Ambulatory

More work has been done looking at staffing in ambulatory care settings.  This work has focused on nursing workload models and adequate staffing based upon these measures.

Gaits (2005) identified 4 categories of questions that can be used to guide staff allocation decisions.  These questions focus on:

  1. Patients and intensity
  2. Staff availability
  3. Expertise of staff
  4. Unit architecture/resource availability (eg documentation system)

The measurement of intensity and nursing workload in the ambulatory setting has been addressed by several authors. 

  • An Ambulatory Intensity System that was developed at the Warren G. Magnuson Clinical Center at the National Institutes of Health to reflect both direct and indirect care needs in oncology ambulatory settings is described in a series of article by Cusack, Jones and Chisholm (2004). (Article 1, Article 2, Article 3)
  • The Ambulatory Intensity System was expanded to address day hospital settings and encompass a greater diversity of patient populations with adapted versions evaluated for the following populations: Pediatric, Medical-Surgical and Hematology-Oncology (Moore & Hastings, 2006 ).
  • Building upon the work done at the National Institutions of Health, a Medical Oncology Acuity of Care Rating System was developed by The Cleveland Clinic Cancer Center at Hillcrest Hospital.

References:

Cusack G, Jones-Wells A, Chisholm L.  Warren G. (2004). Patient intensity in an ambulatory oncology research center: a step forward for the field of ambulatory care. Nursing Economics, 22(2):58-63. 

Cusack G, Jones A, Chisholm L.  (2004). Patient intensity in an ambulatory oncology research center: step forward for the field of ambulatory care--part III.  Nursing Economics, 22(4):193-5, 175. 

Gaits, V.A. (Sept/Oct 2005) Nurse Resource Allocation in Ambulatory Cancer Centers. Oncology Issues. Available online at: http://www.accc-cancer.org/oncology_issues/articles/sepoc05/gaits.pdf

Hawley, E & Carter, N. G. (Nov/Dec 2009). An Acuity Rating System for Infusion Cancer Nurse Staffing. Available online at: http://accc-cancer.org/oncology_issues/articles/novdec09/ND09-Hawley.pdf.    

Jones A, Cusack G, Chisholm L. (2004). Patient intensity in an ambulatory oncology research center: A step forward for the field of ambulatory care--Part II.  Nursing Economics, 22(3):120-3. 

Moore, M. & Hastings, C. (2006). The evolution of an ambulatory nursing intensity system: Measuring nursing workload in a day hospital setting.  Journal of Nursing Administration, 36(5): 241-248.)
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