DIVISION OF NURSING

Wm. Dan Roberts, DNSc,

ACNP-BC Associate Director of Nursing Quality,

Research, and Nursing Support Services

Acknowledgements for this presentation:

A. Kabackinski, NM; E. Rubin, CNS; E. Valdez, Admin Asst

A REGIONAL RESOURCE

• 597 beds

• 34,000 discharges

• 88,000 emergency visits

• 345,000 hospital OP visits

• 4,000 births

• 5,600 employees

• 1,700 nurses

• 1,000 physicians

• 496 medical students and 481

resident physicians

• 634 research projects with

$113 million in funding

IHI Triple Aim: Value based with focus on

Access, Quality, Cost

– Access: Available bed for the optimal medical

service

– Quality: Clinical excellence reported as

outcomes but controlled by best practice

processes and measurement of these

processes [e.g., Central Line Bundle]

– Cost: An appropriate plan of care with an

expected length of stay

Framing Methodology

Division of Nursing response to “Access”: • The right patient [the patient is appropriately admitted for

necessary care needs]

• The right diagnosis [assigned primary working diagnosis]

• The right unit [appropriate level of care for the diagnosis

and acuity of the patient]

• The right plan of care [comprehensive plan of care that

addresses all immediate care needs]

• The right nurse [appropriate assignment with skill set to

meet the nursing needs of the patient]

IHI TRIPLE AIM: ACCESS

IHI TRIPLE AIM: QUALITY

IHI TRIPLE AIM: QUALITY

IHI TRIPLE AIM: QUALITY

IHI TRIPLE AIM: QUALITY

OPERATIONALIZING QUALITY

DATA: MED/SURG UNIT

FMR Daily

Operational Budget

Volume 26.6

Clairvia PCR

Budgeted

FTEs 59.45

Clairvia PCR

Filled FTEs 53.5

FMR

Budgeted

HPPD 10.4

%OT /Total

Hrs Wkd 10.92

% of

Unscheduled

Absence to

hours worked 4.05

Clairvia Avg.

Daily Census 26.6

Annual

Operational

Budget Total

paid FTE 60.82

Unschedul

ed

Absences

to OT hrs. 0.37Total OT

hours 1000.58*Sick/LOA/FMLA/

Fam Sick

Clairvia

Cumulative

Census 880.83

Productive

Hours Target Hours Variance T/P Ratio Float Out Float In

Productive

HPPD Target HPPD Extra Shift

Extra Shift

DRL

*Unscheduled

Absence

744.00 296.00 448.00 39.78% 0.84 0.34 54.75 20

4288.00 4771.25 -483.25 111.27% 120.00 20.00 4.87 5.42 138.5 16.5 144.67

3384.00 3395.78 -11.78 100.35% 56.00 779.33 3.84 3.86 603.58 124

744.00 537.75 206.25 72.28% 24.50 0.84 0.61 187.25 82.5

0.00 #DIV/0! 0.00 0.00

0.00 #DIV/0! 0.00 0.00

0.00 #DIV/0! 0.00 0.00

0.00 #DIV/0! 0.00 0.00

0.00 #DIV/0! 0.00 0.00

0.00 #DIV/0! 0.00 0.00

9160.00 9000.78 159.22 98.26% 176.00 823.83 10.40 10.22 984.08 16.5 371.17

Productivity

Report

Productivity

Report

Productivity

Report

Productivity

Report

Clairvia Staff

Manager

Clairvia

Staff

Manager

Productivity

Report

Productivity

Report

Clairvia

Staff

Manager

Clairvia

Staff

Manager

Clairvia Staff

Manager

RN(RN+DN+Admit RN

12S Clairvia Dashboard Report for March 2012 321343

Skill

T&R III

Total

Source

NA

NSC

Telemetry

UE

MARCH 2012

OPERATIONALIZING QUALITY

DATA

Workforce and Capacity Management Solutions

Demand Manager™

Patient Progress Manager™

Outcomes-Driven Acuity™

Care Cost Manager™

Resource Assignment Manager

CareAware Tracking™

Staff Manager™

Physician Scheduler®

ShiftAlert™

CareAware Patient Flow™

Staffing and Bed Management Managed Services

Care Value Analytics Services

* Featured Solutions

Cerner Clairvia at Stony Brook Medical Center

Target/Scheduled Staffing

Cerner Clairvia at Stony Brook Medical Center

Patient Pattern Manager:

Cerner Clairvia at Stony Brook Medical Center

Patient Acuity

Cerner Clairvia at Stony Brook Medical Center

OPERATIONALIZING QUALITY

DATA: MED/SURG UNIT

Two patient falls on

March 27, 2012:

• Harm score 3

• Post Falls Analysis:

mini-RCA within 1

hour of the event

• Assessment of

Operational Data

Target/Staffing

Assessment:

• Scheduled for one

less RN

• Scheduled for two

less NAs

Operational Data

Trend:

