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Costing Nursing Care per DRG in Critical Care
I
THE 19TH AUSTRALIAN & NEW ZEALAND SCIENTIFIC MEETING ON INTENSIVE CARE CONFERENCE ABSTRACTS
writing but in the rewriting and editing. Tips on getting started on a writing project (blank paper = mission impossible) and sustaining the effort to completion will be shared.
Symposia
I 22nd October, 1994.
The realities of Workplace Reform - an Intensive Care experience Allison Grierson, Phillip Della
Symposia
22nd October, 1994.
Costing Nursing Care per DRG in Critical Care Lorraine J Ferguson a n d Athena Harris-Ingall Royal North Shore Hospital, Sydne~:NSW The Commonwealth Departments of Health have commissioned a number of studies with the intention of developing cost weights per Diagnosis Related Group (DRG). The Sydney Metropolitan Teaching Hospitals Nursing Consortium felt that it was important to include Australian nursing intensity data in any calculation of Australian cost weights and was subsequently awarded research funding to undertake a NSW Nursing Costing Study to determine Nursing Service Weights per DRG in both general ward areas and the critical care setting. This paper reports on the second part of the Nursing Consortium study which was undertaken into nursing intensity per DRG for the critical care portion of the hospital episode classified using the Australian National Diagnosis Related Groups (ANDRGs) classification system. The study ran over two years with part one of the project set up to design and test a patient dependency tool which would be acceptable to users across a large number of intensive care units. Instrument testing was carried out in 14 critical care units in Sydney over a period of six months. A panel of 17 clinical nursing experts formed the Clinical Advisory Committee to the Project. The concepts were iteratively tested using a modified Delphi technique. Timing studies were carried out in four different critical care units with the aim of developing a standard care time per classification category to be applied across units for the purposes of this study. Part two of the project used the dependency tool to collect data at the level of the individual critical care patient for the purposes of calculating hours of nursing care per day the for the entire episode in critical care. The beta weight was adopted as the measure of daily average nursing intensity per class (DRG) and is interpreted as the increment in nursing time occasioned by one more day of stay. This measure permits the development of weights to describe the relative nursing intensity of one DRG compared to another, controlled for length of stay. Data were collected in sixteen critical care units of nine teaching hospitals in Sydney over the period from October 1992 to May 1993. There were nine general intensive care units (ICUs), two neurosurgical lCUs and five cardiothoracic postoperative ICUs. Nursing intensity data for 1857 episodes of care were merged with each hospital's morbidity data to develop the nursing service weights per episode of care and per day of care in the critical care unit for the ANDRG grouper version 1 . There were 34 DRGs which contained 10 or more episodes of care, and these 34 DRGs represented 73% of the sample. The top high volume DRGs for this study included the DRGs for the coronary bypass and valve procedures, craniotomy, major reconstructive vascular procedures, craniotomy and the tracheostomy DRG which is a group containing ventilated patients. The high intensity nursing DRGs recorded included respiratory system operating procedures with complications, liver transplant and the tracheostomy DRGs. Patterns of nursing intensity in critical care are presented as preliminary findings for this study.
Royal Perth Hospital, Wellington Street, Perth, Western Australia. Workplace Reform requires a transformation of the process of nursing care delivery. In order for this transformation to succeed a paradigm shift in professional practice is required. The purpose of workplace reform in health care is to improve the quality of care within the constraints of a diminishing resource base. The workplace reform process was embraced in a large intensive care unit. The aim of the process was to plan interventions and strategies to drive change. An extensive six month period of marketing the concept was introduced and after that time a study was undertaken to assess attitudes to the workplace reform agenda. The respondents indicated attitudes that were influenced by conflicting personal and professional goals. The perception of reduced personal benefits shadowed the professional views of improving work practices. Intensive care nurses perceived the outcome of workplace reform as an increased workload, interference in nursing practice and deceased quality care delivered. While the majority of respondents felt that operating a unit under principles of workplace reform was correct, they also felt that the introduction of change would impact negatively on them. This indicated that they felt uneasy. This was counter balanced by the attitude of a large majority of the respondents looking forward to learning more about workplace reform. The respondents also felt professionally obliged to introduce change. The dichotomy of balancing efficiency and effectiveness between the administrator and practitioner does not lead to an optimal outcome. The balance of power must be transferred to the practitioner to develop a model of care that is sensitive to resources.
Symposia
22nd October, 1994.
An Innovative Roster Danny P Rathgeber Ballarat Base Hospital, Ballarat, Victoria. In 1993, along with all other public health agencies, Ballarat Base Hospital faced severe government funding cuts. Nursing staff comprise 50% of the total hospital workforce. Efficiencies in nursing allocation present administration with clear opportunities for significant cost reductions. A consultative committee brought together management and nurses to negotiate options for change. The objective was to establish an Enterprise Agreement. Initial negotiations failed particularly in the areas of fostering and working hours which had been targeted by management. Using a participative management model, senior staff within ICU evaluated numerous rosters, attempting to find a solution. The following objectives were established: ensure patient care is not compromised, maintain stafflpatient ratios, permit staff development time, maintain 9.5 hour night duty, enable flexibility for requests and shift changes, be cost effective, and bestow negotiating power.
