Purpose: The provision of conscientious nursing care is at the forefront of health quality. Unfortunately, a lack of standardization in the assignment of patients to nurses can lead to care inequities. Rehab MATRIX is a nursing-led tool that equitably assigns patients using select acuity variables. Design and Methods: In this initial study, we asked focus groups of 19 registered nurses and 8 patient care assistants to identify medical interventions that increase the effort of nursing care at a 24-bed inpatient rehabilitation facility (IRF). This IRF is affiliated with a comprehensive heart and vascular institute, a level I trauma center, and a The Joint Commission (TJC) Comprehensive Stroke Center. Findings: Thirteen acuity variables were included in the Rehab MATRIX patient assignment grid. High-acuity patients with greater than 6 variables were color-coded “red,” medium-acuity patients with 3 to 5 variables were color-coded “yellow,” and low-acuity patients with less than 3 variables were color-coded “green.” Each registered nurse and patient care assistant were assigned an equitable number of red-, yellow-, and green-coded patients per shift. New admissions were Rehab MATRIX color-coded during nursing report and assigned objectively. Conclusions: Nursing staff at a wide-ranging IRF created Rehab MATRIX, an equitable patient assignment tool, representative of nursing effort needed to provide quality care. Clinical Relevance: Nursing-led patient assignment tools increase autonomy and provide the opportunity for all nursing staff to influence healthcare practice. These factors may lead to increased nursing satisfaction and decreased burnout.
Questions or comments about this article may be directed to Nneka Ifejika, MD MPH FAAPMR FAHA at Nneka.Ifejika@utsouthwestern.edu. She is Section Chief of Stroke Rehabilitation and an Associate Professor, Departments of Physical Medicine and Rehabilitation, Neurology and Neurotherapeutics, and Clinical Sciences, UT Southwestern Medical Center, Dallas, TX.
Munachi N. Okpala, MSN APRN NP-C MBA DNP(c), is Stroke Nurse Practitioner, Department of Neurology and the Institute of Stroke and Cerebrovascular Disease, McGovern Medical School at UTHealth, Houston, TX.
Hope A. Moser, DNP RN ANP-BC WHNP-BC SCRN ANVP, is Advanced Practice Nurse, Memorial Hermann Hospital – Texas Medical Center, Houston, TX.
Jeffrey N. Watkins, MD, is Staff Physiatrist, Oschner Health System, New Orleans, LA.
Elizabeth A. Noser, MD, is Assistant Professor and James C. Grotta Chair in Neurosurgery and Stroke, Department of Neurology and the Institute of Stroke and Cerebrovascular Disease, McGovern Medical School at UTHealth, Houston, TX.
The Rehab MATRIX protocol abstract was presented at the Association of Rehabilitation Nurses Annual Meeting in October 2015.
N.I. was previously supported by NIH/NCATS McGovern Medical School at UTHealth CCTS Scholar grant UL1 TR000371 and NIH/NINDS Diversity Supplement to P50 NS 044227, UTHSC-Houston Specialized Program of Translational Research in Acute Stroke, and is currently supported by the Texas Health Resources Clinical Scholars Program, UT Southwestern.
The authors declare no conflicts of interest.