Calculating Optimal Patient to Nursing Capacity: Comparative Analysis of Traditional and New Methods (Preprint)

BACKGROUND Optimal nurse staffing levels have been shown to impact patients’ prognoses and safety, as well as staff burnout. The predominant method for calculating nurse staffing levels has been Nurse-to-Patient (N:P) ratios and Nursing Hours Per Patient Day (NHPPD). However, both methods fall short in addressing the dynamic nature of staffing needs that often fluctuate throughout the day as patients' clinical status changes, and new patients are admitted or discharged from the unit. OBJECTIVE The VA Palo Alto Health Care System (VAPAHCS) implemented a new Dynamic Bed Count (DBC) calculation in efforts to target optimal staffing levels every hour to provide greater temporal resolution on nurse staffing levels. METHODS The Dynamic Bed Count (DBC) uses elements from both the NHPPD and N:P ratio to calculate current and target staffing levels, every hour, while balancing across nurse types (registered nurses to nurse assistants) to provide improved temporal insight to staff allocation. The DBC was compared to traditional N:P methods of calculating patient capacity at the VAPAHCS, to assess optimal patient capacity within their acute care ward from January 1st, 2023, through May 25th, 2023. Descriptive statistics summarized patient capacity variables across intensive care units (ICUs), medical surgical-ICUs, and acute care units. Student’s t-tests were used to analyze differences between patient capacity measures. RESULTS Hourly analysis of patient capacity information displayed how the DBC provided improved temporal resolution on patient capacity. Comparing the DBC to the N:P ratio, we found the patient capacity as determined by the N:P ratio was, on average, higher than that of the DBC across VAPAHCS acute care units and the medical surgical-ICU. This suggests that calculating patient capacity using N:P ratios alone could lead to units taking on more patients than the DBC suggests the unit can optimally handle. CONCLUSIONS As a new patient capacity calculation, the DBC provided additional details and timely information about clinical staffing levels, patient acuity, and patient turnover. Implementing this calculation into the management process has the potential to empower departments to further optimize staffing and patient care.