Lorane Kinney – Avantas Founder
Without question few conversations associated with direct patient care induce a higher level of emotion than managing individual patient acuity. It’s easy to understand the anxiety this issue evokes. Various governing bodies require providers to prove that individual patient conditions are being considered in staffing decisions but no single method is prescribed or officially endorsed. Some would say this ambiguity feeds the rhetoric and the rhetoric fires the emotion.
Knowing the importance of proactively managing advanced acuities, we have found five criteria to be at the core of managing patient care in an efficient and sustainable manner:
- Create high quality clinical outcomes
- Provide documentation that satisfies standards of all regulating bodies
- Manage financial responsibilities
- Feed a forecasting tool to improve future projections
- Eliminate complexity and redundancy requiring extraneous activity at the point of care
A simplified method to manage acuity begins when clinical leaders use historical patient conditions and outcomes in comparison to national standards. All required information is easily available specific to each nursing care department. The purpose is to identify a range of patient conditions to manage the care of 97% to 98% of the patient population seen on the nursing unit. Defining this range of “average acuity,” i.e., that which does not require additional staff to care for patients, is the result of more than a decade of research within the Avantas client base. Stated differently, we have found that only 2% to 3% of patient acuity levels require an uptick in staff.
Review of this crucial acuity management process should occur annually, at a minimum, with frequent reviews throughout the year to re-calibrate as new evidence emerges. The resulting range – expressed as an average hourly standard – is used to create a clinically appropriate, financially responsible Ideal Care Model.
The entire exercise – which manages 97% to 98% of acuities – produces a highly customized Ideal Care Model for each nursing unit yet consumes less than an hour of time annually. Once embedded within a staff scheduling tool (Avantas’ tool is called Smart Square) the staffing plan can be automated. It proactively and accurately operates in parallel to the care plan for all but 2% to 3% of the patient population. The resultant level of care for this percentage of patients is identical to that produced by a more complex acuity methodology.
Evidence proves the vast majority of patient conditions and associated staffing decisions fall within the norm and require no additional effort, leaving ample time to document and solve acuity exceptions. The clinical assessment process that identifies an advanced acuity – typically just 2% to 3% – is well established within each of our client organizations and requires no re-engineering associated with the staffing process. Once acuity exceptions are identified it is a simple matter to report, document and cure.
The resulting outcome meets the five criteria identified above. It creates the acuity record required by all governing bodies and creates an order for additional staff to be filled through the normal methods.