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Frequently Asked Questions
1. Why do we need a patient classification system? Is it really worth the time and effort?
Health care leaders and regulators recognize that there is no such thing as an interchangeable patient or caregiver. In order to provide the best quality of care, there needs to be a system that matches unique and evolving patient needs with the appropriate level of caregiver. This is the basic purpose of an effective patient classification system, one that can consistently and objectively:
- Identify patient needs
- Calculate the hours and caregiver skill mix required to meet patient needs
- Trend information specific to needs and staffing for budget planning, recruitment and retention planning, and health plan contracting
- Identify the gaps between patient needs and available resources
- Assist in managing scarce human resources
- Meet regulatory requirements
- Improve caregiver satisfaction
- Support professionalism
2. How does a patient classification system assist in predicting staff required for the next shift?
The patient classification system provides information specific to the current shift that can be combined with information specific to the previous shift(s), expert nurse knowledge of admissions, discharges and transfers, and skill level of caregivers. There is no exact formula that identifies the needs of the next shift—it is a combination of data elements that supports the prediction of staffing needs for the next shift. This is one of the reasons that variance documentation is so important. Variances are expected, but they must be analyzed for the appropriate responses and overall adjustments by leadership.
3. How are admissions taken into consideration?
In most cases, the historical information about unit intensity/activity (admissions, discharges, and transfers) is trended by day of the week and shift and integrated into the core budget. A typical medical-surgical unit incorporates one hour of staffing time (45 minutes RN and 15 minutes non-licensed care) for each admission.
4. What is a CUS and how many CUS profiles do we need?
Time standards for patient care are based on a Comprehensive Unit of Service (CUS); a compilation of the multiple tasks and processes required for patient care as defined by the direct caregivers who actually care for the patients. Most units/ departments/ organizations require less than 100 CUS’s (patient reviews). The goal is to identify the range of patient care needs from the lowest use of staff hours to the highest.
5. How do we know if the acuity is correct? How do we know if the staffing is justified?
Appropriate staffing and level(s) of caregivers are substantiated through regular and rigorous validity and reliability assessments. Assuring that the system represents the work of caregivers and is consistently used 95% of the time is an ongoing and essential goal of the patient classification system. ENEPCS® provides information that can be used by your leadership to evaluate and make adjustments to the system.
6. How does a patient classification system help the Registered Nurse?
A valid and reliable system is essential for planning and meeting patient care needs and identifying a workload that is manageable. The right caregiver for the right patient at the right time is the ultimate goal of an effective workload management system. Knowing when and how to assign patients uses caregiver expertise to the fullest and assists registered nurses in managing the gap between needed staff and available staff.
7. What makes this system so different from other classification systems?
ENEPCS® uses Expert Nurse Estimation instead of listing task after task as some systems do. The old way means that the system asks the nurse to choose any and all tasks applicable to a specific patient, and the result is that the nurse just hopes that he/she has covered all the particulars of care given to that patient. Many nurses don’t believe that task systems are accurate or reliable.
Expert Nurse Estimation incorporates the intuitive knowledge that nurses use as they care for patients. This keenly developed knowledge is not captured in the traditional classification system. The philosophy of the intuitive system is based upon the recognition that the staff nurse or direct caregiver is the person who really knows how much time it takes to care for each of his/her patients. Therefore, it is important to affirm this ability and incorporate it into the classification system.
8. Will we be required to change to team nursing with this system?
The patient classification system is designed to support whatever delivery system the organization or unit believes will support optimal outcomes. The patient classification identifies specific patient care needs for the amount of time and level of caregiver required to provide the care.
9. Why can’t I add up the eight numbers (categories) and get an average acuity score?
Each of the eight categories is based on differing activities that can be performed by differing levels of caregivers. The workload required within each category is varied and therefore the time required to perform that work varies. Adding self-care hygiene needs to a patient’s educational needs would be like adding apples and oranges unfairly assigning equal workload time to each.
10. Can ENEPCS® help me if I don't have an automated patient classification system?
ENEPCS® is an automated system, but the principles that support it can be used to help you analyze and assess the manual system you are currently using. Kathy Malloch & Associates can come to your facility and partner with you to conduct an intensive interview and assessment process.
In two days, you can learn the current status of your patient classification system from the perspective of the JCAHO, HCFA/CMS, ANA Principles for staffing, and California Department of Health Services - Title 22 Patient Classification System Regulations, the most stringent requirements in the country for patient classification systems. Most importantly, you will learn key strategies to improve and sustain current system validity and reliability—and be better prepared for the next surveyor!
Upon completion of the assessment, a detailed, comprehensive report is prepared for your organization. The report includes an overall assessment of the status of the organization’s strengths and opportunities for improvement, and characteristics of the desired patient classification system.
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