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Cooley Dickinson Health Care - Critical Care

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

Variance Info
Current Posted Planned Worked Hours Per Patient Day	14.55
Actual Worked Hours Per Patient Day	11.96
Variance	-2.59
% Variance from Budget	-17.80%

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 2011 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 2011.
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 2011 staffing plan.
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 2011 staffing plan.
Higher patient care needs than planned The average patient required more care than expected and that took more staff than the displayed 2011 staffing plan.
Lower patient care needs than planned The average patient required less care than expected and that took less staff than the displayed 2011 staffing plan.
Staff vacancies The unit had more job openings than planned and that impacted the average staffing hours on the unit.
Adjusted for patient care needs The average actual patient care requirements were different than what was submitted in the 2011 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.
Care delivery model changes The way in which direct care staff are assigned to care for patients changed.	X
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 2011 staffing plan.
Plan based on high needs in critical care The 2011 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 2011 staffing plan requirements.

Other Reasons for +/- 5% Variance
The Care Delivery Model changed for this unit. FY10, this critical care unit housed 2 levels of care that included intensive level of care (ICU) and progressive (PCU), sometimes referred to intermediate level of care. This model worked well to improve our care delivery to our patients with the highest care needs. Because of this success, we added a third level of care for FY11, step down care. This now provides continuity of care for our most acute patients throughout their stay with the same nursing and physician teams whenever possible. We flex our staffing levels to patient acuity needs. The lower level of care created a lower than expected HPPD.

Additional Comments

PatientCareLink is a joint venture of the Massachusetts Hospital Association (MHA), Organization of Nurse Leaders of MA-RI (ONL), and the Home Care Alliance of Massachusetts.