From Evidence to Practice: Developing an Outpatient Acuity-Based Staffing Model

Tuesday, 13 July 2010

Jane E. Vortherms, MHA, RN, OCN
Coborn Cancer Center, St. Cloud Hospital, St. Cloud, MN

Learning Objective 1: Describe two practice changes that resulted from implementation of an outpatient acuity-based staffing model.

Learning Objective 2: Describe three outcomes related to implementation of an outpatient acuity-based staffing model.

Problem was non-existent reliable and valid outpatient acuity/complexity-based staffing system. Staffing inefficiency contributing influences were: unpredictable patient flow; treatment regimen complexity; physician practice variation, and supporting department delays. Goal was development and implementation of an evidence-based acuity staffing method maximizing patient safety and staff satisfaction, with staff-perceived workload distribution equity and decreased workload-related reduced staff hours. Strength of evidence for 34 articles and 4 additional supporting documents was reviewed. 2 meta-analyses, 2 cohort studies, 3 case-control studies, 13 case reports, and 14 opinions demonstrated moderate to strong evidence supporting development of an acuity-based staffing tool for our outpatient Chemo-Infusion department. Evidence indicated that Nursing assignments contribute to patient flow efficiency and that utilizing nurse-sensitive indicators could enhance staffing. Adverse drug events, fall rates, overtime, sick time, turnover, patient satisfaction, employee engagement, and patient wait times were evaluated. Acuity points were established. Education was provided for all staff. A 6-month trial with a control group (patients assigned as roomed), and pilot group (maximum patient acuity points/nurse). All staff rotated through both groups with comparison of inter-group acuity scores. Resultant changes: assignment of support, rapid response and lab staff, scheduled preparation/charting time, scheduled lunch breaks, altering the patient scheduling system, and a revised care delivery model. Conclusion: acuity-based system provides consistent staffing, decreased wait times, increased patient and staff satisfaction, cost-effective productivity and patient safety. Currently used in Chemo-Infusion and expanding to our Infusion Center and Radiation Oncology. Recommendations: Expand/adapt to other outpatient settings. Benchmarking for staffing levels. Our concurrent Oncology Roundtable survey participation will provide future benchmarks on staffing related to patient CPT (Current Procedural Terminology) codes. Lessons Learned: The outpatient setting benefits from acuity-based staffing. Involvement of all staff, physicians and support areas is essential. References: Complete bibliography available with 38 referenced sources of evidence.