Exploratory Study Using Queueing Theory to Improve Nurse Staffing Effectiveness

描述(由申请人提供)：证据表明护士配置水平和患者结果之间存在显著的正相关关系。然而，目前还没有科学的方法来确定什么水平的人员配置是实现高质量患者结果的最佳水平。需要研究确定一种方法来量化不同环境中的护理需求，并将这些需求转化为有效的人员配备水平。该方法应具有通用性，以允许任何特定单位的护士经理确定达到质量标准所需的人员配备水平。排队论将可变的服务需求与响应时间联系起来，以满足给定人员水平的需求，是实现这一目标的一种有前途的方法。排队模型已经成功地应用于许多服务行业和组织。排队模型是服务系统的数学表示，它将需求的平均到达率和满足这些需求的平均服务时间作为输入，并根据各种性能指标通知人员。通过这种方式，排队模型可以向决策者提供关于增加人员数量和改善响应时间之间的权衡的信息。这项探索性研究的目的是：1)确定特定单位的时间敏感型护理干预措施(需求)和执行这些干预措施所需的平均时间(服务时间)；2)确定单位特定护理需求的数量和时间(到达率)；3)制定护理服务可接受延误的绩效标准；以及4)基于排队模型制定和测试注册护士人员配备计划。以一个骨科护理单元为考点，采用定性和定量相结合的方法来实现这些目标。使用排队模型所需的大部分定量数据将以电子方式提供。随着医院越来越多地使用信息技术，这项建议不仅在建立识别、收集和分析这些重要数据的框架方面是及时的，而且在使用排队法指导护士人员配备决策方面提供了第一次临床试验。排队模型在护士人员配置中的应用是现有方法在一个新的科学领域的独特和创新使用的一个例子。这里描述的拟议工作处于早期和概念阶段，因此选择了R21机制。如果这项研究的结果表明排队模型在指导护士人员配备决策方面是成功的，将建议进行进一步的研究，以在多个环境中测试该方法，并将开发一个可推广的框架，以帮助护士经理在他们自己的环境中使用排队模型。这项研究将是使用排队法来指导护士人员配备决定的第一次临床测试。这项研究计划的长期目标是通过开发一个通用的框架来提高床边护理服务的质量，以便使用排队理论来告知各种环境中的护士人员配置需求。

DESCRIPTION (provided by applicant): Evidence indicates a significant positive relationship between nurse staffing levels and patient outcomes. Yet there is currently no scientifically based approach to determine what level of staffing is optimal to achieve quality patient outcomes. Research is needed to identify a method to quantify demands for nursing care in varying settings and translate these into effective staffing levels. The method should be generalizable to allow nurse managers for any given unit to determine the required staffing levels to achieve quality standards. Queueing theory, which relates variable demands for service to the response times to meet those demands for a given level of staffing, is a promising methodology to accomplish this goal. Queueing models have been successfully used in many service industries and organizations. A queueing model is a mathematical representation of a service system, which takes as input the average arrival rate of demands, and the average service time to meet those demands and informs staffing based on various performance metrics. In this way, queueing models can inform decision makers on the tradeoffs between increased staffing levels and improved response times. The aims of this exploratory study are to 1) identify unit-specific time-sensitive nursing care interventions (demands) and the average times required to perform them (service times); 2) determine unit-specific volume and timing (arrival rates) for nursing care demands; 3) develop performance standards for acceptable delays for nursing care; and 4) develop and test a registered nurse staffing plan based on queueing models. Using one orthopedic nursing unit as the test site, these aims will be met using qualitative and quantitative methods. Much of the quantitative data needed for the use of queueing models will be available electronically. With increased use of information technology in hospitals, this proposal is timely in both establishing the framework for identifying, collecting and analyzing these important data as well as providing the first clinical test of the use of queueing methodology to guide nurse staffing decisions. The application of queueing models to nurse staffing is an example of a unique and innovative use of an existing methodology in a new scientific area. The proposed work described here is in the early and conceptual stages and therefore, the R21 mechanism was chosen. If the results of this study demonstrate a queueing model to be successful in informing nurse staffing decisions, further research will be proposed to test the methodology in multiple settings and a generalizable framework will be developed to assist nurse managers to use queueing models within their own settings. This study will be the first clinical test of the use of queueing methodology to guide nurse staffing decisions. A long term goal of this program of research is to improve the quality of nursing services at the bedside by developing a generalizable framework for using queueing theory to inform nurse staffing needs across a variety of settings.