Risk Adjusted Staffing to Improve Patient Value and Financial Performance

Purpose:
The purpose was to develop and implement a “risk adjusted staffing” model to allocate nurse resources to prevent hospital acquired harm. The goal was to measure the impact of a patient risk profile to decide staff distribution on patient safety, nurse sensitive indicators, and financial outcomes.

Significance:
Patient safety requires planning to deploy resources to best meet patient needs in a cost effective way. This project describes the impact of an innovative method to assess patient risk for a safety complication and guide staffing decisions to improve patient value and avoid unwanted costs.

Strategy and Implementation:
Risk management data from near misses and actual events were trended over 12 months to identify patient conditions that had safety complications. Interviews with nurses validated patient types requiring closer surveillance. Four high risk categories were identified: high fall risk and age greater than 78; transplant on current admission; liver failure; and first 24 hours after gynecology surgery. A risk assessment profile tool was developed. Each shift, patients fitting a high risk category were assigned a score of 1 or 2. Care assignments with a total score of 4 or greater were “staffed to risk” with a lower staffing ratio applied. Risk scores were re-evaluated during the shift and nursing care resources adjusted accordingly. Charge nurses were educated on utilization of the tool. Staff nurses were educated one-to-one by charge nurses and the assistant manager. Confirmation of understanding occurred formally during the validation process and informally through conversations.

Evaluation:
Fall rate decreased (4.49 to 0.59). Catheter associated urinary tract infection decreased (3.77 to 1.77). Central line associated blood stream infection remained zero. Pressure ulcer rate decreased (11.11% to zero. Nurse satisfaction with resources improved. Incidental overtime decreased 30%.

Implications for Practice:
In an era of health care reform, when stakes are high to provide patient value, staffing precision is needed to minimize risk and avoid unwanted clinical and financial outcomes. Risk adjusted staffing is an innovative, proactive method to allocate nursing resources and achieve that goal.