NR_552 Week 6 Discussion, Nurse Staffing and Quality of Care

Nurse Staffing and Quality of Care: Case-mix for Emergency Care NAME Chamberlain College of Nursing NR552: Economics of Healthcare Policy Dr. Poirier DATE The Emergency department normally experiences a surge in the number of patients. The clinical stability of patients varies considerably. To provide optimal care for patients a more flexible and responsive staffing pattern is required. In delivering high-quality and timely care in the Emergency Department, correct staffing is essential. A combination of the increased number of patients and shortage of nurses in the Emergency Department has resulted in the formulation of a number of staffing models (Gedmintas et al., 2010). This paper will, however, address the case-mix model which quantifies the type and number of patients or diseases that a nurse attend to or treat (Harrington & Swan, 2003). Case-mix uses diseases as the main criterion for measurement because it forms the primary reason for consuming hospital services (Harrington & Swan, 2003). This system puts patients into categories based on acuity, need or dependency. Then, the service provided to the patients and the required time for each service by each nurse is computed. From here, average nursing resources needed per-patient in each shift is established (Harrington & Swan, 2003). This helps establish the required number of nursing resources. It can be used to establish whether there is a shortage hence more recruitment (Harrington & Swan, 2003). This can produce sufficient staffing to provide quality care. Direct measurement of output can produce positive patient outcome as adjustments to increase efficiency can be made. (Harrington & Swan, 2003). It can also be used to contain costs because it ensures out-put based reimbursement (Twigg et al., 2015). Diseases based grouping ensures consistency in payment (Twigg et al., 2015). To conclude, the case-mix model helps quantify diseases against the available nursing resources hence it becomes easy to identify nursing shortage or surplus. This facilitates nursing staffing. It is also based on the output which helps in containing costs and improving patient outcomes. Consequently, this method is the best for Emergency Department nurse staffing since it faces serious staffing challenges. References Gedmintas, A., Bost, N., Keijzers, G., Green, D., & Lind, J. (2010). Emergency care workload units: a novel tool to compare emergency department activity. Emergency Medicine Australasia, 22(5), 442-448. Harrington, C., & Swan, J. H. (2003). Nursing home staffing, turnover, and case mix. Medical care research and review, 60(3), 366-392. Twigg, D. E., Myers, H., Duffield, C., Giles, M., & Evans, G. (2015). Is there an economic case for investing in nursing care–what does the literature tell us?. Journal of advanced nursing, 71(5), 975-990. PROFESSOR RESPONSE TO POST: Thank you, Carole. Have you seen this model in use? RESPONSE TO PROFESSOR: Dr. Poirier, Skilled nursing facilities (SNF) or nursing homes often use the case-mix system. Skilled nursing facilities serve different types of patients requiring a wide range of care. In skilled nursing facilities, the case-mix system is a means of classifying care based on the intensity of care and services provided to the resident. It takes into account selected diagnoses, conditions, treatments, and assistance with activities of daily living. It classifies residents into groups based on their likely use of resources. In the Cleveland Clinic ED where I’m employed the case-mix system is utilized. The ED consist of four separate areas to treat patients. The main part of the ED treats patients with acuity level range of 1 to high 3 consists of 20 beds. The area is separated into 6 pods, 4 beds to each pod, with one RN and one medic assigned to each pod. There are two intermediate care areas that are 12 beds each and patients with the acuity level low 3 to high 3 are generally treated in these areas. There is usually three RNs and one or two medics assigned to those areas. The Split-Flow area or Fast Track area has 15 beds and treat patients with acuity level range of low 3 to 5. On Monday to Wednesday, there is three RNs and two clinical technicians (CT) scheduled for this area because there is usually a high volume of patients being seen during those days. The rest of the week there is usually two nurses and one or two CTs assigned to the Split-Flow area. The last area is the Clinical Observation Unit, a 23-hour observation unit, can house 20 adult patients with a variety of diagnosis. Depending on the patient census and acuity of the patients, the nursing staff can be rotated throughout each area to supplement the volume of patients being treated. For instance, if the patient census is below 10 patients in the observation unit and there are four nurses assigned, one nurse can float to the Split-Flow unit to assist with seeing a larger volume of patients to decompress the lobby or to have another nurse float to the main part of the ED to assist with seeing a larger volume of patients. However, I’m unsure if this staffing model will continue to work due to a recent large volume of advanced beginner nurses finding job positions outside of the Cleveland Clinic Health System and competent and proficient nurses resigning due to completion of NP programs.