PATIENT CARE DELIVERY SYSTEM

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The Patient Classification System
The Patient classification system (PCS), also known as patient acuity system, is a tool used for
managing and planning the allocation of nursing staff in accordance with the nursing care needs.
Thus, PCS is used to assist nurse leaders determine workload requirements and staffing needs.
There are different kinds of PCS available, but the 3 most commonly used are:
*Descriptive - This is a purely subjective system wherein the nurse selects which
category the patient is best suited.
*Checklist - Another subjective system, wherein the patient is assigned to a numerical
value based on the level of activity in specific categories. The numerical value is added up
to give the nurse an overall rating.
*Time Standards – This is another method where the nurse assigns a time value
based on the various activities needed to be completed for the patient. This time value is
sum up and converted to an acuity level.
Among these three, the most commonly used is the descriptive kind of Patient Classification
System.
4 Classifications of Descriptive PCS:
1. Self-care / Minimal Care. The first classification of patients who are recovering and
normally requires only diagnostic studies, minimal therapy, less frequent observations,
and daily care for minor conditions and are awaiting elective surgery.
2. Moderate care. The patient in this category is moderately ill or under the recovery stage
from a serious illness or operation. They require nursing supervision or assistance that is
related to ambulating and caring for their own hygiene.
3. Maximum care. Patient needs close attention and complete care all through the shift.
The nurses initiate, supervise and perform most of the patient's activities.
4. Intensive care. The last category or classification, wherein the patients are acutely ill and
high level of nurse dependency is required. Intensive therapy and/or intensive nursing
care is needed because of the unstable condition of the patient. Frequent evaluation,
observation, monitoring and adjustment of therapy is also required. Patients in these
levels include those in critical conditions or in life and death situations.

MODALITIES OF NURSING CARE

1. Case Method (also referred to as Total Patient Care (Yoder-Wise, 2014)
Ex. ICU Setting, ED
This method usually involves one nurse responsible for the total care of one
patient but sometimes can include care for two patients.
Advantages of this include better holistic patient care and one-on-one time with
the patient and family. Disadvantages include cost, time consuming, and this type for care
is usually complex .

2. Primary Nursing (No charge nurse; NP ratio 1:5-10-15 responsible for carrying doctors
orders, bedside care, medication, VS taking and any procedure)
3.
Primary nursing and team nursing are the most commonly used nursing
management styles in hospital settings.
 Emphasizes continuity of care and responsibility acceptance by having one
registered nurse (RN), often teamed with a licensed practical nurse (LPN) and/or nursing
assistant (NA), who together provide complete care for a group of patients throughout
their stay in a hospital unit or department. While the patient is on the nurses' unit, the
primary nurse accepts responsibility for administering some and coordinating all aspects
of the patient's nursing care, with the support of other members of the nursing staff. In
primary nursing, one nurse is appointed to several patients to be fully responsible for
their treatment. It may include both medical procedures and other tasks, such as hygiene
and transportation. Flexible work schedules, which allow nurses to work three
consecutive days of 12-hour shifts, followed by four days off. This is a decentralized
delivery model: more responsibility and authority is placed with each staff nurse.
Advantages:
- Increased satisfaction for patients and nurses
- More professional system: RN plans and communicates with all
Healthcare members. RNs are seen as more knowledgeable and
responsible.
- RNs are more satisfied because they continue to learn as as part of the in-depth
care they are required to deliver to their patient

Disadvantages:
- Only confines a nurse’s talents to a limited number of patients, so
other patients cannot benefit if the RN is competitive
- Can be intimidating for RNs who are less skilled and knowledgeable
3. Team Nursing (with Charge Nurse, Medication Nurse/ bedside nurse, NA)
This is the most commonly used model and is still in use today. The goal of team nursing is for a
team to work democratically. In the ideal team, an RN is assigned as a Team Leader for a group
of patients. The Team Leader has a core of staff reporting to her, and together they work to
disseminate the care activities. The team member possessing the skill needed by the individual
patient is assigned to that patient, but the Team Leader still has accountability for all of the care.
Team conferences occur in which the expertise of every staff member is used to plan the care.
Advantages:
 Each member’s capabilities are maximized so job satisfaction should be high.
 Patients have one nurse (the Team Leader) with immediate access to other health
providers
Disadvantages:
 Requires a team spirit and commitment to succeed
 RN may be the Team Leader one day and a team member the next thus continuity of
patient care may suffer
 Care is still fragmented with only 8 or 12 hour accountability

