Simmons Sandra F, Hollingsworth Emily K, Slagle Jason M, Kim Jennifer, Wilson Lucy, Shah Avantika, Duggan Mariu C, Schnelle John F
Vanderbilt University Medical Center, Center for Quality Aging, Nashville, Tennessee, USA.
Vanderbilt University Medical Center, Division of Geriatrics, Nashville, Tennessee, USA.
J Am Geriatr Soc. 2025 Jul;73(7):2146-2154. doi: 10.1111/jgs.19507. Epub 2025 May 9.
Many hospitals have acute care for elders (ACE) units or engage in programs to enhance care for older inpatients. However, few studies have objectively evaluated nurse staffing models to support care for older inpatients.
This study applied discrete event simulation (DES) to an ACE unit to objectively evaluate registered nurse (RN) and nursing assistant (NA) staffing allocations. Research staff collected standardized, objective data related to nursing tasks and time requirements to model the ACE unit clinical care environment and evaluate varying RN and NA staffing allocations on measures of nursing workload, care quality, and care efficiency.
On a 22-bed ACE unit, 85% of patients were aged 65 or older, 37% had cognitive impairment, and 89% required toileting and/or mobility assistance. Nurse care routines were interrupted frequently by unscheduled patient care requests, with an average frequency of 6.1 (±1.6) requests per hour. DES was used to simulate four different RN and NA staffing allocations. Results showed the most common staffing (four RNs and one NA) resulted in the highest nursing workload rates (89% and 88% for RNs and NAs, respectively) and the highest rate of predicted care omissions (6.2%). Additionally, RNs were predicted to help with 83% of NA care tasks related to toileting and mobility assistance. Alternative allocations of four RNs and three NAs or five RNs and two NAs resulted in more feasible workload rates, lower rates of care omissions, and less reliance on RNs for NA care tasks.
DES provides an objective method to identify nurse staffing needs for an ACE hospital unit. This approach can be used to safely evaluate the potential impact of varying nurse staffing allocations. The DES model for the ACE unit is adaptable to other types of hospital units that care for older patients.
许多医院设有老年急性护理（ACE）单元，或参与旨在改善老年住院患者护理的项目。然而，很少有研究客观地评估支持老年住院患者护理的护士人员配置模式。
本研究将离散事件模拟（DES）应用于一个ACE单元，以客观评估注册护士（RN）和护理助理（NA）的人员配置。研究人员收集了与护理任务和时间要求相关的标准化客观数据，以模拟ACE单元的临床护理环境，并评估不同的RN和NA人员配置在护理工作量、护理质量和护理效率方面的差异。
在一个拥有22张床位的ACE单元中，85%的患者年龄在65岁及以上，37%有认知障碍，89%需要如厕和/或行动辅助。护士的护理常规经常被意外的患者护理请求打断，平均每小时请求次数为6.1（±1.6）次。DES被用于模拟四种不同的RN和NA人员配置。结果显示，最常见的人员配置（4名RN和1名NA）导致最高的护理工作量率（RN和NA分别为89%和88%）以及最高的预计护理遗漏率（6.2%）。此外，预计RN将协助完成83%与如厕和行动辅助相关的NA护理任务。4名RN和3名NA或5名RN和2名NA的替代配置导致更可行的工作量率、更低的护理遗漏率，并且在NA护理任务上对RN的依赖更少。
DES提供了一种客观方法来确定ACE医院单元的护士人员配置需求。这种方法可用于安全评估不同护士人员配置的潜在影响。ACE单元的DES模型适用于其他照顾老年患者的医院单元类型。
