Patient Classification System
based on
Dependency of Nursing Care
Cristina Duarte Paulino
Lisbon
Challenge
●Provide high quality care ●Contain the costs
More flexibility from de organisations
More rational use of the existing structures
Patient Classification System
History
1982
Ministry of Health
Information System to Hospital Management Patient Classification System based on Dependency of Nursing Care Levels
Patient Classification System
History
Wide asymmetry regarding the nurses distribution
? Were the differences justified?
? Were they a consequence of an inefficient planning?
Patient Classification System
Project
Create results
Allow a more adjusted allocation of nurses
Meeting the real needs of the patients
Patient Classification System
Goals
Development of tools to measure the number of nursing hours needed for each patient
Train hospital managers in using the information
Patient Classification System
Task
Choose a patient classification system
Subjective
Objective
Patient Classification System
Concept
PCS/N consists of classifying inpatients by critical
activity indicators, according to their nursing care needs
Patient Classification System
Characteristics
Individual Global Flexible Prospective Daily Objective Easy to understandPatient Classification System
Constraints
Complexity and high costs of construction
Advantages
Accuracy in calculating the number of minutes really required
Easiness of its implementation
Patient Classification System
The Development
of Tools: Phases
1. Identify the main nursing activities of direct care 2. Check the percentage
3. Ascertain the standard time
4. Determine the frequency of the direct care provision
5. Validate the model of the patient classification chart 6. Identify the indirect care of nursing activities
7. Develop a conversion table
Patient Classification System
Direct care
Activities which mean the provision of care to a patient to satisfy his/her daily needs
Indirect care
Activities which being part of the care provided to patients are cannot be identified as specifically to one patient
Patient Classification System
Basic Formula
Total Care
Hours
Direct nursing
hour care
(listed and unlisted)
Indirect nursing
hour care
Patient Classification System
based on Dependency of Nursing Care (PCS/N)
Patient Classification System
based on Dependency of Nursing Care (PCS/N)
Objective of the PCS/N
Provide an information tool, allowing the rational management of the human resources through the optimisation of the available nursing staff
Goals of the application of the PCS/N
Optimise the number of nurses available
Plan the delivery of nursing care
Identify the needs regarding the nurses staff
Adjust the allocation of the hospital staff
Patient Classification System
Organizational requirements
Provision of nursing care based on individual method
Existence of the nursing process model
Existence of a definitions and procedures manual
Applied to patients admitted for a 24 hour period or more
Patient Classification System
Application
The method is implemented in 52 of the 100 hospitals from the Portuguese Health System and also the Rehabilitation Centre of Alcoitão
Patient Classification System
•BRAGANÇA •MACEDO DE CAVALEIROS •CHAVES •PONTE DE LIMA •BRAGA •FAFE MIRANDELA FAMALICÃO SANTO TIRSO •LAMEGO •PORTO IPO OLIVEIRA DE AZEMEIS •VISEU •GUARDA •SEIA •TONDELA •COIMBRA FIGUEIRA DA FOZ • COVILHÃ •FUNDÃO •CASTELO BRANCO PONTA DELGADA •TOMAR •ABRANTES •TORRES NOVAS •PORTALEGRE •ELVAS •ÉVORA •BEJA •SERPA •ALCOBAÇA •TORRES VEDRAS H. T.VEDRAS H. BARRO H. CASCAIS H. PAREDE •LISBOA CASCAIS ALCOITÃO H. CURRY CABRAL H. CAPUCHOS H. S. JOSÉ H. SANTA CRUZ H. EGAS MONIZ H. S.FRANCISCO XAVIER IPO •MONTIJO •BARREIRO •SANTIAGO DO CACÉM •FUNCHAL H. CRUZ CARVALHO H. MARMELEIROS HUC CHC IPO
Patient Classification System
Implementation
Internal Medicine (cardiology, gastroenterology, infectious diseases, nephrology, neurology and geriatrics)
Surgery (gynaecology, urology, neurosurgery)
Obstetrics
Orthopedic
Oncology
Pediatrics
Rehabilitation
Patient Classification System
Management indicators
1. Number of hours of nursing care required per inpatient/per day (HCR/ID)
2. Number of hours of care provided by inpatient/by day
(HCP/ID)
3. Staff workload rate
Patient Classification System
Patient Classification System
based on Dependency of Nursing Care (PCS/N)
HCR/ID evolution
0 1 2 3 4 5 6 7 2003 2004 2005 2006 2007 Anos HCD/ID Internal Medicine Surgery Orthopedics Obstetrics PediatricsPatient Classification System
based on Dependency of Nursing Care (PCS/N)
Nursing care hours required per inpat
ient/p
er day
(HCR/ID) 2007
0 1 2 3 4 5 6 7 HCR/ID 5 6,21 4,92 5,43 3,89 Surgery Internal Medicine Pediatrics Orthopedics ObstetricsInternal Audits
Ensure the reliability of the data generated in each service and verify the accomplishment of the patients’ classification regulations
External Audits
Ensure the reliability of the data generated per hospital
Patient Classification System
Conclusion
The most important achievement of the PCS/N is its contribution for improving the organisational and managerial systems of the hospitals
The outcomes indicate the shortness of nurses in internal medicine units
The allocation of the available resources in conformity to the patients’ real needs
Patient Classification System
Conclusion
The influence of the organisational culture in a very positive way
The existence of an information system available
Patient Classification System
Future goals
1. Work in new patient’s classification charts 2. Actualization of the existing charts
3. Improve the informatics tool to obtain an automatic patient classification
4. Total implementation of the PCS/N in the National Health Care Hospitals