Variability in Acuity in Acute Care.

Objective: This study was designed to describe variable acuity among 1 population of acute care patients.

Background: Acuity, defined as the individual patient need for nursing care, can inform level of care, nurse staffing, and the nurse-to-patient assignment. Nurse-generated data in the electronic health record can be mined and analyzed for decision support.

Methods: This study used a descriptive, retrospective analysis of repeated measures of acuity generated from 28 739 nursing assessments of 405 consecutive subjects treated for heart failure (HF) in a 455-bed southern hospital.

Results: Patients treated for HF have variable care needs throughout the course of treatment. Univariate analysis of variance and post hoc analysis found that gender, age, type of unit, and length of stay (LOS) had a significant impact on acuity, P < .01, with a very small effect of less than 1%, indicating that acuity should be measured instead of assumed. Patients in medical-surgical and step-down units had highly variable acuity, ranging from ready to discharge to acuity levels consistent with critical care. Across the LOS, the mean acuity stabilized at 12 hours after admission, decreased until 88 hours, then increased steadily through discharge.

Conclusions: Understanding the variability in acuity within an individual patient, or a specific patient population, will contribute to decision support levels of patient care, staffing, nurse-patient assignments, and the cost of care. Frequent, sequential, and real-time measures of acuity may be valuable for tracking patient progress or measuring response to nursing interventions.