4. MODULAR NURSING (with Charge Nurse/ Team Leader per location; Bedside nurse/
medication nurse; NA)
(Ex. Medical Ward- Female Ward, Male Ward, Communicable & Non-communicable ward)
(Ex. Surgical Ward- Post-op, Orthopaedic) (Ex. OBGyne- NSVD, Post CS, Post-op OBGyne
procedure)
 (Ex. ED--- MedSurg, Paediatric, OBGyne, Molecular/ Onco., Cardio. Dept., Spinal, Sleep
medicine- Polysomnography or sleep study-a comprehensive test used to dx sleep disorders- e.g.
records brain waves, O2 level in the blood, HR & breathing, eye & leg movements during
study--- test Sleep Apnea focusing on diagnosing Obstructive Sleep Apnea (OSA)
Modular nursing is a modification of team nursing and focuses on the patient’s geographic
location for staff assignments.
 The patient unit is divided into modules or districts, and the same team of caregivers is
assigned consistently to the same geographic location.
 Each location, or module, has an RN assigned as the team leader, and the other team
members may include BS nurse, NA, utility
 Just as in the team nursing, the team leader in the modular nursing is accountable for all
patient care and is responsible for providing leadership for team members and creating a
cooperative work environment.
 The concept of modular nursing calls for a smaller group of staff providing care for a
smaller group of patients.
 The goal is to increase the involvement of the RN in planning and coordinating care.
 Communication is more efficient among a smaller group of team members
 The success of the modular nursing depends greatly on the leadership abilities of the team
leader.
Advantages:
1. Continuity of care is improved when staff members are consistently assigned to the same
module
2. The RN as team leader is able to be more involved in planning and coordinating care.
3. Geographic closeness and more efficient communication save staff time.
Disadvantages:
1. Costs may be increased to stock each module with the necessary patient care supplies
(medication cart, linens and dressings).
2. Long corridors, common in many hospitals, are not conducive to modular nursing.

5. FUNCTIONAL NURSING (Licensed & Unlicensed professional)

(1st level hospital setting--- ED admits patients, the ED nurse will handle simple or minor
operation/ minor ER or any special procedure, endorses the patient to ward or private
room while the ward nurse carries out doctors orders and receives incoming patient, there
are decking of admission--- 1st admission 1st NOD, 2ND admission 2nd NOD, 3rd admission 3rd
NOD & so on & so forth ---- division of labor or ratio of patients; NA will get the VS, IO,
IVF change or utility will help with the admission and transfer of patient to ward)
(For example, one nurse may only administer medications while another nurse admits and
discharges patients)-- Functional nursing uses a division of labor where a team leader assigns
each nurse a task. This reduces redundancy and also enhances teamwork.
Functional nursing is a supervisory model that delegates tasks to nursing and auxiliary
personnel. The head nurse assigns functions to other nurses who perform the nursing tasks to all
the patients in a unit. The functional nursing model is hierarchical as the registered nurses take
care of complex jobs while the junior staff and orderlies oversee the basic tasks.
ADVANTAGES:
 This can be very effective
 Each person of the health care team becomes strong with their assigned skills and large
numbers of patients can be taken care of by a group on professional

6. NURSING CASE MANAGEMENT

Nursing case management as a new delivery of care includes providing and coordinating
care across the continuum. The continuum includes prevention, wellness, acute, rehabilitation,
long term, and hospice care/palliative care—nearing the end of life.
Case management focuses on the administrative issues of health care, rather than the
actual delivery of health care.
Case managers follow the progression of a patient’s care to determine the likely
discharge date and her care needs after discharge. Case managers often deal with 12 to 28
patients per day. Case managers communicate daily with attending doctors, nurses and third
party payers. PRIMARY AND SECONDARY LEVEL--- nurses will do the duty as case
managers - b---- social worker, nurse supervisor or charge nurse will do the case managers duty
7. INNOVATIVE/ CONTEMPORARY METHOD
* Perioperative Surgical Home (PSH) – By AHA (American Hospital Association); a
coordinated optimization of patient transitions from the decision to operate through full recovery.
The continuum of care begins at home, and extends to the community through wellness centers,
retail pharmacies, physician offices, diagnostic imaging, and urgent care centers, to the hospital.
Beyond the hospital are post-acute care, home care and rehabilitation.
* Hospital at Home -- the Hospital at Home model was first developed at Johns Hopkins,
opened in 2008 and has served 900 patients to date. (focuses on the aging population and
treatment of chronic diseases, such as congestive heart failure, chronic obstructive pulmonary
disease, and community-acquired pneumonia. The Hospital at Home program improves
individual experience of care, not just by the patient, but by the caregivers. Patients remain in
their home and are treated as if they are in the hospital, receiving core measure elements for
heart failure and pneumonia. There have been no falls and no restraints have been needed.
Readmissions from the program are less than 3 percent at 30 days, and less than 8 percent at 90
days, which for these segments of the population are often upwards of 20-25 percent. The
average length of stay for patients is 3.2 days, compared to the average inpatient hospital stay at
PHS of 4.5 days. Cost of care is 19 percent less than an equivalent hospital episode.