The following is condensed from Dr. Birmingham’s article in the June, 2010 issue of Nurse Leader, available online to subscribers, at the magazine’s website.

Working directly with patients at every moment of every day, nurses can play a transformative role in raising the value of care. When the right nurses are assigned to the right patients, at the right time, outcomes are improved, costs are reduced, and patient, staff and physician satisfaction are increased. Evidence-based staffing models are key to achieving these transformative benefits, and can be implemented using existing information and technology.

Patient-Centered Alignment of Systems

Concrete value is created patient-by-patient, at the point of care. Tracking each patient’s condition, along with the individual and unlicensed assistive caregivers, across the entire episode of care, we can create a vital link between patients and the cost of services they receive.

Tracking Patient Progress to Expected Clinical Outcomes and Length of Stay

Once systems are aligned, tracking each patient’s condition and progress, hour by hour, throughout their stay, must be individualized to expected clinical outcomes and expected length of stay. This tracking can be tailored to individual patient needs via information such as admission diagnosis, ICD9 and DRG, as it exists in current electronic registration systems. Then, a methodology that measures the need for nursing care based on real-time patient outcomes, as opposed to merely census or care activities, can be implemented.

Transforming the Patient Assignment

The patient, condition and caregiver information that forms the foundation for evidence-based staffing is at hand, but needs to be aggregated into an effective decision support system. Combining data such as real-time patient admission, discharge, and transfer (ADT) information, plus patient-specific characteristics (e.g., admitting diagnosis, physician, gender, age, and isolation precautions), as well as nurse and staff licensure, competencies, education, certifications and compensation, we can transform the assignment process by providing charge nurses with evidence that complements their expertise – and empower them to get the right nurse to the right patient at the right time.

Leveraging Electronic Medical Record Data for Patient Outcomes, Risk and Cost

Using existing electronic medical record documentation, patient-specific data can be mapped to clinical outcomes on a Likert scale, making each patient’s current progress, or lack thereof, immediately visible to the nurse and the care team. This provides invaluable evidence to support staffing decisions that will add quality, improve cost performance and deliver real value to the consumer.

Leveraging Embedded Documentation for Outcomes-Driven Acuity and Workload

Using an innovative methodology that translates routine documentation of patient observations, interventions, and lab values into a Likert scale, we can precisely calculate workload for care hours and skill mix based on population-specific outcomes. In addition, we can reduce personnel expenses by accounting for the workload associated with ADT.

The technologies that can integrate patient, condition and staff information for evidence-based staffing are here. Using available evidence, they can drive resource decision making for positive patient outcomes and strong fiscal stewardship while creating a more satisfying workplace.

Your insights and experiences are vital to creating optimal solutions. How is your organization making use of existing information and technology to move toward evidence-based staffing? What obstacles have you encountered? What results have you seen?