Changing the Organizational Structure and Enhancing Nurse-Staffing Levels Based on Patient Acuity in a Tertiary Referral Hospital.

Aims: To enhance nurse-staffing levels in the wards of a tertiary referral hospital by applying a patient classification system based on patient acuity, setting up a new organizational structure in the hospital wards. Design: A retrospective analysis based on administrative data from an electronic patient database. Methods: The data were obtained from the clinical data warehouse of multiple databases from a tertiary referral hospital in Spain and analyzed from January 1st, 2018, to December 31st, 2019. The care plan and the weight of the main diagnosis from 52,974 adult patients admitted to 40 hospital units were analyzed and classified into patient acuity using the acute to intensive care (ATIC) classification system. The frequency of the ten acuity groups was analyzed, and the optimal patient-to-nurse ratio was defined according to the system and the hours effectively assigned to the care units. The percentage of patient needs that were met was also established. Finally, the distribution of the wards was rearranged based on the results. Results: The findings show that patients were mostly clustered in the following groups according to their acuity level: intensification (38.1%), intermediate (30.4%), and acute (21.8%). Therefore, the wards were reorganized into the three dominant levels: four acute, 17 intensification, and 19 intermediate units. A viable model was implemented to provide the number of nurse/patient/day hours by incorporating 104 nurses and improving nursing coverage by 17.4%. Conclusion: The structuring of care units according to the intensity of care has resulted in a significant enhancement in nursing coverage by improving the hours of care needed according to acuity levels. Implications for Patient Care: The findings provide valuable information regarding nurse staffing in hospitals, emphasizing the importance of defining the optimal patient-to-nurse ratio. Establishing this ratio is crucial for improving care quality and ensuring patient safety. Reporting Method: This study's methods and results have been reported following the STROBE checklist. Patient or Public Contributions: No patient or public contributed to design this research. However, patients will contribute later as part of a broader project when we explore their perception following the implementation of a management model based on nursing care intensity.