Patient Acuity Tools and Systems; A methodology in optimizing patient care
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Patient acuity tools and systems: A methodology in optimizing patient care
Literature Review
Introduction
The importance of nursing in any health institution cannot be underscored and countries with superior nurswing systems usually experience better health care as compared to those with only superior technology. Nurses have the responsibility in providing and contributing to the care of the critically ill patients the most prevalent role being directing the health care providers. In addition to that, nurse have four funadametal responsibilities which are promoting health, preventing illness, restoring health as well as alleviating suffering amongst the patients.
One of the prevalent issues in nursing currently is the inadequate of skilled and sufficient man power. This can lead to increased workload, job dissatisfaction, nurse burn-out which cause a subsequent reduction in the quality of patient care provided. This has raised a major coucern in the country that has prompted experts to come up with a systematic approach to find a solution to the existing problem. The patient acuity system is constantly being introduced in the nursing units so as to be more familiar with the nursing ractice and to optimize nurse staffing in an effort of improving patient outcomes.
Description of acuity.
The study of acuity has its genesis in the mid eighties when it was identified as a major concern when it comes to patient service professionals. Acuity is the measurement of the intensity of nursing care that is required by a given patient. An acuity system helps to accurately indicate and regulate the nuber of nurses needed to provide good care to patients. The acuity based staffing systems predict the requirements for patients that will enhance nursing care which could then be used to manage the quality of patient care, costs and the nursing professional resources.
Research Evidence on Patient Acuity System
The assessment of the recent researches about patient acuity, most of the research reports on a comparison of the instruments used in measuring patient acuity. To withdraw evidence from the early Permanent Change of Station which were designed for influencing patient outcomes especially for patients in Intensice Care Units, these instruments are constantly being engaged in reaching out into other settings including enhancing home care, long term care, emergency departments and neurological rehabilitation centres etc. however, there is limited evidence as to the effectiveness and eeficiency in the use of these instrments.
In aother studiy, it shows that when the patient acuity sustem is implemented, the corresponding amount of time of care provided by RNs had reduced the rate at which errors, burnouts, patient complaints and breakdown just to mention but a few, are experienced. In a similar manner, the intensive care unit in Korea, the research evidence portrays a significant impact of nurse staffing on patient outcomes. This research involved 27, 300 ICU patients who were discharged from 36 tertoary as well as 175 secondary health institutions and it indicate that physician and nurse staffing and specialisatio of Intensice Cre Units had an influence on mortality rate of patients. Nevertheless,there was no any significant relationship between nurse experience and mortality rate.
In addition, any of te studies reort that patient acuity increases without supporting data. Only three studies were able to focus and examine the trends involved in patient acuity so as to empirically verify the understanding that acuity is rising. In fact, these studies were conducted outside the borders of the United States where scores were administered to PCS which were compared for two months in 2014 and the same period for 2016 for critical patients in one of the Australian hospital. Form this research, it was reported that acuity varied by shift (morning, evening and night), whereby the evening shift demonstated the highest patient acuity.
Results
A number of various decisions can be made using staffing systems ad tools where the decisions made opeate in different time frames. There is need for the nursing managers to decide in adavance the number of nursing staff to employ and the number of the nursing staff to deploy in each shift as regards to immediate responce to patient demands. Most recently, acuity-dependence system has been used to to appoint scores that can be used in planning, reviewing and supporting deployment decisions.
There are tools also that can be used to specifically balance workload within the nursing units thus, focusing on immediate assignment of duties to staff which can reduce burn-outs. The systems once set, implies that care needs are met by a fixed nurse to patient ratio or the number of hours allocated to each nurse to a given patient per day, however, these ratios may vary between hospials, wards and from the day to day and month to month. This may be brought about as a result of the arising number of patients, admissions and discharges including the specific individual characteristics and specific needs.
In demonstrating a significant variation in demand for nursing care, few of the studies provided a standard that allowed quantification of the results in terms of variability of staff members required rom day to day. Knowledge of this variability would hep determine whether the decision on a fixed staffing plan would be liable in meeting patient need in a regular basis.
The results of recent studies, there is evidence that some systems and tools are reliable, that the workload measured by one system is directly correlated with the other, that low staffing is associated with negative patient outcomes and that an increased staffing levels ssociated with the use of a tool is positively linked to improved patient outcomes. Nevertheless, there is still no basis to determine that any used system would give corret staffing leves.
Further research.
There still remains so much unanswered questions thus a much progress is required especially the extent of which the tools are capable of identifying a level of staffing that is sufficient to meet patient needs as well as the nmber of observations required so as to estimate the average need. The assumption that staffing meets average need is the optimal response to varying demand, remains untested empirically. The systems that are designed to establish the effectiveness and efficiency of stffing levels to match the varying patient needs can be addressed in simulation and qualitative researches.
Conclusion.
There is a vast literature on the staffing methodologies that will reduce nurse burn out and improve patient safety which is ever growing, however, there is a lack of substantial evidence on which to select any particular method or tool. New tools have been developed but with little research addressing the existing tools while on the other hand, the benefits associated with these tools appear to be based on increased levels of staffing. This therefore ledas us to conclude that rather than develop new tools, it is beeter to determine whether the existing ones are any better in practice and also to find ways on how to use them keeping in mind the cots ad the cosequences of doing so.
References
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Benasi, G., Fava, G., & Rafanelli, C. (2020). Kellner’s symptom questionnaire, a highly sensitive patient-reported outcome measure: Systematic review of Clinimetric properties. Psychotherapy and Psychosomatics, 89(2), 74-89. https://doi.org/10.1159/000506110
Jones, A., Whyley, H., Doyle, J., & Bevan, L. (2018). Development of approaches and legislation to optimise nurse staffing levels. Nursing Standard. https://doi.org/10.7748/ns.2018.e11202
Kelley, T. (2019). Emergence of nursing innovation influenced by advances in informatics and health IT. Nurse Leader, 17(6), 531-536. https://doi.org/10.1016/j.mnl.2019.09.012
MARY, H., AMBER, M., KIMBERLY, M., ASHLEY, N., & MARLA, K. (2019). Using an acuity tool that interfaces with the electronic health record to balance nursing workload. i-manager’s Journal on Nursing, 9(2), 1. https://doi.org/10.26634/jnur.9.2.16250
Whitehead, P. B. (2016). Palliative care in the medical, surgical, and geriatric patient care unit. Advanced Practice Palliative Nursing, 74-81. https://doi.org/10.1093/med/9780190204747.003.0008