Question

Sheila Baumgarten, PhD, RN has been the director of the medical product line for 20 years. She is also a nurse informaticist and would like to see more use of software for clinical and management analyses. She is responsible for bot acute and post-acute care services, including clinical, diagnostic facilities, and home health services. She has long been challenged by the limited utility of the financial productivity model. She recognizes that some of the resistance of executives has been due to the lack of software applications to collect and sort essential data elements for more comprehensive analysis of multiple data points.

The organization recently purchased the ideal software to create a comprehensive clinical productivity system. The nurse executive of the system asked Sheila to lead a team to develop the optimal clinical productivity system. She is excited and also cautious about how to do this work effectively using the current evidence for practice and outcomes and how to be innovative in designing a robust model to address the current challenges. She has decided to start small and selected DRG 89, simple pneumonia and pleurisy, to begin this work. Sheila has identified stakeholders to collaborate with and create the desired model. The following information has been identified by the group as necessary to create a clinical productivity system: Inputs (number of patients with DRG 89 for the past 12 months, hours of care provided to each patient by RNs and nursing assistants, intensity projected needs for patient care [patient acuity] in hours, budgeted hours of care for each patient), outcomes (average actual length of stay, average target length of stay, average cost of care per patient, average HCAHPS score for patients, patient satisfaction with clinical outcomes, number of falls/medication hours/pressure ulcers).

The following information was readily available: 200 patients with diagnosis of DRG 89, RNs provided an average of 47 hours to each patient (data extracted from patient acuity system and staffing information), nursing assistants provided an average of 14 hours to each patient, patient intensity hours from the acuity system averaged 65 hours for each patient, budgeted RN and nursing assistant hours for each patient averaged a total of 68 hours for the RNs and nursing assistants, patient satisfaction is 10% lower than the target performance goal, patient falls with injury increased by 10%, and no change in pressure ulcers and medication errors.

Case study obtained from D. Weberg and S. Davidson 2021 book leadership for evidence-based innovation page 203-204. This is all the information I have available for this question.  

1. As a team, consider these data and discuss what they mean.
2. Is this data adequate for new clinical productivity system?
3. What actions would you take, knowing that the hours used were below both the acuity and budgeted hours?

Answer 1

Ans. DRG means Diagnosis Related Group.

1.Classifying a patient under a particular group where those assigned are likely to need a silmilar level of hospital resourses for their cure.

2.This data will be adequate.

3. Now a days heavy workload of hospital nurses are the major problem and also there is inceased demand for nurses, inadequate supply of nurses, increased overtime, etc.

Acuity : is the measurement of the intensity of nursing care that is required by a patient. This will regulate the number of nurses in shift.

Tools to check acuity can be scored like 1 to 4 scale.

1 for stable patient

2 for moderate patient

3 for risk patient

4 for high risk patient

By using this scale assign staff according to the patient need and not according to the raw patient number.

Budget hours

Multiply the number of hours per unit times÷average cost per hour

Eg. If average hours is =25

Average cost per hour=$12

ie=25÷12= 3

Cost will be $3 for each unit