Trinity Medical Center, Rock Island, IL, USA.
J Nurs Manag. 2010 Jul;18(5):592-8. doi: 10.1111/j.1365-2834.2010.01124.x.
For hospitals in the United States, the number of patients who lie in beds at midnight is considered to be the standard indicator of nursing workload; relatively little attention is given to the total number of patients cared for in a 24-hour day. Staffing decisions are related to cost of care. Such decisions are made on a per-shift basis, calculating hours per patient day (HPPD) based upon midnight census provides little decision-making support about variable staffing needs over a 24-hour period. The discrepancy between nurse managers' staffing based on real-time patient needs and financial analysts looking only at units of service captured at midnight clearly speaks to the need for a new metric of measurement.
To describe the variations in nursing workload across two medical units using a comparison of intra-day census recommendations for staffing and those projected based on the midnight census alone.
Data were retrieved from a primary data set that included: (1) the number of patients lying in beds at four different times during a 24-hour period: 06.00, 14.00, 22.00 hours and at midnight; (2) projected nursing hours needed based on the numbers of patients lying in beds at different times during the 24-hour period; and (3) the number of projected nursing hours needed for the numbers of patients lying in bed and those who were admitted and discharged in an 8-hour period of time.
Statistically significant increases in 06.00 hour patient counts were found with statistically lower patient counts at both 14.00 and 22.00 hours compared with the midnight census alone. Nursing hour projections per day did not show any significance when projected based on intra day vs. midnight census alone. Statistically significant increases in nursing hour projections were seen on all three shifts when admissions and discharges and the nursing workload associated with those procedures were calculated.
Findings suggest that the midnight census alone may well not be the most precise measure to predict nursing workload or to cost out nursing care. To accurately capture the realities of a 24-hour nursing workload, the nursing work associated with patient admissions and discharges has to be a part of the equation.
The tradition of using the midnight census to budget 24 hours of nursing services in the hospital setting does not capture the totality of nursing workload. A model that costs out direct nursing care in the hospital and ultimately bills separately for that care is needed to reflect the realities of hospital nursing workload.
对于美国的医院来说，午夜时分躺在病床上的患者人数被认为是护理工作量的标准指标；而相对较少关注 24 小时内护理的患者总数。人员配备决策与护理成本有关。这些决策是按班次制定的，根据午夜统计数据计算每位患者每天的小时数（HPPD），这为 24 小时内的人员配备需求提供的决策支持很少。护士经理根据实时患者需求进行人员配置与仅查看午夜时段捕获的服务单元的财务分析师之间的差异清楚地表明需要一种新的衡量标准。
使用比较日间统计数据推荐的人员配置与仅基于午夜统计数据预测的人员配置，描述两个医疗单元的护理工作量变化。
数据取自包含以下内容的主要数据集：（1）24 小时内四个不同时间点躺在病床上的患者人数：06.00、14.00、22.00 小时和午夜；（2）基于 24 小时内不同时间点躺在病床上的患者人数预测的护理所需时间；（3）在 8 小时内住院和出院的患者人数以及这些患者所需的护理时间。
与仅基于午夜统计数据相比，06.00 小时的患者人数统计上显著增加，而 14.00 小时和 22.00 小时的患者人数统计上显著减少。根据日间与仅基于午夜统计数据预测护理小时数的差异，护理小时数的预测没有任何意义。当计算与这些程序相关的入院和出院以及护理工作量时，所有三个班次的护理小时数预测都有显著增加。
研究结果表明，仅基于午夜统计数据可能无法准确预测护理工作量或计算护理成本。为了准确捕捉 24 小时护理工作量的实际情况，必须将与患者入院和出院相关的护理工作纳入其中。
在医院环境中使用午夜统计数据来预算 24 小时护理服务的传统做法并没有完全涵盖护理工作量。需要一种为医院护理工作量计费并最终单独计费的直接护理护理成本模型，以反映医院护理工作量的实际情况。
