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Paperless Charting: A staff substitution enabler. HSCI 740 Keith Fawcett June 7, 2004. The Hospital Unit. 34 beds, 16 rooms. 2 staff shifts: night shift & day shift. Each 12 hours. RN must perform and chart a physical assessment every 12 hours for each patient.
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Paperless Charting: A staff substitution enabler. HSCI 740 Keith Fawcett June 7, 2004
The Hospital Unit • 34 beds, 16 rooms. • 2 staff shifts: night shift & day shift. Each 12 hours. • RN must perform and chart a physical assessment every 12 hours for each patient. • The required charting results in a significant amount of time spent on paperwork by the RN. • Paper work that should be completed includes: Identification sheet, MD orders, Progress notes, PT teaching form, falls risk form, physical assessment form, neurovascular assessment form and pain rating form.
LPN: The RN substitute. • The Licensed Practical Nurse can perform a great number of tasks with regards to patient care. However, there are legal limits which prevent the LPN from being able to complete a great deal of the paperwork. • LPN’s can cut costs on a unit substantially. Unfortunately, the paperwork is a limiting factor in employing the use of LPN’s. • 3 RN’s and 5 LPN’s could handle the care of 32 patients, but 3 RN’s could not handle the paperwork of 32 patients. • Before dealing with the paperwork problem. First, we should try to determine what the best mix of LPN’s and RN’s on the unit would be considering the cost of labor and the fact that there must be some RN’s.
Cost Minimization • First, assume that the unit always has 32 patients. • Second, assume the wage for an RN is $25/hour and the wage for an LPN is $16/hour. Suppose: q = 8*LPN.5RN.5 Minimize: w1RN + w2LPN Subject to: 32=8*LPN.5RN.5 Lagrangian for this problem: =w1RN + w2LPN + (32 – 8 LPN.5RN.5) (lamda) is a multiple which relates to the marginal utility from consumption. First order conditions (derivative): #1. /RN= w1 - (4 LPN.5RN-.5) #2. /LPN= w2 - (4 LPN-.5RN.5) #3. /= 32 – 8(LPN.5RN.5) -continued-
Cost Minimization Manipulate Equations #1 and #2: w1 / w2 = (4 LPN.5RN-.5)/ (4 LPN-.5RN.5) = MPRN /MPLPN = RTSRN, LPN =LPN/RN Substitute Manipulated equation into First order #3: 32 = 8(w1 / w2 *RN).5 * RN .5 4 = (w1 / w2 *RN).5 * RN.5 4 = w1.5 * w2-.5 * RN w1 = $25 & w2 = $16 So: 4*w1-.5 * w2.5 = RN Likewise: 4*w1.5 * w2-.5 = LPN Minimization ratios: RN = 3.2 & LPN = 5 Check: 32 = 8LPN.5 RN.5 TC=Total Cost TC = 3.2(25) + 5(16) vs. 8(25) = 200 TC = 160
Results • $40 hourly savings • Problem: RN’s overwhelmed with paperwork • Therefore, these ratios cannot be maintained unless something is done with the paperwork. • Paperless charting is a solution to this problem. • We will need to construct a computer network on our 32 patient unit to create paperless charting. • Will the cost savings of our new staffing ratios outweigh the costs of our computer network?
Financial Analysis • This question will be best answered through conducting a net present value and discounted cash flow analysis. • First, imagine that the computer network is an investment that will produce revenues by enabling the use of the optimal ratios of RN’s and LPN’s. Annual revenues can be calculated by multiplying the hourly savings of $40 by the number of hours in one year.
