Determining acuity with CancerConnections

Tool helps determine overall patient need

An important element of the CancerConnections program at OhioHealth Cancer Services in Columbus is a tool to measure patient acuity.

According to the tool, acuity equals time plus complexity measured at each interaction with patients. It helps staff members who are navigating cancer patients through the diagnosis and treatment process to manage workload.

"Basically, what we were looking for was a way to determine what makes one patient take up more time than another," explains Mary Szczepanik, MS, BSN, RN, manager of Cancer Education, Support, and Outreach at OhioHealth Cancer Services.

Time is measured in 15-minute increments that are counted as one point. In addition, there is a list of activities that make work with the patient more complex, and each is counted as a point. Whenever a patient is contacted, he or she is assessed for distress, fatigue, or pain using the National Comprehensive Network measurement scales. If a patient scores higher than a 3 on a scale that is measured from 0 to 10, one point is documented.

Some of the categories that receive a point if the box is checked include:

• Patient is hospitalized.

• Diagnosis of cancer is unexpected

• Patient suffers from addiction.

• Patient has psychiatric diagnosis.

• Patient required financial assistance.

• Patient has complex family history/lives alone/other.

• Nurse must assist patient with physician communication.

• Nurse attends appointment with patient for support.

• Nurse does chemo teaching.

• Nurse does radiation therapy teaching.

• Nurse makes referral to other member of Connections team.

• Nurse must consult with physician.

Information is entered into a database to track numbers. For example, the average acuity for each month is calculated to determine the workload for staff in CancerConnections. An average acuity of 35% would mean that 3.5 patients out of 10 had acuity higher than three.

Monitoring acuity helps the program run smoothly because problems can be avoided. Szczepanik says she would not let the average acuity get much higher than 50% before asking that staff be given more hours or an additional staff member is hired.

If acuity is high for three months, it would not be long before there is a decline in staff members' ability to see all cancer patients before discharge or contact patients scheduled for radiation therapy 24 hours before their consult — all of which are program quality measures.