IT tackles CA staff ratio crisis
As California hospitals wrestle with legislation mandating staffing levels for nurses, health executives in other states are watching to see what happens.
While the situation in California remains chaotic, some hospitals hope that information technology can help them deal with increased staffing needs. However, IT solutions will provide only management assistance and don't fully address the state's nurse shortage.
California's experience will be significant because many other states have similar regulations in place or under consideration. By some estimates, hospital staff ratio legislation has been introduced in about 20 states.
California is in distress because it simply doesn't have enough nurses. According to federal data, it ranks 49th in the nation in the number of nurses to population, with 544 RNs per 100,000 residents. While it has 275,000 licensed nurses, it needs 30,000 more to meet staffing requirements right now and will need another 109,000 by 2010 to meet mandated targets, state officials estimate.
The rule sets a variety of staffing levels in different hospital settings, ranging from one nurse for every six patients on medical-surgical floors to one nurse to every two patients in intensive care units. Ratios must be maintained around the clock, even during breaks.
Taking effect on Jan. 1, Title 22 has prompted at least hospital, Santa Teresita Hospital in Duarte, to announce it was closing because it couldn't meet requirements. The California Healthcare Association, representing the state's nearly 500 hospitals and health systems, has filed suit against the state's Department of Health Services over the interpretation of the staffing regulations.
While the true scope of non-compliance won't be known for a few months, hospitals are trying to improve staff management and incorporating IT into those efforts, said Shuja Ali, MD, who heads The Sajo Group Inc., a San Francisco-based staff management consulting company.
Hospitals are looking at ways to integrate their staff scheduling and payroll systems to both manage staff and provide reports to show compliance with the regulations, he said. The ultimate solution is to integrate patient care information systems, so staffing can match patient needs. "That's where we'll see improvement as a result of technology," Ali said. "There's probably 5 percent to 9 percent inefficiency that we can wring out of the system, so if you have 100 nurses, with a good IT system, they can be rescheduled to do 109 nurses' work."
However, it will be difficult to integrate patient information with staffing systems without specifically designed middleware, Ali said. Only a few IT systems can pull staffing and acuity data together well, he contends.
One such system is from OptiLink Healthcare Man-agement Systems, Portland, Ore. The application provides alerts when staffing ratios are not being met and produces reports to show compliance, said Debbie Wall, executive vice president for the company. It receives information from admission, discharge and transfer systems, determining the contact census for each shift.
Hospitals will be addressing staffing issues anyway, and IT will be critical to those efforts, Ali said.
"The issue is not so much that there's staffing legislation," he explained. "It's around nursing satisfaction and quality of care. Hospitals are going to be addressing these issues anyway, irrespective of legislation."
In California, some solutions for meeting staffing ratios will be unexpected, Wall predicts. They may have to limit admissions to maintain staffing ratios, or they may decide to hire more registered nurses at the expense of support staff, requiring nurses to provide more mundane care and patient services.