Adverse events cost the healthcare industry billions of dollars. According to a 2010 report in the Archives of Internal Medicine, hospital-acquired sepsis and pneumonia in the United States caused more than 48,000 deaths and cost more than $8 billion to treat in a single year.
With healthcare reform's new system of Medicare-reimbursement rewards and penalties based on patient outcomes, hospitals that don't address quality issues will feel a direct impact on their bottom line.
Beginning in October 2012, hospitals that exceed federal performance standards for at least five measures, including certain hospital-acquired infections, will receive higher Medicare payments. In 2014, the federal government will reduce Medicare payments by 1 percent for those hospitals with the highest rates of hospital-acquired conditions.
Under the new penalties, a 300-bed hospital with low quality metrics could be penalized more than $1.3 million a year beginning in 2015.
One essential strategy to improve patient outcomes is examining staffing strategies. The link between patient outcomes and staffing levels has been well documented. In a 2011 study published in the New England Journal of Medicine, Jack Needleman and his research team found that when units were understaffed, patient mortality increased by 2 percent. Numerous studies have found that understaffing is linked to other adverse outcomes, including more patient falls, more failures to rescue and longer lengths of stay.
While staffing levels are clearly linked to patient outcomes, the path to improving outcomes isn't necessarily to simply increase the number of caregivers. Rather, the focus needs to be on developing staffing strategies that use data to match patients and caregivers to optimize both clinical and financial outcomes. Those data-driven strategies require comprehensive, timely data about both patient care needs and the staff that will provide that care.
The ability to accurately project patient care needs requires information beyond the midnight census. The midnight census gives a one-dimensional picture of patient care needs not taking into account patient turnover. The midnight census might be 14 two days in a row, but that gives no indication of the five admissions and five discharges that required extra caregiver time. And, accounting for increased staffing needs during times of high patient turnover is critical. The Needleman study also found that patients in units with high patient turnover saw the mortality risk increase by 4 percent.
Measuring the census more frequently and using that data to make staffing decisions is still not enough because census numbers don't include any information about the amount of care each patient needs to achieve the desired outcomes. The next logical progression is to track patient acuity information, which provides more detail about how sick each patient is. While this information leads to better staffing decisions, it does not provide enough data for workforce optimization.
True workforce optimization requires integration between the patient classification and staffing and scheduling systems. A patient classification system takes a more comprehensive approach to patient care needs, going beyond the patient's pathological and physiological issues and taking into account emotional, psychological and social concerns as well family dynamics. This multi-dimensional view of the patient enables accurate calculations about the amount of care the patient needs during the current shift.
More importantly, it enables accurate projections about how much actual care will be needed on the upcoming shift. With an accurate picture of staffing needs, the nursing team is empowered to make proactive decisions that improve care and lower costs.
Here's how workforce optimization can meet patient needs and reduce labor costs: Three hours before the shift starts, a staffing coordinator looks at projected patient care needs and finds that in one unit, they can call off a nurse if they bring in an aide instead. She sends out a text to alert qualified, available aides about the open shift. Once an aide picks up the shift, she uses the staffing and scheduling system to determine which nurses are scheduled for the next shift, which are approaching overtime and whose turn it is to be called off.
Based on this information, she sends a text message to cancel one nurse. Within minutes, the shift is right-staffed and labor costs have been reduced.
Getting staffing levels right for each and every shift is critical to both delivering high quality patient outcomes and maintaining fiscal health. Consistently achieving right-staffing is dependent the organization's ability to match patient care needs and caregivers. Integrated patient classification and staffing and scheduling solutions deliver that ability.
J.P. Fingado is president and CEO of API Healthcare.