ECO 605 Discussion 7.1: Measures of Work Intensity
ECO 605 Discussion 7.1: Measures of Work Intensity
Given all three examples admission, discharge and transfer (also known as ADT) fits my nursing unit most accurately. Currently I work the floor, supervise at times, and staff a skilled nursing unit. Skilled nursing is diverse in and of itself considering various patients of all ages and needs are admitted to it from acute care hospitals. ADT accounts for the a amount of admissions, total discharges, and transfers within a 24 hour period (Waxman, 2018). Out of the five units making up the facility, the skilled nursing unit is usually the unit to accept all admissions save an anomaly occurs (respite care or room is not available on the skilled unit). The acuity on each of the other units tends to be slightly lower even though there may be more patient’s present on those units since they are “long term” units. Those residents live on these units, are usually less acute because of this, and have a standard routine. This week alone, for example Monday, I accepted three admissions along with two resident discharges for the day and transferred two patient’s back to their home unit post COVID-19 monoclonal antibody treatments. I feel the increasing number on my unit as well as the discharge and transfer activity occurring while accounting for general acuity justifies greater staff as multiple activities are occurring at the same time it’s easier for mistakes to be made or details to be forgotten.
Waxman, K. T. (2018). Financial and business management for the Doctor of Nursing Practice, Second edition. Springer Publishing Company.
I work in an outpatient FQHC so none of the metrics in measures in UOS really apply to me. I do think that the Admissions, Discharge, and Transfer work intensity index or ADT is the best way to determine elasticity for direct patient care. This is calculated by taking the total admissions plus the discharges and then adding any transfers in a 24 hour period and then dividing this by the total by the midnight census (Waxman, 2018). This method helps to prepare for a unit’s ebb and flow throughout the workday. If a nurse leader can anticipate the need and demands of her workforce, she can better staff to alleviate pressure points and ensure the correct number of staff is on shift. Based on the trends, a nurse can report the utilization of her floor to the rest of the hospital which can be especially useful during a pandemic or catastrophic event.
This method takes more of a calculation, but it is also widely recognized as the most accurate measure of intensity (Waxman, 2018). This can help a nurse leader ensure that she has staffed her unit efficiently, but also keep the quality of care at a high level. Productivity targets, quality metrics, and key indicators of performance can aid the nurse leader in amending the staffing needs with this method (Hunt & Hartman, 2018). I think the ADT work intensity index accurately reflects the needs of a nursing unit and can help reduce non-productive time and overstaffing.
Hunt, P. S., & Hartman, D. (2018). Meeting the measurements of inpatient staffing productivity. Nursing Management, 49(6), 26-33.
Waxman, K.T. (2018). Financial and business management for the Doctor of Nursing practice (2nd ed.). Springer Publishing Company. ISBN 13: 9780826122063
I work in an intensive care unit at a medium sized hospital in a mid-sized town. There are a half dozen larger hospitals within a four
hour drive or two hour flight from my home hospital so we do a bunch of transfers. Since we are one of the few intensive care units in the area, we admit many patients for a few hours until a transfer can be made. The unit also downgrades many patients to a med-surg area. The ADT work intensity index would be the best measure of unit intensity because of the number of admissions and transfers we do.
The midnight census would be inadequate because it changes day to day. The midnight census looks at how many patients are present at midnight each day (Waxman, 2018). In my home ICU, we admit and transfer many patients each day and night with a different number of crew members. Oftentimes, the night shift runs a skeleton crew where there are a bare minimum number of nurses so admitting new patients is harder while sometimes, we are overstaffed for a single day and make a dozen admissions and transfers. The midnight census would not give an adequate level of unit intensity since it is taken at the same time each day and has no way of accounting for what busy periods occurred in other parts of the day.
The inverse length of stay would not be adequate for my unit because of how much patient turnover there is. The ADT work intensity index is the best measure for my unit because it accounts for the number of admissions, discharges, and transfers that my unit makes.
Reference
Waxman, K.T. (2018). Financial and Business Management for the Doctor of Nursing Practice. Springer Publishing Company.
Discussion Board 7.1
Taking into consideration the three measures of ADT intensity, I believe that the Admission, Discharge, and Transfer Work Intensity Index is the best way to measure unit intensity for an emergency department setting. First, I want to explain why I believe that the other two forms of measurement would not be as accurate for an emergency department setting to measure intensity. The midnight census is not a strong form of measurement for an emergency department due to the busy times for the unit not usually occurring throughout the middle of the night. Through working both day shift and night shift, I have found that our busiest times in the emergency room occur throughout the day and typically get slower throughout the middle of the night. The inverse length of stay considers the turnover of a same hospital bed within a 24-hour stay. This could be beneficial to measure the intensity of the ER, but with recent holds becoming the new normal, this is not an accurate measure for workload intensity since it is not considered. A good example of this is an ICU hold that stays in the ER for days on end. This patient is requiring a ton of resources and is nearly needing 1:1 nurse staffing. The i/LOS does not take the workload of that patient into consideration.
The Admission Discharge and Transfer Work Intensity Index would be most accurate in an emergency department setting because it considers all admissions, discharges, and transfers in a 24 hour period when calculating workload intensity. This is very important to capture the active movement of patients either discharging home or being admitted to the unit in a busy ER setting. This can also be measured during the busiest time of day to help provide adequate staffing when it is needed in the department. (Waxman, 2018, p. 75-78).
References
Waxman, K.T. (2018). Financial and business management for the doctor of nursing practice (2nd ed.). Springer Publishing Company.
One of the concepts described in this lesson was unit intensity, which measures the “Business” of a unit. In the lesson, three measures of ADT intensity were given: midnight census, inverse length of stay (LOS), and the ADT work intensity index. Given the type of unit you work in or have worked on, what do you believe is the best measure of unit intensity? Explain why.
I currently work at a older adult skilled nursing facility. The days there are usually hectic because you can have up to 17 patients that you care for and throughout the day you may have a couple discharges and then admissions. I believe that the best measure of unit intensity would be the ADT work intensity index. According to the lecture presentation, ” the ADT is found by taking total admissions adding discharge—discharges adding transfers in 24 hours and then dividing this the sum of these three items by the midnight census.” The ADT is the most accurate measure of unit intensity or busyness. If the ADT shows that the unit is intense/busy, then it could result in an increase in nursing staff requirements. Recently my work place has noticed how busy it is for nurses to have so many patients where we have to give medications, do wound care, and prepare for discharge or readmissions; this resulted in the company hiring an extra nurse to work on the unit and provide wound care to all the patients so the unit nurses can properly take care of patients’ medications and do assessments. This is a good example of how the ADT work intensity index would go into effect because if businesses were using this to measure level of intensity, then they could increase nursing staff requirements if needed based on busyness/intensity level.