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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.