Patient care time allocation by nurse practitioners and physician assistants in the intensive care unit.
Crit Care. 2012 Feb 15;16(1):R27
Authors: Carpenter DL, Gregg SR, Owens DS, Buchman TG, Coopersmith CM
Abstract
ABSTRACT: INTRODUCTION: Usage of nurse practitioners and physician assistants ("affiliates") is increasing significantly in the intensive care unit (ICU). Despite this, there are little data on how affiliates allocate their time in the ICU. The purpose of this study was to understand the allocation of affiliate time into patient care and non-patient care activity, further dividing the time devoted to patient care into billable service and equally important but non-billable care. METHODS: We conducted a quasi experimental study in seven ICUs in an academic hospital and a hybrid academic/community hospital. Following a period of self-reporting, a one-time monetary incentive of $2500 was offered to 39 affiliates in each ICU in which every affiliate documented greater than 75% of their time devoted to patient care over a 6 month period in an effort to understand how affiliates allocated their time throughout a shift. Documentation included billable time (critical care, evaluation and management, procedures) and a new category ("zero charge time") which facilitated record-keeping of other patient care activities. RESULTS: At baseline, no ICUs had documentation of 75% patient care time by all of its affiliates. In the 6 months in which reporting was tied to a group incentive, six of seven ICUs had every affiliate document greater than 75% of their time. Individual time documentation increased from 53% to 84%. Zero charge time accounted for an average of 21% of each shift. The most common reason was rounding, which accounted for nearly half of all zero charge time. Sign out, chart review and teaching were the next most common zero charge activities. Documentation of time spent on billable activities also increased from 53% of an affiliate's shift to 63%. Time documentation was similar regardless of which shift an affiliate worked. CONCLUSIONS: Approximately two thirds of an affiliate's shift is spent providing billable services to patients. Greater than 20% of each shift is spent providing equally important but non-reimbursable patient care. Understanding how affiliates spend their time and what proportion of time is spent in billable activities can be used to plan the financial impact of staffing ICUs with affiliates.
PMID: 22336491 [PubMed - as supplied by publisher]