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Spaulding Rehabilitation Hospital Cape Cod - Inpatient Unit

Rehabilitation
Inpatient Unit
Adult Rehabilitation

Variance Info
Current Posted Planned Worked Hours Per Patient Day	7.48
Actual Worked Hours Per Patient Day	8.25
Variance	0.77
% Variance from Budget	10.29%

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 2014 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 2014.	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 2014 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 2014 staffing plan.	X
Higher patient care needs than planned The average patient required more care than expected and that took more staff than the displayed 2014 staffing plan.	X
Lower patient care needs than planned The average patient required less care than expected and that took less staff than the displayed 2014 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 2014 unit staffing plan.	X
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.
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 2014 staffing plan.
Plan based on high needs in critical care The 2014 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.	X
Change in patient mix The actual type of patients admitted on this unit was different from the development of the 2014 staffing plan requirements.

Other Reasons for +/- 5% Variance
The 2014 census and patient volume fluctuated above the budgeted average daily census (ADC) of 40.5. The actual average daily census (ADC) for 2014 was 43.43. Therefore, additional staff were added to care for the additional patients, increased census, and volume. Midnight census is used to capture the average daily census (ADC) and does not account for the number of admissions, discharges and transfers (ADT) that occur in the 24 hr period which can range from an average of 5 to 18 per day.

Additional Comments
Patients who require 1:1 observation for safety may require a patient observer (observation only) or a clinical sitter (provides observation and clinical care). Occasionally, Rehab Aides and Nursing Assistants are put into the role when Observers are not available. This increases the worked hours per patient day.

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