Evidence-Based Staffing Enhances Patient-Centered Care

Patient-centered care is a healthcare buzzword, but what does it really mean? A bedside nurse would say that all her care is patient centered. It's the paperwork and bureaucracy that draws the nurse's focus from patients. All nurses want is time and appropriate staffing levels to focus on patients and their needs.

Patient acuity systems give hospitals flexibility to maximize staffing effectiveness. The systems demonstrate how hospitals can provide adequate staffing based on actual patient needs, rather than restrictive ratios.

Edwin Loftin, RN, MBA, FACHE, is the vice president of nursing at Parrish Medical Center in Titusville, FL. The hospital takes patient-centered care seriously. In the 1990s, when PMC realized it was time to build a brand new hospital, it was one of the early adopters of designing a healing environment. It designed a new space that used spirit-lifting architecture and decor, natural light, and intelligent patient-centered design to aid patient healing.

Parrish Medical Center uses an acuity system built around patient needs, rather than staff workload. Loftin says this provides better patient-centered care. Evidence-based indicators determine the hours of care needed by patients without nurses having to manually classify patient condition.

"That was actually a big buy-in that I could take to my nursing staff that, they won't have to do anything different," says Loftin. Along with not adding to workloads, his staff also bought in to the system's evidence-based data.

Hospitals traditionally assign staffing based on patient needs, with the charge nurse on each shift determining how many patients each nurse will care for and where unlicensed and assistive personnel will be deployed. Acuity software, however, makes the determination much more accurate and, crucially, it can change in real time, giving hospitals greater flexibility.

The system "validates the hours of care that are needed for any unique patient, be it a med-surg patient with a stroke or a patient on dialysis," Loftin says. "From those hours of care, we break it down into the disciplines of care that are needed."

For executives, the benefit is a real-time, high level of analysis for daily needs. Loftin says he looks at total hours per patients that day and knows what he'll need on any given unit for any given day.

"I then give that total number of hours to my frontline directors or managers," he says. "They, along with the unit leaders of their shifts, subdivide those total hours into their licensed, unlicensed, and non-direct care, and can evolve them and use them to best fit the workload of their unit."

The in-depth analysis of staffing patterns has allowed Parrish Medical Center to drill into outcomes.

"Because the indicators are patient-focused and evidence-based, it gives me a debate to use when we're looking at financial implications as well as outcome implications," says Loftin.

Loftin says PMC has not had a case of ventilator-acquired pneumonia in more than four years, the fall rate is well below the national best percentile ranking, and the hospital has decreased the catheter-associated urinary tract infection rate to all but nothing, with just one in the last six months.

"All those are [National Database of Nursing Quality Indicators] NDNQI nursing indicators," says Loftin. "It's not just science we're using, it's making sure we have the right staffing and support of the workload of staff so they can pay attention to the important things."

The acuity system has also contributed to increased nurse morale. Loftin says nurses feel the units are staffed appropriately when following the guidelines. In the real world no system works perfectly. Sick days and vacations mean not every shift is always staffed at the correct level. But PMC is flexible and works around problems.

On days with lower census or patient acuity needs, the hospital looks at other ways to deploy staff across the system or gives the opportunity of taking vacation time. Nurses understand such flexibility, as they are used to being called in when patient acuity needs or census numbers rise and units need extra help.

Evidence-based staffing is key to the hospital's desire to provide community-centered care.

"[It's] one tool that we use to establish and project what kind of staffing we need to have today and into the future," Loftin says. "It gives argument cognitively for the staff. But it also helps us hold each other and the staff accountable when we need to staff correctly."