Inpatient rehabilitation hospitals present additional expectations for nursing skills and practice that they place on nursing personnel. Predicting the correct number of staff and skill mix to address the individual patient needs presents a challenge to traditional acute hospital staffing models.
Accountable care will become a greater influence on hospital operations than traditional fiscal practices of staffing, the what-we-think-we-can-afford methods. Providing the appropriate skill mix and intensity of nursing services for patients in the rehabilitation hospital requires a reexamination of nursing practice, expectations and performance metrics matched to the quantification of patient requirements so that a prediction of nursing hours per patient per day is available for staff scheduling. The prediction of patient centric nursing demand and the ability to provide and report performance against it is currently before congress for consideration in the next round of CMS mandates.
One model for calculation of patient centric demand follows the CMS methodology for estimating resource costs and patient classification of the Medicare Prospective Payment System for inpatient rehabilitation hospitals.
The estimate of nursing hours of care for each patient is dependent upon the routine daily assessments of medical and functional status. Utilizing professional, organizational and licensure standards of practice criteria to establish appropriate nursing skill requirements for rehabilitation (rehab nursing), medical-surgical (med-surg nursing), and activity of daily living (ADL nursing) each patient’s total nursing hours per patient per day can be predicted for RN, LPN and CNA personnel. Institutional productivity, personnel benefits and workload factors are added to predicted demand to derive staffing requirements. All individual patient totals for the three nursing skill levels when aggregated at the Unit and Facility levels establish the respective demand for the institution’s current nurse staffing requirement.
These concepts are not unique or new, and not until accountable care forces their use will sufficient attention be given to managing a hospital’s nursing resources based upon what the patient needs rather that what the CFO thinks we can afford.