Variability in nursing workload within CMGs (case mix groups)

This study examines the differences in workload estimates of three patient classification systems in nursing, within selected Case Mix Groups (CMGs). The amount of variation explained by selected patient-specific variables within CMGs on average nursing workload by each system is also analyzed. Results show that, when patient classification data are used to explain nursing time within the Diagnosis Related Group (DRG) context, absolute hours of care estimates of the various systems may not be equivalent. This inequality may result in biased budget review practices unless relational statements are developed between systems.

Management of nursing intensity

The Yale Nursing Intensity Project explored the use of patient classification, done primarily for staffing, as a measurement of nursing resources. Cross-hospital comparisons showed considerable interesting variation, yet to be explained, in minutes of care but there was considerable consistency in the relative nursing intensity of DRGs. Because of differences in staffing and charging practices, intensive care and routine floor care should be separated in any further study of nursing intensity. And because different clinical services show large differences in nursing resource use, costing nursing should be done at least at the service level, if not the actual unit level. A method for establishing a nationwide data set in which nursing could be included is suggested. The virtue of this approach is to provide cross-hospital evidence on which policy decisions about weighting DRGs for nursing in deciding reimbursement levels could be made. In addition, such a system would require hospitals to account for nursing separately from other hospital costs, with attendant benefits for nursing management.

The role of an intensive care unit in a community hospital. A ten-year review with observations on utilization past, present, and future

A retrospective ten-year review of the surgical-intensive-care-unit utilization practices at Riverside Community Hospital revealed that, according to the author's criteria, an average of 32% of over 800 yearly admissions could have been safely managed in a less intensive and expensive environment. The admission practices, monitoring parameters, length of stay, and intensity of nursing interaction were evaluated and compared with those of published reports. Prospective payment by diagnosis-related groups will likely force a change in the existing use of surgical intensive care units. Surgeons are urged to examine the utilization of their hospitals' intensive care units and actively work with their hospital administration to establish intermediate care units so that patients will not be jeopardized by the impending fiscal constraints of diagnosis-related groups.

The measurement of nursing intensity

At this stage in the development of diagnosis-related groups (DRG's), there is an imperfect record of the value and amount of nursing resources used by individual patients during a single hospital stay. Previous attempts to isolate the costs of nursing care in relationship to DRG's are reviewed. A research strategy to attain such relative measurements is proposed. Such inquiries are necessary if precise measurements of the relative contribution of nursing to each DRG are to be isolated, if new managerial models are to be isolated, if new managerial models are to be developed, and if objective measurements of severity within DRG's are to be devised.