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Written by: Bob Habasevich, PT on Tuesday, December 11, 2012 Posted in: Inpatient Rehab

Hours per patient day (HPPD) is the standard measure of nursing care intensity for most hospitals. It refers to the number of nursing hours paid to care for the average patient in the hospital on any given day. HPPD is used to estimate the cost of nursing care projected for the number of patient to be seen for some future time-period. It gets plenty of attention and reference around budget preparation time each year and whenever nurses compare their work situation to peers.

As a quality or management metric, it doesn’t get much respect as  any estimate of historical average lacks the specificity or refinement necessary to apply to the current situation. When HPPD is used as a staffing reference for nursing units, most observers are quick to inquire about the acuity of the patient population and make mental adjustments to the stated value.

Adjusting HPPD appears to occur with equal frequency to its use. In fact, there are no standards for nursing hours per patient per day.  Even in rehabilitation hospitals where CMS has gone to great expense to establish a detailed payment classification system to predict resource utilization, nursing intensity of HPPD is undefined. This seems like a major deficit since nursing is the predominant resource expense in rehabilitation hospitals where therapy resources are rigidly mandated at three hours per day.

As a measure of nurse to patient contact time per 24 hour period it equates poorly to what has been budgeted or is required from a workload standpoint.  When evaluated, the difference may be as great as fifty percent or more.

Easily calculated by dividing the total nursing hours paid by the number of patient days for the same period average, HPPD seems meaningful and most CFOs would rather not have to deal with all the variables why we need more nurses if next year will not see more patients. But once vacation, education, sick, holiday and administrative time is removed from the calculation what is left for direct care time delivered to the patient is considerably less.

Given the physical layout and workflow of the hospital’s units, each has a different efficiency factor that further erodes nurse-patient contact time. Changing nurse practice demands for IRF documentation and reporting while implementing new systems for operations and communicating professionally progressively limits the nurse to patient availability.

Finally, nobody is actually asking the question, “how many hours of nursing care does the patient require?” And after, “how many hours of nursing care did the patient receive?”

It appears, with the size of nursing expenses per hospital, someone would want to know the answers.  The cost associated with getting those answer may be worth it if the measures were valid.

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