• Reduction in OT as

operational target

• Increased

Absences in RN

staff and NA staff

March 2012

Target/Scheduled Staffing

Cerner Clairvia at Stony Brook Medical Center

FALLS

OPERATIONALIZING QUALITY

DATA

Mar Apr May Jun Jul Aug Sept Oct Nov Dec

RN 111.27 91.35 96.23 96.23 96.05 92.76 91.24 91.64 87.98 88.32

NA 100.35 90.16 119.26 119.26 119.54 111.12 109.46 103.83 109.12 115.02

T/P > 105 = Not enough

staff

T/P < 95 = Too much staff

OPERATIONALIZING QUALITY

DATA

Mar Apr May Jun Jul Aug Sept Oct Nov Dec

RN 111.27 91.35 96.23 96.23 96.05 92.76 91.24 91.64 87.98 88.32

NA 100.35 90.16 119.26 119.26 119.54 111.12 109.46 103.83 109.12 115.02

T/P > 105 = Not enough

staff

T/P < 95 = Too much staff

Med Surg Unit Demographics:

• 60-75% of patient population have a

Psych/Behavioral Health co-diagnosis

• Large Orientation group annually: 4-6 RNs

are in orientation each quarter

• 28% RN Turnover rate; Training unit for Med

Surg experience in order to transfer to ICR or

ICU level care

• At least 7 FTEs are utilized each month in

SCA/1:1 sitters

OPERATIONALIZING QUALITY

DATA

OPERATIONALIZING QUALITY

DATA

Mar Apr May Jun Jul Aug Sept Oct Nov Dec

RN 111.27 91.35 96.23 96.23 96.05 92.76 91.24 91.64 87.98 88.32

NA 100.35 90.16 119.26 119.26 119.54 111.12 109.46 103.83 109.12 115.02

T/P > 105 = Not enough

staff

T/P < 95 = Too much staff

Solutions:

• Target staffing needs: “Nursing Matrix: how

many staff members of a certain skill are

needed for a given number of patients”

[Target]

• Per shift: How many staff members of a

certain skill mix are working [Productive]

• Watch for over and under staffing by skill mix

• For Stony Brook: Falls and Pressure Ulcers

are sensitive to NA HPPD

Operationalizing quality data OOPERATIONAL DATA:

SOLUTIONS

Operationalizing quality data OOPERATIONAL DATA:

SOLUTIONS

Solutions:

• Understand the unit demographics, in a

meaningful way, for each metric [e.g., post falls

assessment for Patient, Environmental,

Location, Patient Activity, Unit Acuity, Staffing

and Staffing Skill Mix

• Use Operational-Quality data to change

Staffing and Skill Mix

• Be compliant with the New York State Nursing

Care Quality Protection Act [e.g., data driven

Staffing Models

Operationalizing quality data OOPERATIONAL DATA:

SOLUTIONS

NDNQI: Medical-Adult 0 Direct +

Indirect

Care Nurse: Pt Ratio 1: 4 ADC 25.2 Occup 87% Nurse: Pt Ratio 1: 4 ADC 25.2 Occup 87%

Staffing Plan: RN, NA, NSC 7 days; NM 5 days Beds 29

Beds 29

RN1&2 NA LPN Total NM NSC HA Aides RN3 Total

Day 7.00 5.00 0.00 12.00 Day 0.40 1.00 0.00 0.00 1.00 2.40

Evening 0.00 5.00 0.00 5.00 Evening 0.00 1.00 0.00 0.00 1.00 2.00

Night 7.00 5.00 0.00 12.00 Night 0.00 1.00 0.00 0.00 2.00 3.00

Total 14 15 0 29 Total 0.40 3 0 0 4 7.4 36.40

FTE Calculation FTE Calculation

Hrs/Day 168.00 120.00 0.00 288.00 Hrs/Day 3.20 24.00 0.00 0.00 48.00 75.20

Hrs/Week 1,176.00 840.00 0.00 2,016.00 Hrs/Week 16.00 168.00 0.00 0.00 336.00 520.00

Hrs/Year 61,152 43,680 0 104,832.00 Hrs/Year 832 8,736 0 0 17,472 27,040

FTE 29.40 21.00 0.00 50.40 FTE 0.40 4.20 0.00 0.00 8.40 13.00

PTO 18% 5.29 3.78 0.00 9.07 PTO 18% 0.00 0.76 0.00 0.00 1.51 2.27

Overtime 0.00 Overtime 0.00

Subtotal FTE 24.78 0.00 59.47 Subtotal FTE 0.40 4.96 0.00 0.00 9.91 15.27 74.74 Use text box for

comments ---> Readjust NA's to 5due to increased sitters averaging 7 FTE's/month. Add Nurse Educator to night shift under indirect RN 3. Average of float in NA hrs.

=300. NA HPPD are under the NDNQI mean.