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Implementing an Acuity-Adaptable Care Model in a Rural Hospital Setting

Ramson, Kathy Paulik DNP, RN, NE-BC, CCRN; Dudjak, Linda PhD, RN; August-Brady, Michele PhD, RN; Stoltzfus, Jill PhD; Thomas, Paula DNP, RN

Journal of Nursing Administration: September 2013 - Volume 43 - Issue 9 - p 455–460
doi: 10.1097/NNA.0b013e3182a23b9b

OBJECTIVE: This study examined the effects of an acuity-adaptable care model in a rural hospital setting on nurse satisfaction, patient satisfaction, patient safety, and quality indicators (events, falls, and medication errors), patient length of stay (LOS), and worked hours per patient-day (WHPPD).

BACKGROUND: Acuity-adaptable care models have been implemented as a nursing strategy to improve workflow through the elimination of unit-to-unit patient handoffs. However, to our knowledge, this model of care has not been studied in a rural hospital setting.

METHODS: A descriptive, comparative design with repeated measures was utilized for this study. A professional nurse survey was created to measure staff satisfaction; separate t tests for percentages were utilized to evaluate patient satisfaction and patient safety/quality indicators. Financial data were examined to perform the analysis of patient LOS and WHPPD.

RESULTS: The nurse satisfaction survey demonstrated a decrease in weekly floating and cancellations due to low census. There was a statistically significant improvement in patient satisfaction for overall rating and willingness to recommend the hospital. No significant difference was noted in patient quality indicators or LOS; however, there was a favorable trend for all events and medication errors. This study also found a decrease in WHPPD, with a corresponding salary expense reduction reported.

CONCLUSION: Acuity-adaptable units may be a viable strategy for rural facilities.

Author Affiliations: Vice President Patient Services (Dr Paulik Ramson), St Luke’s University Health Network, Quakertown; Associate Professor (Dr Dudjak), University of Pittsburgh; Associate Professor (Dr August-Brady), Moravian College, Bethlehem; Director Research Institute (Dr Stoltzfus), St Luke’s University Hospital, Bethlehem; VP Patient Care Services, CNO (Dr Thomas), UPMC Medford Memorial Hospital, Bedford, Pennsylvania.

The authors declare no conflicts of interest.

Correspondence: Dr Ramson, St Luke’s Quakertown Hospital, 1021 Park Ave, Quakertown, PA 18951 (

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins