Achieving Equitable Patient-Nurse Assignments in the ICU/HDU to Optimise Patient Care

Year Submitted: 2024
Published Date: 31 March 2025

Tags: Operational Management, Resource Allocation, Scheduling ＆ Planning, Human Resource, Staff Management, Staff Wellbeing

About this Content

Aims

To reduce Registered Nurse (RN) dissatisfaction with patient-nurse assignments in Gleneagles ICU/HDU by 10% within six months.

Background

Gleneagles Hospital Singapore ICU is a 21-bed unit combined High-Dependency Unit (HDU) and Intensive Care Unit (ICU). It caters to a full range of patients, from post-operative HDU care to critical patients on Extracorporeal Membrane Oxygenation (ECMO), and for all age groups, from neonates to geriatrics. Workload measurements were based on simple volume census data, and workload distribution relied solely on shift in-charge competencies to determine patient-nurse assignments. From 2022 to 2023, nurses reported burnout, unfair workload distribution, and missed nursing actions.

Methods

A pre-implementation survey reported 57% of Registered Nurses (RNs) in the ICU were dissatisfied with their given patient-nurse assignments, and only 50% of RNs felt that patient-nurse assignments were done fairly. A cause-and-effect analysis identified a lack of an objective measurement of workload and patient acuity as a leading cause for RN dissatisfaction caused by a lack of an objective and transparent patient-nurse assignment process. Three PDSA cycles were implemented to address this. The team developed an Acuity Trend Scoring Tool with 12 parameters, each rated on a 5-point Likert scale from stable (1) to complex (5). First three months of data concluded that each RN should have a maximum patient acuity score of 50. Shift in-charges utilised these scores to balance patient-nurse assignments. RNs were empowered to provide feedback on workload distribution fairness, and shift in-charges ensured adequate staffing for the next shift.

Results

A post-implementation survey reported, despite an increase in RN shortage (78.9% to 93.3%), shift in-charge RNs reported that assignment difficulty reduced (85% to 60%), and decision justification difficulty reduced (80% to 53.4%). RNs dissatisfaction reduced (50% to 40%), and daily assignment dissatisfaction reduced (57.1% to 44.8%). Furthermore, assignment fairness perception by RNs improved (50% to 57.9%). Key Performance Indicators also improved - medication errors dropped from 7 to 1, and pressure injuries decreased from 14 to 3 (Jan-Jun 2024). The Patient Acuity score tool improved nurses work environment and optimized patient care.

Conclusion

This ground-up approach not only improves the way we deliver care to our patients, but also empowers nurses to advocate for themselves, thereby reducing the risk of burnout. This project has also provided a tangible measurement of workload for manpower planning, and staffing decisions.

Lessons Learnt

This was a Quality Improvement Project (QIP). This project can be implemented as a pretest-posttest research study with content validation of the tool to ensure sustainability, and for more institutions to adopt this practice.

Additional Information

This project was the winner of Gleneagles Hospital Singapore Storyboard Competition 2023. Its poster was presented in the BMJ International Forum on Quality and Safety in Healthcare London 2024. It was also nominated for poster presentation for the IHH Quality Summit 2024 in India.

Keywords

Staff satisfaction, Workload Distribution, Patient Care Optimisation

Innovators' Details

Connect with this contributor!

Lee Qi Carin - Carin.leeqi@gleneagles.com.sg

Project Attachment

216_IHH, GEH_IHHSG _Achieving Equitable Patient-Nurse Assignments in the ICU to Optimise Patient Care.pdf