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Patient Classification System

A patient classification system is a means of categorizing present patients on the


basis of certain care needs that can be clinically observed by the nurse.

This system can serve as a basis for planning the staffing needs of patients. There
are three methods of classifying patients: the descriptive method, checklist of nursing tasks
methods and the time standard or relative value unit.

In descriptive method, which is the most common means of patient classification, the
nurse classifies or assigns the patient to a category that closely describes the level of care
needed.

The checklist style divides descriptions of care routine into activity categories, such as
eating and bathing. Activity levels are described in each category.

Time standard or relative value unit (RVU) systems assign a value unit (usually a
measure of time) to various activities of patient care. Those activities are usually clustered
according to categories, such as diet, bathing, and mobility.

The patient classification system is described as follow.

Category I: Minimal Care

Minimal Care is given to patients who are convalescing and who no longer require
intensive, moderate, or maximum care. These patients still may need supervision by a
nurse in the course of a day, even if only at infrequent intervals. This care group also
includes patients who require diagnostic studies, minimal therapy, less frequent
observations, and daily care for monitor conditions, and who are awaiting elective surgery
or have difficulty arranging transportation between home and hospital, or whose home
environment temporarily makes discharge undesirable or impractical.

Time requirement: 1-2 hours per day

Category II: Moderate Care

Moderate care is given to patients who are moderately ill or are recovering from the
immediate effects of a serious illness and/or an operation. These patients require nursing
supervision or some assistance related to ambulating and caring for their own hygiene.
They may be ambulatory for short periods.

Time requirement: 3-4 hours per day

Category III: Maximum Care

Moderate Care is given to patients who need close attention throughout the shift,
that is, complete care for patients who require nursing to initiate, supervise, and perform
most of their activities or who require frequent and complex medications or treatments.

Time requirement: 7-8 hours per day

Category IV: Intensive Care

Intensive care is given to acutely ill patients who have a high level of nurse
dependency, including those, requiring intensive therapy and/or intensive nursing care and
whose unstable condition requires frequent evaluation with adjustment therapy.

Time requirement: 10-14 hours per day

Staffing Formulas

When determining the number of staff to hire, one must consider hours needing
coverage, vacations, holidays, absenteeism, and staff development time. If nurses
work 5 days a week and coverage is needed for 7 days, it takes 1.4 nurses to have one
nurse on duty 7 days and 2.8 to have two nurses on duty for 7 days. This is calculated by
multiplying the number needed on duty days by days of the week needing coverage and
dividing the number of days each employee works per week to determine the number of
personnel needed for coverage. For example:

Number
Needed
Days of
Week
Number of
Days Each
Workweek
Number of
People
Required


1 x 7 5 = 1.4
2 x 7 5 = 2.8
3 x 7 5 = 4.2
4 x 7 5 = 5.6
5 x 7 5 = 7.0

Vacation Coverage

Number of Number of Total vacation days
vacation days per year x full-time people = by skill level
at that skill level

Total vacation days Total days worked Number of
By skill level per person per year = full-time people needed for
Vacation relief coverage

Holiday Coverage

Number of personnel x Number of holidays = Number of holidays needing coverage

Number of Number of
holiday relief days days worked per year = Number of personnel required for holiday
per person coverage per year
Absentee Relief Coverage

Weeks/year x Days worked/week x % of absenteeism = Absentee days/person/year

Personnel Absenteeism Absentee coverage
requirements (7day/week) x days/person/year = for staffing

Absentee coverage Total days Full-time personnel required for
required worked/person/year = absentee coverage per year

