The following article by John Rutkowski, Delegate from New Jersey, originally appeared in the Management Section bulletin. The editors agreed to share them with readers of The AARC Record, as we feel the topics and content are pertinent to all of us. For more information, contact John at jarutk@worldnet.att.net, or 732.828.3000, x2898.

Patient classification systems, acuity indexing, and severity of illness classifications categorize patients based on an assessment of the patient's care requirement for a specified period of time. The classifications can then be used to determine required staffing level and assignment of personnel and other resources. In addition to predicting staffing needs, they can be used to validate budget requirements and perhaps set differential charges.

Classification of patients by acuity differs from measurement of productivity in several ways. Productivity deals specifically with the amount of work accomplished in a period of time. Additionally, productivity measurements may not be effective in care settings when the nature of the work is non-repetitive, or the output cannot be easily measured. Productivity measurements are always retrospective. Classification of acuity is always looking forward.

Respiratory therapy departments in New Jersey are required to set staffing in Critical Care Units based on acuity levels. In July 1990 the NJ Department of Health -- Standards for Acute Care Facilities required that assignments of staff to critical care units be based on the acuity of illness assessed each shift.

Recent years have brought significant change to the way health care is delivered, reimbursed, etc. Over time the acuity based staffing systems developed essentially to comply with the facility licensing requirements have become less effective. If your institution is similar to many in NJ, patients that would have been in critical care units ten years ago are now being cared for in step down or med/surg floors. Many of the department managers in New Jersey have recognized this redistribution of acuity of care and through the NJSRC are meeting in an attempt to standardize the reformation of the old systems and to share benchmarking data on productivity.

At this point in time we are meeting to discuss the types of classification systems being used, common problems, determination of validity and reliability, and building confidence in patient classification systems. When an acuity classification system is implemented and utilized effectively a number of advantages should accrue. These advantages include:

• a high degree of staff satisfaction, because the staff determines how much time should be spent with each patient.
• good prediction of workload before the shift begins.
• improved distribution of workload
• the staff has a significant role in determining when overtime is necessary, not just the ability to voice complaints.
• there is a sound method for demonstrating that the patients are really sicker.
• the staff makes a commitment to spending more time with the "sicker" patients
• workload is easier to adjust mid shift.
• patient satisfaction improves.
• the system is valid and reliable when compared to the retrospective determinants of workload. It is able to predict the workload that was accomplished.

We are committed to making acuity based staffing work to the advantage of our patients, staffs and facilities. As our work to reform the older systems continues, I hope that we will be able to use the management section as a sounding board.

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