Management of nursing intensity.

The Yale Nursing Intensity Project explored the use of patient classification, done primarily for staffing, as a measurement of nursing resources. Cross-hospital comparisons showed considerable interesting variation, yet to be explained, in minutes of care but there was considerable consistency in the relative nursing intensity of DRGs. Because of differences in staffing and charging practices, intensive care and routine floor care should be separated in any further study of nursing intensity. And because different clinical services show large differences in nursing resource use, costing nursing should be done at least at the service level, if not the actual unit level. A method for establishing a nationwide data set in which nursing could be included is suggested. The virtue of this approach is to provide cross-hospital evidence on which policy decisions about weighting DRGs for nursing in deciding reimbursement levels could be made. In addition, such a system would require hospitals to account for nursing separately from other hospital costs, with attendant benefits for nursing management.