An appropriate nursing skill mix: survey of acuity systems in rehabilitation hospitals.
ABSTRACT In a descriptive study, freestanding rehabilitation hospitals were surveyed to determine which acuity systems were in use in 1988. A questionnaire was developed by the researcher and sent to 83 freestanding rehabilitation hospitals in the continental United States. The results of the study showed that no one acuity system was being used. Additional findings were that the majority of the rehabilitation hospitals are not for profit, all of the hospitals have some type of accreditation, and there seem to be enough rehabilitation beds in the United States. Staffing patterns of the hospitals revealed that registered nurses and nursing assistants were the type of staff used predominantly; licensed practical nurses were used least. Ninety-one percent of the hospitals reported having registered nurses with associate's degrees or bachelor of science degrees, and 88% reported having nurses who had earned a diploma. Primary nursing care was the type of nursing care delivered most often, although many of the hospitals were using more than one form of care. Staff assignment was based on both census and acuity.
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ABSTRACT: The complexity and mix of rehabilitation patients varies across clinicians and institutions. Comparisons of outcomes across providers must therefore adjust for differences in risk factors across patient populations. Research on risk adjustment has generally focused on acute care hospital outcomes, although techniques for risk adjusting financial outcomes are fairly well developed in rehabilitation, primarily to support Medicare and other prospective payment systems. This article reviews important methodologic issues in risk adjusting rehabilitation outcomes in observational studies of routine clinical practice or for management, such as assessing quality or costs of care. Risk adjusting rehabilitation outcomes is more difficult than risk adjusting other clinical results, such as outcomes of many acute care services. At the outset, characterizing rehabilitation interventions is frequently difficult. Furthermore, outcomes are diverse and depend on myriad factors, including patients' physical and cognitive abilities, underlying medical diseases, sensory and emotional factors, willingness to participate in care, and supportive environments. No risk-adjustment approach can control for every factor affecting outcomes of care. Knowing which risk factors are missing helps guide interpretation of the results and determines how well risk-adjusted outcomes fairly compare providers or treatments.American Journal of Physical Medicine & Rehabilitation 05/2004; 83(4):316-26. · 1.73 Impact Factor
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ABSTRACT: This article describes the process used by nurse executives at four freestanding rehabilitation facilities to implement and validate an interactive patient classification system. The research process involved defining critical indicators, measuring workloads by level of staff, and validating the number of care hours for the levels of patient classification. The database enabled the four consortium members to share their knowledge, resources, and costs of implementing a patient classification system, and it provides a benchmark of rehabilitation services. The study data are being used in making staffing decisions, preparing and defending budgets, and identifying the cost of care by disability classification.Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 05/1999; 24(3):103-8. · 0.78 Impact Factor
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ABSTRACT: Development of a prototype patient classification (PCS) instrument designed specifically for rehabilitation patients is the focus of this article. The process of instrument development is discussed, as well as strategies used in implementing the PCS. These strategies include: staff education, management support, data collection, data analysis--including the development of supporting information systems, and ongoing use of the rehabilitation PCS. Changes engendered by implementation of the PCS also are discussed.JONA The Journal of Nursing Administration 04/1998; 28(3):35-43. · 1.33 Impact Factor