Defining Acuity

Patient acuity is a concept commonly referenced by caregivers and the health science literature but without specificity or consistency of definition or measurement.

Acuity has become a reference for estimating nurse staffing allocations and budget determinations.  One hospital publishes a definition on its website “PATIENT ACUITY—The measurement of the intensity of care required for a patient accomplished by a registered nurse. There are six categories ranging from minimal care (f) to intensive care (VI)”.

Current legislative proposals impose requirements of patient acuity measures be used to adjust nurse staffing specifically to current patient census in an attempt to improve the quality of patient care.

In Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043) Colonel Bonnie M. Jennings concludes, “Patient Acuity is a concept that is very important to patient safety. Presumably, as acuity rises, more nursing resources are needed to provide safe care. Very little research has actually been conducted, however, to verify this premise. Moreover, findings from the research that has been conducted are largely inconsistent. Design issues account for these differences. In addition, it is possible that factors other than patient acuity may contribute more to patient outcomes. It remains important to derive a much better grasp of the relationship between patient acuity, outcomes and patient safety. At present, little can be said with confidence about this association.”

Current research suggests the Medicare case mix index (CMI) provides a surrogate for patient acuity and provides a means to estimate patient centric nursing demand with changes in patient status reflected by CMI change.

Inconsistent measurement, undefined standards, patient, provider and facility variables have so far frustrated the attempt to demonstrate acuity as a predictor of demand to reliably influence practice decisions.

Recently progress was made to improve the measurement issues in post-acute care.  The Centers for Medicare and Medicaid Services (CMS) issued a report to Congress on the Post Acute Care Payment Reform Demonstration (PAC-PRD) with focus upon standardizing measures across providers to relate patient status and resource use in a site neutral analysis.  One of the most important contributions of this project is the consistent measures of patient severity across the different PAC settings.  We should expect a refinement of the CMI ability to predict resource requirements specific to patient centric status to improve its use in estimating acuity.

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