Overall recommendations
Appendix 3 Template Scoring sheet
yesterday to 11am
today
Please record any additional staff used for the reason below for the previous afternoon,
night, and current
morning. Comments
Patient Dependency Score Sheet
Acute Care Unit Signature
For each bed space record 1 in the appropriate column (Empty, 0, 1a, 1b, 2 or 3.)
Escorts off Site 11am yesterday to 11am Escorts on Site 11am
yesterday to 11am Transfers Out 11am
yesterday to 11am
Deaths 11am yesterday to 11am
Ward Attenders 11am yesterday to 11am Transfers in 11am yesterday to 11am Discharges 11am yesterday to 11am
Other Please complete for the previous afternoon, night and current morning
Additional Staff Obs / Falls risk Mental Health Learning Disability
Appendix 4
Item
Target / number
Proposed impact Evidence Audit
process Anticipated Financial
return
Measures responsive to increases in staffing levels 1 Patient Experience
FFT
40%
1.Achieve 40% response rate for all inpatient areas.
2.Improve scores for patient Trust and confidence in nursing staff by 10% for each ward with increased staffing
Response rate for the question; ‘how likely are you to recommend our ward to friends and family if they needed similar treatment?’
Trust and confidence in nursing staff
Optimum We currently have a 10% chance of failing the F&F test response rates by year end, but with the new nursing establishments, that risk would drop to 0%. Therefore the value is 10% x £78k = (Other staff groups are involved)
Decrease in number of
HCAI’s by 10%? Plowman R. 1999. urinary tract, on average cost the equivalent to 1.8 times more (then an additional £1327 per patient).
- lower respiratory tract, skin, surgical wound or ‘other sites’ cost 2-2.5 times more (the equivalent to an additional
£1618 - £2398 per patient.)
- blood stream infections incurred costs that were 4 times higher (the equivalent of an average additional
£5397 per patient (only 4 patients, 2 died so caution with general conclusions.)
- more than 1 HCAI had the highest expenses, on average 6.6 times higher (the equivalent to an additional £9152 per patient)
DATIX/HCAI
data Fewer Hospital acquired infections resulting in a reduced length of stay and increased bed days available for other activity.
Costing being worked up related to nursing
Reduce from 7 to 3
Decrease in number of avoidable falls.
50% reduction in the number of falls resulting in major harm e.g.
fractured femur or humerus from 7 to 3.
Tian et.al. 2013.
• Torbay;TABLE 2 Mean monthly average cost per service user inpatients = £2,117,
RN+RN=Better Care National Nursing research unit “evidence for associations with outcomes such as pressure ulcers, falls and UTI’s that are expected to be highly sensitive to nursing is not clear.”
DATIX ACE lighthouse programme
Income attached to LOS if we decrease the number of falls by 4 we in theory reduce the cost of the individual patient admission itself and increase the number of available bed days.
If a fall with major harm results in an average increase in bed days of ?Z then a reduction by 4 pts will produce 4 x Z bed days
4 Patient safety
Reduce hospital acquired pressure ulcers and have
no avoidable deterioration of PU’s
? Reduction in length of stay on wards where patients have historically had PU’s
NICE 2014. The daily costs of treating a pressure ulcer are estimated to range from £43 to £374. For ulcers without complications the daily cost ranges from between £43 to £57 (Bennett, Dealey and Posnett, 2012). These costs assume that patients are cared for in a hospital or long-term care setting but are not admitted solely for the care of a pressure ulcer.
By reducing the incidence of pressure ulcers, commissioners could make savings from a reduction in excess bed day payments to hospitals where patients’ length of stay exceeds the Healthcare Resource Group trim point.
Patients with pressure ulcers stay in hospital an average of 5–8 days longer than other patients. The average per day payments for days exceeding the trim point is £236 (national tariff, 2014–15).
RN+RN=Better Care National Nursing research unit “evidence for associations with outcomes such as pressure ulcers, falls and UTI’s that are expected to be highly sensitive to nursing is not clear.”
Datix There is a CQUIN of
£165k relating to having “no more than two new grade three and four avoidable pressure ulcer cases per month”. We have failed this target for one month out of six recorded so far, thereby suffering a penalty of £14k.
Extrapolated to year end, higher nursing levels would save us
£28k.
