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Patient Acuity Tool: Where Are We Now?

Assessing patient acuity has been around in some version for more than 50 years. But has anything changed? Has technology improved the process of capturing a patient’s acuity so that the nursing staff can use that information to better manage its workflow and throughput? Perhaps more importantly, has the use of some kind of patient acuity tool improved patient outcomes and nurse satisfaction?

Recent research suggests that patient acuity tools do positively impact nursing care, but they may also still be a work in progress. First, the benefits.

In a recent study, researchers wanted to know how a patient acuity tool affected both nurse satisfaction and the perception of equitable workloads, specifically as it related to pulmonary care. The study was conducted over a two-month period and included 35 Registered Nurses in an acute care hospital in southwestern Pennsylvania.

When asked during the qualitative phase of the study what they liked about the patient acuity tool they were asked to use, they said that their assignments were more equal or fair after implementation and that the tool promoted verbal communication. It also made them think more critically. In general, the focus group participants said that their satisfaction was also increased due to having input on their assignments. On the quantitative side of the study, the results also showed increases in the amount of satisfaction and equity among the nurses sampled in the survey.

Those results are consistent with other studies.

For example, a study by a PhD candidate at Valparaiso University showed that 60% of her participants noted marked improvement in equity of shift assignments from using a patient acuity tool, while 85% said they would like to continue using the tool after the project’s completion. In addition, 55% of participants reported better balanced nursing shift assignment with utilizing the tool. A similar study an Indiana hospital in 2014 showed similar results, which suggested higher nursing satisfaction after the implementation of a patient acuity tool.

But current patient acuity tools are not without problems.

First, there’s still a question of what exactly is “acuity.” Since there is no standard for how the term should be measured and categorized, some nursing units have struggled with using tools that don’t accurately capture their unique situation. Conversely, a few tools have so many categories and rules, their use has not only been cumbersome, but in some cases untenable. Any tool is only as good as its utility.

Another problem still associated with patient acuity is the process itself. While some units and hospitals have standardized the different categories associated with acuity, the manner in which they first identify the acuity level and then try to use that criteria to assign patients to nurses is typically done manually. While assigning acuity scores to each patient may not be that difficult, matching up those scores with patient location on the unit, nurse skills, and continuity of care of the staff can be a logistical nightmare. Current patient acuity tools only solve one part of the equation—the acuity categorization. They are not equipped to automatically match up patients with nurses.

Patient acuity tools clearly enable nursing management to make more informed staffing and operational decisions. In addition, the research strongly supports the notion that their use improves nurse satisfaction and the perception of more balanced workloads. But they still at the beginning of their evolution and need to be better integrated into the entire patient assignment process to be fully beneficial.

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MedAptus Launches New Patient Assignment Software for Nurses

Assigning patients just got a whole lot easier for charge nurses.

MedAptus has launched ASSIGN for Nurses, a new software program that matches the right patients with the right nurse by applying a proprietary protocol engine designed to handle the complexities of patient assignments.

More than a year in development, ASSIGN for Nurses replaces the cumbersome manual assignment process that most charge nurses or assistants use, which is slow, inefficient and often unfair because of imbalanced workloads.

“This is a sea change when it comes to patient assignments,” says Eugene C. Schneider, MedAptus president and chief executive officer. “Not only can ASSIGN for Nurses handle the complexity of balancing multiple protocols, but it does so quickly and easily.”

Using ASSIGN for Nurses is straight-forward.

First, ASSIGN automatically taps into a patient census from the EHR, along with data from the hospital’s nurse scheduling software. Then, it applies protocols – such as patient acuity, geography, continuity of care and others simultaneously – to intelligently match patients with nurses. Once the assignment process is completed, the final list is then automatically generated and distributed, either electronically or in print. The entire process takes minutes to complete.

“I really like how ASSIGN for Nurses accounts for the many variables that can affect care,” said Lisa Quinn, PhD, RN, OCN. “Too often, we just focus on one factor, such as patient acuity, when in fact patient-centered care involves a whole range of variables.”

Studies show heavy nurse workloads can have a significant impact on patient safety and satisfaction, length of stays and readmissions. Imbalanced workloads can also lead to feelings of unfairness, frustration and even burnout. That’s one reason why developing patient assignment software for nurses was so important to MedAptus.

