Currently, one of the prevalent issues in nursing is the lack of sufficient manpower, which causes an increase in workload, job dissatisfaction, burn-out and subsequently, a reduction in the quality of patient care provided.

This has urged experts to develop a systematic method to solve the problem. In order to be more familiarised with nursing units, patient acuity system is being introduced as a way to optimise nurse staffing so that patient outcomes can be improved.

Acuity can be defined as the measurement of the intensity of nursing care that is required by a patient. An acuity-based staffing system regulates the number of nurses on a shift according to the patients’ needs and not according to raw patient numbers. By using specialised softwares and computers, this system effectively eases the nurse manager’s task of allocating the number of nurses based on the care needed by patients.

Acuity-based staffing and nursing hours

In nursing, the nurse manager will take the responsibility of allocating the resources and disseminating the tasks equally to deliver better quality care. Even so, determining how to measure the nursing care needed for one patient is quite a challenge in this profession.

Hence, this is where the patient acuity system comes into play. Based on patient data on any given day, nurses will enter the data into the computer. Afterwards, the nurse manager will run a report for determining the nurse staffing pattern for every shift.

The computer is equipped with specialised software that makes the process more efficient, faster and accurate. If the report shows high patient acuity on the next shift or the next day, the nurse manager will then allocate more nurses to be on staff for that shift or day.

Depending on the patient’s needs, this system assists nurse managers to place the float nurses, so that patients who require more intensive care will be under experienced and skillful staff member. On account of that, patient acuity data offer transparency that allows accurate calculation of how many nurses and nursing hours are needed in a given situation.

Acuity-based staffing and adverse outcomes

Acuity-based staffing is also associated with decreased adverse events, including falls, infections, and pressure ulcers. A study in one transplant unit has identified four patient risk factors that indicate a higher acuity level.

The indicators included falls incidence, catheter-associated urinary tract infections, central line–associated bloodstream infections, and pressure-ulcer prevalence. The findings discovered that the rates for all four indicators decreased after staffing was adjusted to account for higher-acuity patients. Study findings also showed decreased overtime hours and reduced costs for each case.

Researches on patient acuity system

Some studies have revealed the positive outcomes of patient acuity system. One clinical study has shown that when the system is implemented, the proportion of hours of care delivered by RNs had significantly reduced the rates of medication errors, patient falls, skin breakdown, patient and family complaints, infections and death.

Likewise, in Korean intensive care unit, the research evidence suggested that nurse staffing influenced the patient outcomes. In this study, involving 27,372 ICU patients discharged from 42 tertiary and 194 secondary hospitals, indicated that nurse and physician staffing and specialisation of ICUs impacted on patient mortality. However, nurse experience had no significant relationship with mortality.

Patient acuity is a concept that is very important for patient safety. Acuity-based staffing is not simply a way to achieve better patient outcomes. It is also an opportunity to demonstrate the significant value of nursing in providing patient care. MIMS

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Sources: nurse-staffing/
Cho, S.H., Hwang, J.H., & Kim, J. (2008). Nurse staffing and patient mortality in intensive care units. Nurses, 57(5):322-30. doi: 10.1097/01.NNR.0000313498.17777.71
Jennings, B.M. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
Pappas, S., Davidson, N., Woodard, J., Davis, J., & Welton, J.M. (2015). Risk-adjusted staffing to improve patient value. Nurs Econ. 33(2):73-8.