IT solutions key to matching capacity to care with patient demand

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Picture: Registered Nurses Scott Elbanbuena (left) and Paula Waterhouse (right) use TrendCare in Tauranga Hospital’s Assessment Planning Unit.

eHealthNews.nz editor Rebecca McBeth

As part of the Safe Staffing Accord reached between district health boards and the NZ Nurses Organisation in July 2018, Care Capacity Demand Management will be rolled out to all DHBs by mid-2021. eHealthNews.nz editor Rebecca McBeth explores the technology behind the programme.

IT solutions are essential to the success of the CCDM programme, says Colette Breton, programme consultant CCDM Informatics at the Safe Staffing Healthy Workforces Unit.

CCDM is a programme that helps DHBs better match the capacity to care with patient demand and is run by the SSHW unit – a collaboration between the NZNO and the DHBs.

Breton says a lot of IT sits behind the programme, automating and providing visibility of care capacity and patient demand, which is essential to maintain safe staffing levels for nurses and midwives.

The programme relies on a specific CCDM software tool that was built by Designertech and is maintained by the unit. This tool helps DHBs complete annual FTE calculations using a roster model that determines how many staff should be on a shift on any given day and also on annual leave and professional development.

Data from patient acuity software TrendCare is imported along with other data, and the hours of patient care needed on every day and every shift are then graphed so that the best matched roster can be selected. Once the roster has been selected the system automatically calculates the FTE needed.

Breton says this process of predicting capacity based on expected demand should be done annually before budgets are set, so that budgets are driven by demand.

“We want to move away from making a roster fit a budget,” she says.

Implementation

Technology is also used on a daily basis to provide a visual indicator score, which is a seven-point early warning system of mismatch between capacity and demand and is updated electronically throughout a nurse’s shift.

She says the IT solution, which is usually built into an existing DHB system, displays the score as a traffic light on an electronic board so that staff can take action.

All DHBs have now implemented or are about to start implementing CCDM.

CCDM councils within DHBs are responsible for driving the programme, with support from the SSHW unit, which has a number of programme consultants whose role is to help with CCDM implementation.

An injection of money from the Ministry of Health will also increase the number of personnel employed at DHBs to support both the acuity system and CCDM, with one FTE funded per 600 staff.

This could be in the form of informatics support or administrative support, depending on what is needed, Breton says.

All but one DHB – Waikato – is already using or planning to use TrendCare as their acuity system.

Tech in action

Bay of Plenty DHB implemented TrendCare in 2000 as part of a national research project looking at workload measurement and patient acuity. 

BOPDHB director of nursing Julie Robinson says it was extended to further wards in 2004 and the departments using the system now cover medical, surgical, orthopaedics, paediatrics and intensive care. Mental health was implemented at a later date.

“The value of having information which enables you to roster your most valuable resource, your staff, to better match the care needs of your patients was recognised from the outcomes of the initial pilot,” she says.

“Health has a wealth of financial information but, in the early 2000s, having easily accessible information about the care needs of patients which then informed staffing was lacking.”

She explains that while TrendCare’s primary use was workload measurement and nursing staff management, over time many features have been developed in response to user feedback, including care pathways, discharge analysis, diet ordering and a huge number of reports to inform decision making.

The reports include such things as bed availability and bed management, the ability to understand the over or under supply of staff across the hospital inpatient units and roster reengineering reports.

“Many of the reports are based on years of trends now for our DHB,” Robinson says.

“The beauty of TrendCare is the ability to benchmark with the required care hours for many patient specialties based on users of TrendCare across Australasia.”  

Robinson says the quality of the data is hugely important and the information it produces is shared at board level, helping to make nursing and midwifery more visible.

“We have been fortunate to have chief executives and chief operating officers over the years who value the information and support our staffing decisions based on this information,” she explains.

“We have also worked closely with our union partners and wouldn’t have made the progress we have without this partnership approach.” 

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