Staff Development Relief

Number of hours
required or
recommended for staff
development per year
per person


x


Number of
staff


=
Number of hours
per year for staff
development needing relief
coverage


Number of staff
development
hours needing
coverage



Hours worked/
day


Total days
worked/person

=
Full-time personnel
required for staff
development
coverage

Staffing to Meet Fluctuating Needs

Full-time Staff may be hired to meet the average staffing needs of an institution.
- oriented to many areas and like the challenge of different types of patients
and settings
Part-time Staff flexible working hours can be an incentive for inactive nurses to start part-
time employment and can thus reduce staffing shortages
- most nurses are women who have to combine their nursing role with
many others
- broaden the womans horizons beyond her home, increase her income,
give her ego satisfaction, and help her maintain her continuing their
education.
- Disadvatages: 1) educational and administrative expenses are higher. For
example, it is likely to cost as much to orient part-time as a full-time nurse.
2) maintaining continuity of care is complicated, because
two or more part-time people may fill budgeted full-time positions
3) For the employee, may not receive benefits such as
paid sick or vacation days and it not likely to be considered for promotion.

Rightsizing/downsizing
Productivity - product or work produced through a specific amount of resources,
measured as outputs divided by inputs.




The procedure for computing the number of staff needed in the in-patient areas of
the hospital is as follows.

1. Categorize the number of patients according to the level of care needed by hospital
classification.
a. Total number of patients x percent at each level of care.

2. Find the total number nursing hours needed by patients per day at each categorized
level.
a. Number of patients at each level average nursing hours needed per day.
b. Get the sum of the nursing hours in the various levels.

3. Find the total number of nursing hours needed by the patients per year
a. Total number of nursing hours needed per day x 365 days of the year

4. Find the actual number of working hours rendered by each nursing personnel each year.
a. hours on duty per day x actual working days per year

5. Find the total number of nursing personnel needed
a. Divide the total number of nursing hours needed by the given number of patients
per year by the actual number of working hours rendered per year/
b. Find the relief. Multiply the number of nursing personnel needed by .095.
c. Add number of reliever to the number of needed nursing personnel
6. Categorize into professional and non-professional.
a. Multiply number of nursing personnel according to ratio of professional to non-
professional.
7. Distribute shifts.

Example: Find the number of nursing personnel needed for 100 patients in a tertiary
hospital.

1. Categorize patients according to levels of care.

100 patients x .65 = 65 patients needing minimal care
100 patients x .30 = 30 patients needing moderate/intermediate care
100 patients x .05 = 5 patients needing intensive care

2. Find the number of nursing care hours (NCH) needed per day at Level I, Level II, and at
Level III.
Given: Level I: Minimal Care: 1.5 NCH needed per patient per day
Level II: Intermediate Care: 3.0
Level III: Intensive Care: 4.5

Level I = 65 x 1.5 = 97.5 NCH needed by 65 patients
Level II = 30 x 3 = 90 NCH needed by 30 patients
Level III = 5 x 4.5 = 22.5 NCH needed by 5 patients or a total of 210 NCH per year

3. Find the actual number of NCH needed by 100 patients per year.

210 x 365 = 76, 650 total NCH needed per year

4. Find the number of nursing personnel needed.

a. 76, 650 NCH per year = 44 nursing personnel
1, 728 (working hours per year for 216 working days at 40 hours per week)
b. 44 x .095 = 4.18 or 4 nursing personnel as relievers
(Note: Total average of absences of an employee is 35 days per year. This includes
vacation, sick levels, and holidays.)
35 divided 365 = .095 relief needed
c. 44 + 4 = 48 total nursing personnel needed

5. Categorize into professional and non-professional
44 x .60 = 26 nurses
44 x .40 = 17.6 nursing attendants

6. Distribute by shifts

26 x .45 = 24 nurses on 7-3 shift 17 x .45 = 8 nursing attendants
26 x .37 = 10 nurses on 3-11 shift 17 x .37 = 6 nursing attendants
26 x .18 = 4 nurses on 11-7 shift 17 x .18 = 3 nursing attendants
26 Total 17 Total

Note:Ratio of professional nurses to non-professional according to level of care.

Level I - Minimal Care 55-45
Level II - Intermediate or Moderate Care 60-40
Level III - Intensive Care 65-35
Level IV - Highly Specialized Intensive Care 70-30 or 80-20