

Census Analysis report 237classification

about 2, 17, 53automatic ADT 58by profile 55framework for data validity 124guidelines 58import interface 59indicator definitions 61manual ADT 58monitoring 101objectives 53on other unit 57overview 53process 54terminology 60timeframes 54who to classify 54

Classification Accuracy by Classifying Nurse report 241

classification time studycompile data 435data retrieval form 434data summary form 436use of the data retrieval form 433

clerical support personnel 13client support xviiiclinical service 154Complexity and Acuity Analysis report 244complexity of care methodology

about 79development 77objectives 77overview 77



pre-testing 78research 77skill distribution 83testing 78testing institutions 79

conventions, typographical xviicueing 60customer support xviii

DDaily Assignment report 208Daily Shift Staffing report 247Daily Staffing report 251data entry personnel 13day definitions, system setup 419Default Classification Detail report 256Default Classification Summary report 258direct care hours

additional 88minimum 88

direct care providers 87direct staff 373Do Not Classify Detail report 260documentation, related xvi

Eeducation

See staff educationExecutive Patient Care Summary report 262

Ffacility layout 158First Line Manager 12Full Time Equivalent (FTE) 372

Ggoal sets, testing 168

HHardware and Systems Engineer 14Hospital Indicator Agreement Summary

worksheet 108Hospital Monitoring Summary worksheet 105, 403Hospital Summary in Dollars report 270Hospital Summary report 267Hours Per Patient Day (HPPD) 373

Hours Per Workload Index (HPWI) 153

Iimplementation

committee 6objectives 3overview 3roles 6timetable 4

Indicator Agreement Report worksheet 106indicator definitions

application examples 63list of 61

Indicator Detail by Patient report 274Indicator Specific report 276Indicator Usage report 278indicators, application test 135Inpatient 17Inpatient methodology

about 20alpha testing 18beta testing (phase i) 19beta testing (phase ii) 19development 17objectives 17patient classification tool 33pre-testing 18research 17

instruction 60inter-rater reliability

test A 109test B 116

intervention 60

Jjob skills, system setup 418job title parameters, system setup 427job titles, system setup 418

Llength of stay (LOS) 154LOS and Average Daily Patient Turnover

report 284

Mmanagement reports

See reportsmethodology

See Inpatient methodology and complexity of

Index


care methodologymidnight census

system setup 429Minimum Direct Staff Analysis report 286monitoring

about 97guidelines 101Hospital Indicator Agreement Summary

worksheet 108Hospital Summary worksheet 105Indicator Agreement Report worksheet 106Unit Summary worksheet 104worksheet 103

Monitoring Detail report 291Monitoring Summary report 291Monitoring Trend report 293Multiple Classifications and Edit Classifications

Detail report 296Multiple Classifications and Edit Classifications

Summary report 298

NNetwork Services Analyst 14New Features xxiinon-direct care hours

additional 88minimum 88

non-direct care providers 87non-direct staff 373nonproductive time 374Nursing Project Coordinator

about 6post-implementation activities 9

Oobservation 60occupancy, average 155orientees, staffing data 91Over/Under Use of Indicators report 299overtime

about 91staffing data 91

PPaid to Actual Staff Analysis worksheet 404Patient Activity by Hour report 301patient age 154patient classification

See classification

Patient Classification Committee 11Patient Classification Detail report 304Patient Classification Monitoring worksheet 103,

401patient information 154Patient Selection Screen xxiiiposition 372productive time 374productivity targets 161Project Sponsor 13

Qquality of care 157

Rratio staffing, calculating 192Recommended Alternative and Actual Direct

Staffing with Dollar Variance report 195Recommended Direct Care Staff with HPWI

Target and Min/Max Ranges report 306Recommended to Actual Staff report 308relative values 26reliability scores 97reliability testing 100replacement factor

about 374calculating 380

Reports xxiiireports

Actual Staffing by Hour of Day 223Budget Recommended and Actual

Productivity 231Census Analysis 237Classification Accuracy by Classifying

Nurse 241Complexity and Acuity Analysis 244Daily Assignment 208Daily Shift Staffing 247Daily Staffing 251Default Classification Detail 256Default Classification Summary 258Do Not Classify Detail 260Executive Patient Care Summary 262Hospital Summary 267Hospital Summary in Dollars 270Indicator Detail by Patient 274Indicator Specific 276Indicator Usage 278LOS and Average Daily Patient Turnover 284Minimum Direct Staff Analysis 286Monitoring Detail 291



Monitoring Summary 291Monitoring Trend 293Multiple Classifications and Edit

Classifications Detail 296Multiple Classifications and Edit

Classifications Summary 298Outcomes Data 185Outcomes Indicator 185Over/Under Use of Indicators 299overview 205Patient Activity by Hour 301Patient Classification Detail 304Recommended Alternative and Actual Direct

