ATTACHMENT 1.-COST PER PATIENT-DAY BY SERVICE, STATE OF CALIFORNIA The results of the survey are divided into five main sections, namely: Part 1-Utilization This refers to (1) an analysis of present staffing practices, and (2) an insight into the effect of improved utilization on increased patient load. Part 2-Displacement This refers to (1) an analysis of the number of Registered Nurses presently being utilized in departments other than staff nursing, and (2) an evaluation of the potential increased patient load that could be absorbed if a portion of the Registered Nurses could be returned to Staff Nursing. Part 3-Reallocation This refers to (1) an analysis of major nursing and non-nursing activities as they are presently being performed and (2) a further analysis of recommendations by those who completed the questionnaire resulting in changes that could be made to improve the utilization of Registered Nurses, and (3) an evaluation of the effects of such changes on an increased patient load. Part 4-Recommendations This refers to a summary of the general recommendations submitted by those who completed the questionnaire, that pertain to the problem. Part 5-General information This refers to the analysis of turnover, impeding policies and practices, and other information of a general nature. A total of 132 questionnaires were submitted by California hospitals. Due to the urgency of the problem CASH analysts first selected 25 questionnaires for analysis. The second phase involved the analysis of 52 additional questionnaires. Since there appears to be only minor differences in the ratios and statistics derived the the total of 77 were considered adequate, and the results are contained in this report. PART 1-UTILIZATION SUMMARY The average reporting hospital can care for an 18.2% increased patient load by attaining a 90% proficiency level (with no increase in personnel) as follows: The total RN potential increase in patient load based upon recommended nonnursing activities (see following two pages) and the two major activities shown below is 23.5%. Functions: Nonnursing activities Medications Paperwork, charting Total Potential percent increased patient load 7.6 6. 1 9.8 23.5 PART 4-RECOMMENDATIONS BY NURSING Improve salaries, benefits.. Increase clinical practice-students--- Avoid nonnursing activities by nursing personnel. Improve productivity of present RN's Utilize LVN's and aides to their potential__ Initiate formal recruiting programs_. Provide nursery service for employees' children. Community planning for special facilities. Eliminate traditional practices when not required. Train increased number of surgical technicians__ Replace RN's in doctor's office with medical assistants_ Educate M.D.'s to RN shortage and role change. Increased support from housekeeping and dietary to free nursing personnel Pooling of "inservice" programs in the community. PART 5-GENERAL INFORMATION HINDERING POLICIES, PRACTICES, AND CONDITIONS 1. Hospital policy prohibits LVN's from administering medications and some treatments__ 2. Too many nonnursing tasks.. 3. Lack of medical staff cooperation-- 4. Performing duties of departments that work 8 hours a day 5 days a week 5. Lack of pharmacy coverage 6. Too many trips to service areas.. 7. Reluctance of personnel to transfer.. 8. Excessive paperwork- SUMMARY OF BLUE CROSS ASSOCIATION SURVEYS ON AREA WIDE PLANNING The area wide planning of health facilities provides the orderly development of an appropriate supply of facilities and services. It can have an important effect on total health care costs through eliminating the costs of unnecessary construction and the operating costs of the resulting surplus facilities. It can eliminate unnecessary and expensive duplication of services. Because of these reasons, Blue Cross has a vital interest in areawide planning. Successful planning can also have an effect on hospital utilization. First of all it can curb whatever upward pressure on use exists as a result of surplus availability of beds. Secondly, it can help motivate effective use of a restricted number of beds, It has often been noted that it is easier to stimulate hospital utilization committees to action where there is a tight bed situation. The core of the utilization control problem is the discrimination between necessary and unnecessary use-this is what makes it difficult and also worth |