Much of the management of clinical demand is based on simple single operating statistics, cases, visits, patient days. These statistics are accumulated for intervals, days, months, years and combined with a labor ratio to define clinical workforce needs. Hours per visit in Emergency rooms, Hours per minute in Operating Rooms, and Hours per patient day on Inpatient Units, are often the bench marks used to set staffing. These methods do not depict the variation of individual patient needs and dependency, nor do they depict the complex arrival and discharge patterns common to a clinical environment. These simple metric are wholly inadequate to manage day to day or hour to hour workforce decision.
Clinical demand can be characterized best using an encounter approach. By knowing when an individual patient arrives, and knowing the patients treatment needs and dependence it is possible to determine the staffing requirements pattern of a group of patients. As patients improve or deteriorate through a clinical encounter the information that is the basis for the patients need changes. In most clinical environments much of this information resides in the electronic patient records. There are three primary segments of the information system that should be used to define clinical workforce needs.
Patient Scheduling and Tracking Systems
A large percentage of caring organizations have invested in these systems. Once a patient is admitted as an inpatient a Patient Admission, Discharge, Transfer (ADT) system is used to track the movement of each patient from room to room and transfers between departments. Bed management systems extend the ADT System capability by providing prospective placement management. Many Ancillary departments such as Emergency Rooms, Surgical Suites, and Clinics have automated the patient scheduling process as well as detailed throughput tracking. Furthermore many tracking systems used RFID or Ultrasound technology to track patients and staff passively. RIS/PACS systems in radiology also contain information on patient location and services provided.
These systems contain a wealth of information that can be employed to improve clinical workforce decisions. Access and exchange of these data falls within the scope of the Health Level 7 (HL7) data exchange protocol which standardizes the exchange of information between vendors.
Patient Coding System
Coding is used in a clinical environment to standardize the definition of treatments and services provided for billing purposes. ICD9/10, CPT4, APCs, and DRGs are examples of coding system that define the physiological issues and interventions important to each patient’s situation.
Patient Assessment Systems All patients with the same physiological issues do not present the same clinical workforce needs. Clinical Professional use assessment systems to identify unique needs or the status of their patients so that all care givers that interact with a patient can understand the patient’s needs and risk factors. Common assessments include Emergency Triage, ASA Classification, Labor and Deliver Phases, Patient Outcome Progress. These professional assessments can be used to define care needs.