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Cooley Dickinson Health Care

Acute Care
Critical Care
Adult Critical Care - Medical / Surgical Combined

Variance Info
Current Posted Planned Worked Hours Per Patient Day	15.53
Actual Worked Hours Per Patient Day	20.34
Variance	4.81
% Variance from Budget	30.95%

Reason For +/- 5% Variance From Budget
No explanation required No explanation of staffing hours was required if the unit's actual worked hours were within +/- 5% of the 2008 submitted unit staffing plan.
Fluctuating day to day census The number of patients on the patient care unit varied significantly from day to day impacting the overall actual staffing hours provided in 2008.	X
Lower daily census than planned The actual average number of patients per day on the unit was less than the planned average patients per day submitted in the displayed 2008 staffing plan.	X
Higher daily census than planned The actual average number of patients per day on the unit was greater than the planned average patients per day in the displayed 2008 staffing plan.
Higher patient care needs than planned The average patient required more care than expected and that took more staff than the displayed 2008 staffing plan.
Lower patient care needs than planned The average patient required less care than expected and that took less staff than the displayed 2008 staffing plan.
Staff vacancies The unit had more job openings than planned and that impacted the average staffing hours on the unit.	X
Adjusted for patient care needs The average actual patient care requirements were different than what was submitted in the 2008 unit staffing plan.
Minimum fixed staffing requirements A minimal level of staffing is required on each unit regardless of the number of patients or their care needs. Adjusting to a minimum fixed staffing level increases staffing care hours.	X
Care delivery model changes The way in which direct care staff are assigned to care for patients changed.
Increased 1:1 staffing requirements The number of patients on this unit requiring one nurse assigned to one patient was higher than planned.
Closure of unit The unit was closed at some point and that impacted overall staffing hours.
Not admitting to beds due to staffing Patients were not admitted to the unit because there were lower staffing levels on the unit than planned.
Increased census to telemetry patients The number of patients requiring cardiac monitoring was higher than the 2008 staffing plan.
Plan based on high needs in critical care The 2008 critical care staffing plan based staffing on high acuity or patient care requirements.
Increased staff hours to facilitate admissions and discharges This unit required more staffing than expected because of the number of patients being admitted and discharged from the unit each day.
Change in patient mix The actual type of patients admitted on this unit was different from the development of the 2006 staffing plan requirements.	X

Other Reasons for +/- 5% Variance
The Critcal Care Unit is in the second year with an Intensivist program. The Intensivists are involved on a daily basis regarding admissions and discharges based on admitting criteria and appropriate level of care. Patient length of stay has decreased and patients are triaged more quickly to telemetry or med-surg in part to the success of daily multidisciplinary rounding of members of the healthcare team. The average daily census (ADC), in turn, was lower than projected volume. In addtion, the ICU hired several new RNs to address both vacancy and the expansion of the telemetry unit. Many of the Critical Care nursing staff work on telemetry and ICU; therefore are oriented and maintain competency for both areas. The orientation is a minimum of 12 weeks.

Additional Comments

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