BOOKS OF RtfiDIfGS - PAHO/WHO

"'1 .'.
- 324 -
Using Computer Simulation
to Predict ICU Staffing Needs
by N. Duraiswamy, R. Welton, and A. Reisman
Tis aricl dacritbe a compurt imubdon study to deiwufs
¡he ambr oM!f fuff-¡u ;te:t d nmra sequdt
to ddv~r afe nur h a 20.had medical
_Lawev mr usat n Le asheonr' compua dmul~ion
madd p d/ffwu, stafrdu r i* /for two sLr-
MIh* lo np a e aborot~l he.ao tMhe w
ddi wn am omplhd ad ndisuahe dost omd
/fffO, f/ ,, o, t dmt loa ohr e t.
ami~p.
The rfi nutning cervi.e stadrd of the Joint Commisaioa
cm Acdliuati of HoSptir (JCAH) cabll for "a
fflca mnumber of duly iUcnsed rqlered nures on
dry all en a ... to live patient the nurnin car
timt mq~ir the judgmant ud pcilkted sklil of a
_ ~tr au m"ll¡1. Many rect muanmcnt dudk-1
4e a mued tn to define how many nurnes consImuem
a ufllciem ?umbur.
m qh aay bpita, nurdn rnaffins is done -lmost by
tidon;a~ maa addas, wbrmt. and r aem.,la
taff on the baais of a ubjective prception of what
msems o~siary. Nurs are often reaacned from noto~uy
uare to cover busy ars$l5. However, in thc
mitlve cue unlt (ICU). whau ou must be knowlodgab
a caxtive, observant, diQnostic, and therapWdc
daona of altial care(6), reasniln nunrcs
from other au~ can jeopardlte c unit's standard of
are. Ths intuiti approah to rtafMng al o difficult
N. O. D , PaD., ik iata porI or Of bulesa m ladr
Uam V, Ko. .k ~recdd u MS. md Ph.D. la opea
da_ mrerb kr~ Cau Wemua Ium Ui vduy.
IL Wll, LNR., IM. LN., bk a m,~t dese ~uind e lba e n Prono
P~ lid Sodd do Nl~ . Can Wqm a~maere U-ailty.
A. l5m , P.D., P., kL pmomw o
Wmm Iammw Umial~y.
o opa~i rtuar., Cmu
*19SI The Jounml ot Nunda Admitnmiwn
Thb Joural of Nwiqa Admimmu / Feb~ruy I1N
ID translp i to quantifiabl terms that are uaderstandable
to othrs, including hospital administrators, boards
of trustees, and other nurses.
This article describes a system-analytic study of the
nurse staffing needs of the Medical Intensive Care Unit
(MICU) at the University Hospitais of Cleveland. la
consdering how to determine the efficacy of various
staffmrn alternatives, we decided that a computer simulaion
woud be the best method. Computer simulation
acraes a computer version of the real system and provides
laboratory conditions in which decision makers
can tet lternative policies. Simulation allows the testing
of muffina choices in the light of the conflcti~g
objective of cost continment and quality of care.
Morcover, it allows consideration of variations in patient
admission and discharge ratcs, lesnth of stay,
leves of acuity, and levels of nursing care requirements.
Traditional assessments for staffing
Syutematic mcthods for staffin8 have taken several approche.
One approach takes such dements as diet,
toileting, vital sign measurement, respiratory aids, hyiene.
suctionn,. and turning and/or positioning(7-9)
and applie a wcigbted point *ystem to these uarcas of
care. Ihe point total is then converted to some unit
equlvaat o a specific amount of nursing care time.
Other approaches have lumped all care categories tother
and subjctively established required levels of
care ranfin8 from hih to minimal(0l] without def'ning
the criteia to be used. An "hours per patient-day" formula
multiplies the number of patients by standard
houn of nunin care, such as 5.0 per patient, and then
multiplies this total by 7 to obtain the required hours of
nutinl care per week. Another approach uses patient
care categoric such as minimal care, partial care, modrate
care, complet care, and intensive carell 1-131 but
includc criteria for indirect ad supportive elements of