The workload acuity tool in CareConnect was rolled out in 2021 to reduce documentation and give nurses accurate and helpful information to determine the workload demands of a patient in real time. Since then, 15,000 nursing surveys have been received as part of the yearly validation process to assess the tool’s effectiveness. The most recent validation took place in early 2024. It included nurses from across the health system who completed digital surveys for each of their patients, documenting their perception of the score compared with the acuity score from the tool.
“We asked the nurses to rank their patients from most-to-least difficult that day,” says Stesha Selsky, DNP, RN-BC, a nursing informaticist who helped spearhead the project. “They also gave us the patients’ total workload acuity scores so we could see if the patients were trending in order.”
The scores for bedside RN-completed surveys were:
- ICU/NICU/PICU: 209 surveys; 29 mismatches for review; 87% without review
- MedSurg/Peds: 1,210 surveys; 140 mismatches for review; 88.5% without review
- Perinatal: 48 surveys; 5 mismatches for review; 89% without review
Looking for gaps
Each year, the workload acuity tool’s accuracy scores have exceeded Nursing’s internal benchmark of 80%. More important than accuracy, however, is identifying the mismatches, says Ida Anderson, MSN, RN, director of nursing in adult critical care at Ronald Reagan UCLA Medical Center.
“I want to identify the gaps so we can fix them,” Anderson says. “The whole point of the annual validation is to expose the cracks in the armor so that we can address them and enhance the tool to make it work better.”
For example, Anderson says, after the first year, results showed a 98% match, whereas this year they were just under 90%.
“That tells me that the nurses have thought about other things they need to document,” she says. “Nurses are smart; we can count on them noticing things. I think the beauty of this whole project is that our nurses have been so supportive in participating and giving us information, which we can then analyze. We rely heavily on our clinical nurses’ judgment for this because we want it to reflect the work that they’re doing.”
Enlisting volunteers
For the first time, the Nursing Acuity Committee asked for volunteers to analyze the surveys and investigate the causes of mismatches. Twenty-six nurses from various units and departments participated. After a training session, mismatches were distributed among the nurses, who then thoroughly examined the patients’ charts. The committee sent 174 clinical nurse mismatches for review: 77 surveys were reviewed and returned by clinical nurses and 35 surveys were reviewed and returned by charge nurses. The findings for mismatches included late or missing documentation, completed medications or transfusions, absence of psychosocial and care-management documentation and patients having been admitted, transferred or discharged.
Balancing assignments
The goal of the acuity tool is to give an accurate picture of staffing needs, Anderson says, so the charge nurse can give out balanced assignments.
“One thing that we discovered in the process of this survey is that the charge nurses are doing a really good job at evening out the assignments. That was a little nugget, which we didn’t anticipate, that we got to prove objectively with this information,” Anderson says.
Mary Gay Dacquel, RN, an administrative charge nurse in 6W, a medical/surgical specialty unit, says the workload acuity tool has helped her distribute patient assignments more efficiently for current as well as future shifts.
She also appreciates that nurses get a chance to optimize the system and make periodic adjustments.
“For me, it’s a constant way of communicating and conversing on how to improve our patient care,” she says.