understanding staff-to-patient ratios - nhlc / cnls ottawa/singer poster fsi...the mix of staff on a...
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The mix of staff on a nursing unit is reflective of the level of care required. On nursing units with patients who require the most medical care, such as the intensive care nursing unit, we expect to see the majority of care provided by registered nurses.
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What CIHI is investigating the development of a staff-to-patient ratio that will provide a nationally comparable, systematic method of measuring the number of patients cared for per staff member.
These ratios can be used to
• Better understand staffing levels between different areas of a hospital (e.g., between the intensive care and long-term care units);
• Compare resource utilization at the facility, regional, provincial or national levels;
• Direct resources where they can be most efficiently used to facilitate improvements in patient care; and
• Examine the relationship between staffing and safety, quality of care, value for money and the health of the workforce.
AboutEstablished in 1994, the Canadian Institute for Health Information (CIHI) was created to support the production of comparable, pan-Canadian information. The Canadian MIS Database (CMDB) is the national data source for financial and statistical information about the day-to-day operations of health service organizations and health regions. The data is submitted to CIHI according to the MIS Standards.
The data collected provides comparable information across the country that can be used to support health system decision-making.
Authors: Jacqueline Singer, Theresa Negrello, Adam Rondeau, Anyk Glussich, Christine Boyes
Understanding Staff-to-Patient Ratios
Our visionBetter data. Better decisions. Healthier Canadians.
Our mandateTo lead the development and maintenance of comprehensive and integrated health information that enables sound policy and effective health system management that improve health and health care.
Our valuesRespect, Integrity, Collaboration, Excellence, Innovation
Why• Data on hours worked by staff and
on patient stays is routinely collected and used to manage the day-to-day operations of a facility.
• Internationally, staff-to-patient ratios are a well-established indicator and are often mandated by legislation.
• In countries where minimum staff-to-patient ratios have been mandated, such as in Japan and Australia, better care and improved patient outcomes have been demonstrated.
• Although staff-to-patient ratios have been recommended in parts of Canada, a comparable indicator for public reporting is currently not available.
• CIHI is looking to fill this knowledge gap.
DataFigure 1 shows that in Canada, the nursing unit with the highest staff-to-patient ratio is intensive care and the unit with the lowest ratio is long-term care. This is expected based on the different care needs of the patients in these units.
What’s next• This indicator would be the first of its
kind — a source of comparative information on a pan-Canadian scale, opening the door to better understanding the relationship between staffing levels and clinical outcomes.
• CIHI will consult an expert advisory group to discuss results and explore future opportunities.
• Preliminary results will be shared as part of the consultation process.
Figure 1 Average number of patients per staff member by nursing unit
0 1 2 3 4 5 6 7 8 9 10
Residential long-term care
Hospital long-term care
Physical rehabilitation nursing unit
Mental health long-term care nursing unit
Medical nursing unit
Mental health and addiction services nursing unit
Combined medical/surgical nursing unit
Surgical nursing unit
Palliative nursing unit
Obstetrics nursing unit
Pediatric nursing unit
Intensive care nursing unit
Patients
SourceCanadian MIS Database, 2014–2015, Canadian Institute for Health Information.
of the cost of a hospital stay can be attributed to staff compensation
72%
$
Figure 2 Average proportion of staff mix by nursing unit
Other staffLicensed practical nurses (LPNs)Registered nurses (RNs)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Mental health long-term care nursing unit
Physical rehabilitation nursing unit
Medical nursing unit
Combined medical/surgical nursing unit
Palliative nursing unit
Mental health and addiction services nursing unit
Pediatric nursing unit
Obstetrics nursing unit
Intensive care nursing unit
Residential long-term care
Hospital long-term care
Surgical nursing unit
SourceCanadian MIS Database, 2014–2015, Canadian Institute for Health Information.
When considered alongside quality indicators, such as Potentially Inappropriate Use of Antipsychotics in Long-Term Care or Obstetric Trauma (With Instrument), staff-to-patient ratios can help identify promising clinical and work environment practices to optimize the delivery of health care, as well as patient, organizational and systemic outcomes.
HowInpatient days, resident days and staff-worked hours collected by CIHI’s CMDB can be used to calculate the ratio by nursing unit in reporting hospitals and residential care facilities.
A nurse-to-patient ratio for registered nurses and licensed practical nurses can be calculated. Data can also be used to calculate staff-mix proportions (of registered nurses, licensed practical nurses and other health care staff) within a nursing unit (see Figure 2).
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