THE 19TH AUSTRALIAN & NEW ZEALAND SCIENTIFIC MEETING ON INTENSIVE CARE CONFERENCE ABSTRACTS
writing but in the rewriting and editing. Tips on getting started on a writing project (blank paper = mission impossible) and sustaining the effort to completion will be shared.
Symposia
I 22nd October, 1994.
The realities of Workplace Reform - an Intensive Care experience Allison Grierson, Phillip Della
Symposia
22nd October, 1994.
Costing Nursing Care per DRG in Critical Care Lorraine J Ferguson a n d Athena Harris-Ingall Royal North Shore Hospital, Sydne~:NSW The Commonwealth Departments of Health have commissioned a number of studies with the intention of developing cost weights per Diagnosis Related Group (DRG). The Sydney Metropolitan Teaching Hospitals Nursing Consortium felt that it was important to include Australian nursing intensity data in any calculation of Australian cost weights and was subsequently awarded research funding to undertake a NSW Nursing Costing Study to determine Nursing Service Weights per DRG in both general ward areas and the critical care setting. This paper reports on the second part of the Nursing Consortium study which was undertaken into nursing intensity per DRG for the critical care portion of the hospital episode classified using the Australian National Diagnosis Related Groups (ANDRGs) classification system. The study ran over two years with part one of the project set up to design and test a patient dependency tool which would be acceptable to users across a large number of intensive care units. Instrument testing was carried out in 14 critical care units in Sydney over a period of six months. A panel of 17 clinical nursing experts formed the Clinical Advisory Committee to the Project. The concepts were iteratively tested using a modified Delphi technique. Timing studies were carried out in four different critical care units with the aim of developing a standard care time per classification category to be applied across units for the purposes of this study. Part two of the project used the dependency tool to collect data at the level of the individual critical care patient for the purposes of calculating hours of nursing care per day the for the entire episode in critical care. The beta weight was adopted as the measure of daily average nursing intensity per class (DRG) and is interpreted as the increment in nursing time occasioned by one more day of stay. This measure permits the development of weights to describe the relative nursing intensity of one DRG compared to another, controlled for length of stay. Data were collected in sixteen critical care units of nine teaching hospitals in Sydney over the period from October 1992 to May 1993. There were nine general intensive care units (ICUs), two neurosurgical lCUs and five cardiothoracic postoperative ICUs. Nursing intensity data for 1857 episodes of care were merged with each hospital's morbidity data to develop the nursing service weights per episode of care and per day of care in the critical care unit for the ANDRG grouper version 1 . There were 34 DRGs which contained 10 or more episodes of care, and these 34 DRGs represented 73% of the sample. The top high volume DRGs for this study included the DRGs for the coronary bypass and valve procedures, craniotomy, major reconstructive vascular procedures, craniotomy and the tracheostomy DRG which is a group containing ventilated patients. The high intensity nursing DRGs recorded included respiratory system operating procedures with complications, liver transplant and the tracheostomy DRGs. Patterns of nursing intensity in critical care are presented as preliminary findings for this study.
Royal Perth Hospital, Wellington Street, Perth, Western Australia. Workplace Reform requires a transformation of the process of nursing care delivery. In order for this transformation to succeed a paradigm shift in professional practice is required. The purpose of workplace reform in health care is to improve the quality of care within the constraints of a diminishing resource base. The workplace reform process was embraced in a large intensive care unit. The aim of the process was to plan interventions and strategies to drive change. An extensive six month period of marketing the concept was introduced and after that time a study was undertaken to assess attitudes to the workplace reform agenda. The respondents indicated attitudes that were influenced by conflicting personal and professional goals. The perception of reduced personal benefits shadowed the professional views of improving work practices. Intensive care nurses perceived the outcome of workplace reform as an increased workload, interference in nursing practice and deceased quality care delivered. While the majority of respondents felt that operating a unit under principles of workplace reform was correct, they also felt that the introduction of change would impact negatively on them. This indicated that they felt uneasy. This was counter balanced by the attitude of a large majority of the respondents looking forward to learning more about workplace reform. The respondents also felt professionally obliged to introduce change. The dichotomy of balancing efficiency and effectiveness between the administrator and practitioner does not lead to an optimal outcome. The balance of power must be transferred to the practitioner to develop a model of care that is sensitive to resources.
Symposia
22nd October, 1994.
An Innovative Roster Danny P Rathgeber Ballarat Base Hospital, Ballarat, Victoria. In 1993, along with all other public health agencies, Ballarat Base Hospital faced severe government funding cuts. Nursing staff comprise 50% of the total hospital workforce. Efficiencies in nursing allocation present administration with clear opportunities for significant cost reductions. A consultative committee brought together management and nurses to negotiate options for change. The objective was to establish an Enterprise Agreement. Initial negotiations failed particularly in the areas of fostering and working hours which had been targeted by management. Using a participative management model, senior staff within ICU evaluated numerous rosters, attempting to find a solution. The following objectives were established: ensure patient care is not compromised, maintain stafflpatient ratios, permit staff development time, maintain 9.5 hour night duty, enable flexibility for requests and shift changes, be cost effective, and bestow negotiating power.