Description Patient acuity assessment tools estimate how many nursing care hours patients require. They are used to help make equitable nurse-patient assignments, which is essential for the delivery of high-quality patient care and nursing job satisfaction. Survey results from Humber River Hospital (HRH) nursing staff on a pilot medical unit revealed the majority were not satisfied with the current patient acuity assessment tool and felt the nurse-patient assignment process was inequitable. As such, nursing staff on the pilot medical unit set out on a quality improvement initiative to redesign and implement the patient acuity assessment tool and nurse-patient assignment process.

AimTo redesign and implement the patient acuity assessment tool and nurse-patient assignment process.

Actions Taken The patient acuity assessment tool was redesigned based on current literature and nursing staff input. The nurse-patient assessment process was modified based on feedback collected from various group nursing sessions. Using Plan-Do-Study-Act (PDSA) methodology, both interventions were implemented on a pilot medical unit and modified based on nursing feedback.

Summary of ResultsThe patient acuity assessment tool was redesigned to be more comprehensive and objective. The nurse-patient assignment process was modified to include input from the primary care nurse when assessing a patient’s acuity level. Next steps include measuring nursing satisfaction with the tool and nurse-patient assignment process.

Redesigning the Patient Acuity Assessment Tool and Nurse-Patient Assignment Process at Humber River Hospital

Alisha Aggarwal, RN, MN, CNA(c); Eliza Mirshahi, RN; Tian Sun, RN; Anthony Obeng, RPN; Brianne Orlando, RN; Braydon Bak, BA, MA; Jennifer Yoon, RN, MSc (QI/PS); Vanessa Burkoski, RN, BScN, MScN, DHA; Derek Hutchinson, RN, BScN, MN; Barbara Collins, RN, MBA

Figure 2. Comparison of Initial and Modified Nurse-Patient Assignment Process

Figure 1. Summary Flow Chart of Actions Taken and Next Steps

Assess Tool Effectiveness

Nursing staff feedback regarding the tool’s effectiveness was collected via a suggestion box and during huddles.

Needs Assessment

Survey results from Humber River Hospital (HRH) nursing staff on a pilot medical unit revealed the majority were not satisfied with the current patient acuity assessment tool and felt the nurse-patient assignment process was inequitable.

Redesign Patient Assessment Acuity Tool and Nurse-Patient Assignment Process

The patient acuity assessment tool was redesigned based on the current literature and input from front-line staff and nursing unit leaders.

An updated nurse-patient assignment process was developed taking nursing staff feedback into account.

Implement on Pilot Medical Unit

The updated patient acuity assessment tool and nurse-patient assignment process was implemented on the pilot medical unit.

Environmental Scan

Analyzed the current patient acuity assessment tool and nurse-patient assignment process used at HRH.

Reviewed literature on patient acuity assessment tools used for nurse-patient assignment at other healthcare organizations.

Tool Modification

The patient acuity assessment tool was modified based on feedback from frontline nursing staff and unit nursing leaders.

Staff Education

Using case studies, nursing “champions” educated frontline nurses on the updated patient acuity assessment tool and nurse-patient assignment process.

Assess Tool Effectiveness

Frontline nursing staff feedback will again be collected via a suggestion box and during huddles.

Implement Modified Tool

The updated patient acuity assessment tool will be implemented on the pilot medical unit.

Next steps

Assess Nurse Satisfaction

Survey will be distributed to nursing staff on the pilot medical unit to assess satisfaction with regard to the updated patient acuity assessment tool and nurse-patient assignment process.

Figure 3. Pre-Implementation Nursing Satisfaction Survey (participants = 15)

“I am satisfied with the current nursing assignment tool on my unit.”

“I believe I can safely and effectively provide high quality care for my patients with the current assignment tool.”

67%Strongly

Disagree or Disagree

93%Strongly

Disagree or Disagree

87%Strongly

Disagree or Disagree

“I think all nursing staff are assigned to a fair assignment on my unit.”