Question

what tools are available to measure and capture nursing workload in ambulatory care?

Answer 1

The following tools are available to measure and capture nursing workload in Ambulatory Care:

1. Taxonomy of Ambulatory Nursing Practice:  Identified the six domains of ambulatory care nursing and described functions of nurses in ambulatory care.

2. Diagnosis Clusters : Developed to facilitate comparison of ambulatory practice patterns across differing providers; 92 clusters were formed representing 86% of all diagnoses.

3. Ambulatory Patient Related Groups (APGs): Designed to classify all ambulatory care patients into 14 major ambulatory categories (MACS); sub-divisions under each category resulted in 154 APGs.

4. Ambulatory Patient Classification System: Developed an instrument to assist in controlling costs in the ambulatory setting.

5. Ambulatory Care Clinic Classification Instrument (ACCCI): Measured nursing care complexity in ambulatory care; comprises 44 nursing activities weighted for complexity factors and grouped into six responsibility areas.

6. Ambulatory Care Organizational Analysis Scale
(ACOAS): Measured concepts of Knowledge of Client,
Standardized Treatment, Workload Variability, and Analysis of Intervention Strategies; 20-item visual analog scale.

7. Nursing Technology Model(NTM):  Complexity of nursing care in ambulatory setting;model tested using ACCCI and ACOAS.

8. Nursing Patient Classification System (NPCS):  Adapted inpatient patient classification instrument, 35-items, and piloted test in ambulatory surgery center.

9. Ambulatory Severity Index(ASI): Adapted from the Severity of Illness Index, a generic measure of patient severity designed to assess the total burden of illness a patient presents to the hospital.

10. Ambulatory CareClinic Classification
Instrument (ACCCI): Adapted and tested Verran’s instrument; adapted instrument composed of 34-items and patient visits were categorized 1 through 4 based on nursing intensity scores; tested in pediatrics, OB/GYN,medicine, outpatient surgery.

11. Student Health Services Patient Classification System: Developed 26-item patient classification
instrument for use in student health service.

12. Ambulatory Care Clinic Classification
Instrument (ACCCI): Adapted and tested Verran’s instrument; adapted instrument composed of 61 nursing activities grouped into nine responsibility areas.

13. Allocation,Resource Identification, and
Costing (ARIC): Adapted inpatient patient classification instrument for use in large multi-specialty ambulatory care setting.

14. Taxonomy of Ambulatory Nursing Practice(Verran): Adapted Verran’s taxonomy using a time and motion methodology to develop new patient classification instrument for adult ambulatory surgery clinic.

15. Patient Intensity for Nursing Index(PINI): Developed to measure nursing intensity needed by patients in inpatient settings (general medical surgical, specialty, and intensive care); includes four dimensions of care including severity of illness, patient dependency, complexity of nursing care, and time.

16. Patient Intensity for Nursing Ambulatory Care(PINAC):Adapted from PINI to measure nursing intensity for use in ambulatory care; includes 4 dimensions of care including severity of illness, patient psychosocial needs, complexity of nursing care, and time.

17. Ambulatory Care Patient Classification Tool(ACPCT): Adapted and tested Verran’s ACCCI instrument;adapted instrument composed of 44 activity categories and both time and complexity weights were established.

18. Ambulatory Oncology Nursing Checklist: Adapted from Verran’s taxonomy to develop a patient classification instrument for ambulatory oncology clinics.

19. Dimensions of Current Staff Nurse Role: Defined core dimensions of the current and future role of ambulatory care staff nurses in four types of ambulatory care settings (university hospital outpatient, community hospital outpatient, physician group practices, and health maintenance organizations)

20. Patient Classification System for Freestanding Ambulatory Surgery Centers:Adapted from an inpatient patient classification and developed a patient classification instrument for preoperative and postoperative care delivered in a freestanding ambulatory surgery center.

21. Resource 9 Patient Classification: Developed staffing model for same-day surgery unit based on patient acuity, census, and physical facility.

22. Care Tracker: Developed to describe nursing encounters by type, intervention, staff, time, and cost.

23  Staffing formula guided by industry standard bench-
marks: Described staffing benchmarks by job category based on support staff per physician FTE and staffing expenses as a percent of revenue with adjustments made for midlevel providers, physician productivity, satellite locations, practice styles, staff expertise and experience, work performed by others outside the practice, and staff salaries.

24  RRM Ambulatory Nursing Staffing Module: Developed to estimate the requirements for nurses that provide comprehensive health care and education to the individual and family in the ambulatory care setting.

25  Ambulatory Intensity System: Developed to quantify nursing care in an out patient cancer center and used in conjunction with a computerized appointment system.