Number of Hospital attributable pressure ulcers in 2014 was Z.
Improved staffing levels are thought to impact on this area of care by Y.
Therefore anticipated reduction in the number of pressure ulcers is Z multiplied by Y.
Financial savings on treatment of pressure ulcers are ZY multiplied by the day cost multiplied by the number of Length of Stay
Decrease in LoS by 0.5 days?
Section 2 and 5’s submitted in a timely manner to reduce the delayed transfers of care.
RN+RN=Better Care National Nursing research unit “There is clear evidence of an association between the numbers of registered nurses and patient outcomes in acute care.
? Discharge team audits of section 2 and 5 /DTOC
Louise to provide data re the delays in issuing section 2 and 5’s to look at whether that translates into an increased length of stay. If it does then to recommend a reduction in delays according to increased staffing that could perhaps be costed as bed days
6 Staff understand what is required of them and have a clear personal development plan.
95%
Increase in the number of
staff appraised West MA et al 2002 The link between management of employees and patient mortality in acute hospitals.
The International Journal of Human Resource Management. 13(8) p1299-1310. Found that good HR practices (training / teamwork / appraisal) reduce mortality. (Not restricted to nurses doctors, nurses and midwives, PAMs, ancillary staff, professional and technical staff, administration and clerical staff and managers)
Dashboard Workforce reports
Ask Iain for whether we would look at % or number.
7 Patient experience is improved resulting in fewer complaints
track
Improved reported patient experience.
Reduction in number of patient complaints associated with ward nursing care.
Reduction in the number of patient comments / complaints indicating more staff are needed.
West (2011) shows how good management of NHS staff leads to higher quality of care and more satisfied patients
Optimum.
PALS. - CLIP Complaints.
- CLIP
cost of nursing time spent on
investigating and responding to complaints is difficult to calculate as it varies so widely depending on the complexity of the complaint.
Anecdotally this can be between 4-16hours. Average per complaint 6hrs Band 8 and 6hrs band 7 (this does not account for time to release staff to write statements.) b Reduction in the
number of staff reporting they do not feel supported by manager to
Reduction in short term sickness.
West MA et al (2002) The link between management of employees and patient mortality in acute hospitals.
The International Journal of Human Resource Management. 13(8) p1299-1310. Found that good HR practices (training / teamwork / appraisal) reduce mortality.
Staff survey ? reduce sickness therefore reduce temporary staff requests
c The wards are seen as a good place to work with patient focused care
Reduced vacancy rate by July 2015 (accepting that initially vacancy rate will increase if WTE’s are added to establishment.)
Aiken et al. Int J Qual Health Care.
2002 Feb;14(1):5-13. Hospital staffing, organization, and quality of care.
Adequate nurse staffing and organizational/managerial support for nursing are key to improving the quality of patient care, to diminishing nurse job dissatisfaction and burnout and, ultimately, to improving the nurse retention problem in hospital settings.
Dashboard
7 Reduction in the number of patients where there was a failure to recognise acute deterioration
Early detection and improved management
of responsive complications such as
sepsis or acute kidney injury – not nurse specific but evidence to suggest this is influenced by nursing numbers.
Rafferty et al (2007). International Journal of Nursing Studies. 44(2): 175–
182 http://www.ncbi.nlm.nih.gov/pmc/arti cles/PMC2894580/
Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing.
Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12–
49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals.
“Failure to rescue does not appear to be specifically nurse sensitive indicator although this conclusion should be regarded as tentative.” An Assessment of failure to rescue derived from routine NHS data as a nursing sensitive patient sensitive indicator for surgical inpatient care. 2011 Jones, S. et al http://www.kcl.ac.uk/nursing/researc failure to respond to these complications.
Data needed for 1)No. of patients with Sepsis, PE, Kidney Injury
2)No. of these admitted to ICU
Increased LOS and treatment work with patient focused care
Reduced vacancy rate Aiken LH1, Clarke SP, Sloane DM;
International Hospital Outcomes Research Consortium. Int J Qual Health Care. 2002 Feb;14(1):5-13. Hospital staffing, organization, and quality of care: cross-national findings.
Adequate nurse staffing and organizational/managerial support for nursing are key to improving the quality of patient care, to diminishing nurse job dissatisfaction and burnout and, ultimately, to improving the nurse retention problem in hospital settings.