“We wanted to create a product that specifically addresses one of the most pressing challenges nurses face,” said Schneider. “So much is affected by nurse workloads. It’s nice to be able to provide software that dramatically improves such an important nursing function as patient assignments.”

ASSIGN for Nurses is designed to work in any unit and with any staff size. It also integrates seamlessly with all of the major EHR systems and nurse scheduling software programs, while requiring minimal IT staff involvement during implementation.

The software is the second patient assignment product MedAptus has launched in the past year. Previously, the company unveiled ASSIGN for Physicians, which applies similar rules-based algorithms to rounding assignments. The company is also developing a proprietary software for case managers and therapists as well, creating a full suite of care coordination products.

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Is Physician and Nurse Burnout Contagious?

Is burnout contagious? Is it communicated from one provider to another?

Two different studies—on focusing on physicians and another on nurses—tried to answer that question and, not surprisingly, both came to same conclusion. Burnout is contagious.

In one study, a questionnaire on work and well-being was completed by 1,849 intensive care unit nurses working in 12 different European countries in 1994. Burnout was measured using several established criteria and the participants were surveyed regarding the perceived burnout complaints among colleagues, using a common measurement called the Maslach Burnout Inventory. The areas measured for burnout were emotional exhaustion, depersonalization, and personal accomplishment.

What did the results show?

Nurses who reported the highest prevalence of burnout among their colleagues were also the most likely to experience high levels of burnout themselves. In addition, perceived burnout complaints among colleagues had a positive, independent impact on each of the three burnout dimensions.

In another study, researchers looked at whether burnout was contagious among physicians. For this study, the sample was 507 general practitioners in the Netherlands and they wanted to know if there existed a positive relationship between perceived burnout complaints among colleagues and emotional exhaustion.

Burnout was measured using the same Maslach Burnout Inventory format described earlier, and susceptibility to emotional contagion was measured with a scale that included 6 items, including such statements as “I cannot continue to feel O.K. if people are me are depressed” and “I tend to remain calm even though those around me worry.”

According to the researchers, the perceived burnout complaints among colleagues, and individual differences in the susceptibility to emotional contagion were positively associated with emotional exhaustion. Emotional exhaustion, in turn, was positively associated with negative attitudes, leading to developing negative, cynical attitudes towards patients and the tendency to believe that “one is no longer effective in working with clients and in fulfilling one’s job.”

J Adv Nurs. 2005 Aug;51(3):276-87.
Burnout contagion among intensive care nurses.
Bakker AB1Le Blanc PMSchaufeli WB.
Journal of Social and Clinical Psychology: Vol. 20, No. 1, pp. 82-98.
Burnout Contagion Among General Practitioners
Arnold B. Bakker1, Wilmar B. Schaufeli2, Herman J. Sixma3, Willem Bosveld4
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Nurse Empowerment and Better Patient Outcomes

With hospitals around the U.S. looking at nurse burnout and how it might be affecting patient care, researchers in the past several years have looked at which factors have most contributed to the nurse malaise. Are there some factors that seem to have more impact on nurse dissatisfaction and thus directly impact health outcomes? Or is too difficult to pinpoint one area of concern versus another?

Nurse staffing has become an important consideration in terms of nurse burnout and patient care. In recent study, for example, higher number of nurses were associated with improved survival rates among patients that were very seriously ill. In another study, an increase in nurse numbers was linked to better survival rates in ICU.

But there’s been another thread of study that ties patient outcomes to a nursing work environments. The premise for all of these studies is – a better working environment results in higher nurse satisfaction, which in turn results in better patient safety and outcomes.

BETTER WORK ENVIRONMENT

Two particular studies appear to confirm this hypothesis.

In one study canvassing nurses in 137 Pennsylvania hospitals, researchers looked at whether or not improvements in nurse work environments over time were associated with lower rates of burnout, intention to leave one’s current position and job dissatisfaction. The results showed that the percentage of nurses with high burnout across hospitals decreased by about 5% between 1999 and 2006 when work environments were improved. Similarly, the percentage of nurses who reported intention to leave diminished from 22.4% to 14.2% during that same time frame and job dissatisfaction decreased from 40% to 31.5%.[1]

But what constitutes an improved work environment and what factors or factor could be deployed to make it happen?