Staffing with Dollar Variance 195Recommended Direct Care Staff with HPWI

Target and Min/Max Ranges 306Recommended to Actual Staff 308RN WI Staff Ratio 310Rolling Indicators Detail 313Rolling Indicators Summary 314Staffing Analysis 315Staffing by MIS Guidelines 318Staffing Notes 320Staffing Percentages 322Staffing Ratios 324Staffing Recommendation Comparisons 327Staffing Variance 330Treatment Area Workload 335Unclassified Patient Detail 337Unclassified Patient Summary 339Unit Monthly Trend 340Unit Performance Summary 344Unit Period Detail 346Unit Period Detail by Day of Week 352Unit Period Detail by Shift and Day 352Unit Statistics 356WI Measurement Summary 358Workload Analysis 363Workload Analysis by Hour of Day by Day of

Week 365Workload by Hour of Day 368

review 203RN WI Staff Ratio report 310Rolling Indicators Detail report 313Rolling Indicators Summary report 314

SScheduled/Actual Staffing worksheet 400Security Parameters xxivshift definitions, system setup 419shift distribution

developing 164system setup 421testing goals 409

Shift Distribution and Skill Mix worksheet 167,

407Shift Distribution by Patient Type worksheet 163,

406shift distribution parameters 153, 158shifts, partial 91skill distribution

complexity of care methodology 83system setup 421testing goals 409

Skill Distribution by Patient Type by Shift worksheet 163, 406

skill mix 156developing goals 164

skill mix parameters 153, 159software support xviiistaff education

frequently asked questions 148indicator application test 135objectives 131outline 132overview 131

staff information 156staffing

actual 157calculating recommended 176calculating variable 385experience 156framework summary 160minimum requirements 156organization of care 156professional support 156recommended staffing calculation sample 174skill mix 156support personnel 156targets for non-direct care providers 177translation framework 153unit administration 156

staffing analysispaid to actual 125

Staffing Analysis report 315Staffing Analysis worksheet 127staffing by census, system setup 429Staffing by MIS Guidelines report 318staffing data 91

collecting actual 91guidelines for collecting 89objectives 87orientees 91partial shifts 91

staffing framework 2staffing framework parameters 160Staffing Notes report 320staffing parameters, system setup 424

Index


Staffing Percentages reports 322staffing ratio module 191Staffing Ratios report 324Staffing Recommendation Comparisons

report 327Staffing Variance reports 330Steering Committee 10support services 157support, client xviiisymbols xviisystem control

objectives 93overview 93

System Parameters xxivsystem parameters, objectives 153system setup

day definitions 419job skills 418job title parameters 427job titles 418midnight census 429shift definition 419shift distribution 421skill distribution 421staffing by census 429staffing parameters 424treatment areas 429weekly schedule 430

TTarget Hours Per Workload Index (THPWI) 157,

161Target Hours Per Workload Index Analysis

worksheet 162, 405Technical Installation Analyst 15tests

indicator application 135inter-rater reliability 109, 116

Transparent Classification xxivTreatment Area Workload report 335treatment areas, system setup 429typographical conventions xvii

UUnclassified Patient Detail report 337Unclassified Patient Summary report 339unit facilities 155unit information 155Unit Labor Resource Budget worksheet 377, 415

unit layout 155, 158Unit Manager 12Unit Monitoring Summary worksheet 402Unit Monitoring worksheet 104Unit Monthly Trend report 340Unit Performance Summery report 344Unit Period Detail by Day of Week report 352Unit Period Detail by Shift and Day report 352Unit Period Detail report 346Unit Statistics report 356Updated Icons xxi

Vvariable staffing calculations 385

Wweekly schedule, system setup 430WI Measurement Summary report 358Workload Analysis by Hour of Day by Day of

Week report 365Workload Analysis report 363Workload by Hour of Day report 368workload fluctuation analysis

historical analysis example 392historical analysis worksheet 391overview 387

workload index 27workload measurement 26

data 157workload, calculating 35worksheets

Hospital Indicator Agreement Summary 108Hospital Monitoring Summary 105, 403Indicator Agreement Report 106Paid to Actual Staff Analysis 404Paid to Actual Staffing Analysis 127Patient Classification Monitoring 103, 401Scheduled/Actual Staffing 92, 400Scheduled/Actual Staffing worksheet 92Shift Distribution and Skill Mix 167, 407Shift Distribution by Patient Type 163, 406Skill Distribution by Patient Type by Shift 163,

406Target Hours Per Workload Index

Analysis 405Target Hours Per Workload Index Analysis

Worksheet 162Unit Labor Resource Budget 377, 415Unit Monitoring Summary 104, 402

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