Simulating the Impact of Patient Acuity and Nurse-Patient Ratio on Nurse Workload and Care Quality

Increased patient acuity and nurse-patient ratios are associated with increased nurse workload and deteriorated care quality - quantifying this change is a challenge. A novel approach to nurse focused simulation approach was conceived, to quantify the effects of changing nurse-patient ratios and patient acuity in terms of care quality and nurse workload. The demonstrator model was run on different levels of patient acuity (present-case, -10%, +10%, +20%, +30%), and nurse-patient ratio (one nurse assigned to 2, 3, 4, 5, 6 patients). Inputs to the model were: real patient-care task data, workflow process sequence, and physical layout. Outputs included: nurse workload in terms of walking distance, care delivery time, and task in queue, and care quality indicators including missed care delivery time and missed care. The model was able to quantify: as nurse-patient ratios decreased and patient acuity increased, nurse workload increased and care quality deteriorated. In comparison to the base case, walking distance increased up to 18%; care delivery time up to 40%; task in queue up to 354%, missed care delivery time increased up to 354%; and missed care increased up to 253%.