Researchers in Canada tried to tackle that question and the conclusion they reached was – empowered workplaces significantly improved and supported positive outcomes for both nurses and patients.

The researchers looked principally at structural empowerment – those elements within an organization or team that enable an employee to get work done. The also looked at two different structural factors – a formal environment in which power was achieved from specific roles within an organization and informal factors, which were achieved through personal alliances and connections within the work setting.

What did they conclude?

NURSE EMPOWERMENT IS THE KEY

Structural empowerment, mediated through group processes, significantly impacted a variety of patient outcomes.[2] That is, when managers gave employees the opportunity to take more responsibility, initiate or make decisions without having to ask someone, complete a task in one’s own time frame, and take calculated risks without fear of repercussions, a higher level of care was achieved.

The researchers also noted that there were several ways in which managers could foster nurse empowerment. These included:

  1. Increase opportunities for professional growth
  2. Ensure access to information required for care
  3. Provide support and guidance
  4. Provide the necessary resources such as time and equipment to get the job done
  5. Provide regular feedback on performance or change assignments to ensure growth opportunities.

The results of the study suggest that “empowered work environments are predictive of nurses feeling autonomous and self-efficacious, which meant they felt their work was more meaningful and thus contributed to their overall job satisfaction.

[1]Int J Nurs Stud. 2013 Feb;50(2):195-201. doi: 10.1016/j.ijnurstu.2012.07.014. Epub 2012 Aug 14.
Changes in hospital nurse work environments and nurse job outcomes: an analysis of panel data.
Kutney-Lee A1, Wu ES, Sloane DM, Aiken LH.
[2]Br J Nurs. 2017 Feb 9;26(3):172-176. doi: 10.12968/bjon.2017.26.3.172.
Effects of work environment on patient and nurse outcomes.
Copanitsanou P1, Fotos N2, Brokalaki H3.

To learn more about MedAptus’ patient assignment software — ASSIGN for Nurses — that saves time and balances workloads, click here

 

Why Nurses Are Hurting and How to Save Them

Earlier this month, MedAptus unveiled our vision for our Assign for Nursing solution at the 2016 American Nurses Credentialing Center (ANCC) National Magnet Conference held in Orlando. Also unveiled at event was a new campaign aimed at helping minimize work related injuries for nurses, “Save Our Nurses.” This movement recognizes the sacrifices nurses make every day to care for their patients and also recommends the implementation of changes to protect those who provide care.

So in the MedAptus booth, we met with hundreds of nurses to talk about how our Assign platform aligns nurses to the right patients, much like a “match.com.” The concept was well received by both nurses and charge nurses. Items of particular interest included workload balancing using acuity, continuity of care across multiple hospitalizations, and, of course, saving time. A few nurses asked, “How do you define the acuity?” Our answer? “We have built a customizable acuity tool that is embedded in the product.” While some thought that was ideal others told us that they have an acuity tool in their EMR. “Not a problem,” we replied. At MedAptus one of our guiding development principles is flexibility, followed closely by interoperability. We know that hospitals want to leverage what they have already and provide workflows that enhance a caregiver’s efficiency, not hinder.

Now, back to the Save Our Nurses movement for a moment. What does it have to do with workload balancing? Well, a lot quite possibly. According to Save Our Nurses, “One of the primary reasons for workplace injuries among caregivers is repositioning patients in bed to make them more comfortable or for clinical assessments/procedures. This includes turning patients from side to side and pulling them up in bed, both of which occur numerous times during every shift. While progress has been made in the industry to reduce this strain, nurses continue to sustain injuries from performing the basic functions of their jobs.”

Imagine if patient distribution could consider the repositioning related requirements of each patient and ensure that “physically intensive” patients could be spread across nursing resources in a fair manner? Well, with MedAptus Assign, this is completely achievable as one of our embedded protocols.

Suffice it so say, we agree completely with Save Our Nurses and their belief that, “It shouldn’t hurt to be a nurse.” While this is focused on the physical pain that can drive some out of the profession at an early age, this can also apply to the emotional pain that can come with the demands of the profession. Feelings of burnout and unfairness related to assignments can have a huge negative impact on a workforce that Congress is currently focused on helping to expand. We think our Assign platform can help tremendously in this area, and we are happy to report that many nurses at the ANCC Conference agreed.