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Spaulding Hospital for Continuing Medical Care Cambridge - 3 South

Long Term Acute Care
3 South
Adult Medical

Variance Info
Current Posted Planned Worked Hours Per Patient Day	8.37
Actual Worked Hours Per Patient Day	10.18
Variance	1.81
% Variance from Budget	21.62%

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 2015 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 2015.
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 2015 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 2015 staffing plan.
Higher patient care needs than planned The average patient required more care than expected and that took more staff than the displayed 2015 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 2015 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 2015 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.	X
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 2015 staffing plan.	X
Plan based on high needs in critical care The 2015 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 2015 staffing plan requirements.	X

Other Reasons for +/- 5% Variance
Spaulding Cambridge utilizes the Quadramed nursing acuity tool to identify changes in nursing workload which will require staffing adjustments. We have also experienced a significant increase in our patient acuity due to CMS changes in admission criteria for LTACS. 3 South has experienced an increase in VAD patients and complex ventilator patients requiring additional RN staffing. The acuity on this unit shifts very quickly due to the medical complexity of this patient population.

Additional Comments

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