Using a Patient Acuity Tool: Examples and Tips

When making a shift assignment, it’s important to balance the sickest patients among the nursing team. A patient acuity tool helps charge nurses quantify how much nursing attention each patient requires, so that staff are assigned patients with relatively equal needs. How do these tools work, and what should nurses know about them?

Have you ever struggled through an excessively busy shift, with several patients deteriorating at once and another that’s constantly on the call bell? Meanwhile, your friend finished rounds and charting on their patients in record time. Imbalances in nursing assignments lead to stress on staff, and if nurses perceive assignments as consistently unfair, this can lead to resentment.

The patient assignment a nurse receives determines the course of their shift, yet historically, the process for codifying patient acuity has been informal. In many units, assignments are based on how the unit is laid out, mandated ratios, clusters of diagnoses, and care continuity between shifts. A standardized tool for evaluating patients can streamline the process of nursing assignments and ensure an equitable system for staff.

What Is a Patient Acuity Tool?

Acuity refers to the amount of nursing attention a patient needs at this point in their care. Patients with higher acuity tend to be at greater risk for complications and mortality, and they also represent a heavier workload for staff. Acuity is a complex, dynamic concept that can be difficult to quantify. Many hospital systems and nursing organizations have developed tools to estimate acuity throughout a patient’s stay.

As patients have grown sicker in the last several decades, tools like this are even more valuable — not just for nursing care, but also for qualifying the demand for more healthcare resources. Tools can help bed management staff determine the unit a patient should go to and ensure they’re in the appropriate hospital for their condition. They can also reduce safety events, potentially improving outcomes.

Acuity tools are typically population-specific — for example, you wouldn’t use the same patient acuity tool on a medical-surgical unit that you would in pediatrics. And while these tools were initially used exclusively in med-surg units, they’re now found in additional settings such as:

• Long-term care
• Home health
• Emergency departments (ERs or EDs)
• Rehabilitation

Examples of Patient Acuity Tools

Let’s take a look at a few different tools and how they apply to patients with different needs. Remember to refer to your facility’s acuity guidance when assessing patients in your unit.

1. Oncology Patient Acuity Tool Sample

The Cleveland Clinic Cancer Center developed the following rating system to rank acuity in patients coming in for oncology infusion treatments. Each acuity level corresponds to an ideal time estimate for each patient to receive the care they need. Once a nurse has treated the patient, they can modify this estimate based on their experience. The new acuity level will be used for the next day’s assignment.

2. Neonatal Intensive Care Unit (NICU) Acuity Tool Sample

The California Department of Public Health (CDPH) developed a tool for evaluating infants in a NICU setting. The tool uses 15 parameters to assign points, and the greater the point value, the higher the infant acuity. Nurses use the scale each shift to rate patients and predict their needs for the next shift.

These are the classification tool parameters:

1. