Chapter 23. Patient Acuity

For more than 50 years, researchers have worked to develop staffing methodologies to accurately indicate the number of nurses needed to give good care to patients. By the 1980s, patient classification systems (PCSs) were in common use to predict patient requirements for nursing care. These requirements, or patient acuity, could then be used to manage nursing personnel resources, costs, and quality. 3 PCSs have numerous limitations, however. Paramount among these are (a) validity and reliability are infrequently monitored; 5 (b) the tools are often complex and require considerable time to complete; (c) they lack credibility among staff nurses and administrators; 6 (d) they are not designed to detect census variability throughout the day from patient movement due to admissions, discharges, transfers, and short-stays; 8 and (e) their focus on tasks shortchanges the cognitive work and knowledge inherent to expert nursing care and sophisticated surveillance. 10 As restructuring and mergers escalated in the 1990s, issues of patient acuity once again moved to the foreground. Patients were said to be sicker and leaving health care facilities more quickly. Concerns about rising patient acuity continue into the new millennium because of the relentless change that is now common in health care. Moreover, acuity is one of many elements that comprise the often used but not yet well specified concept of workload. 12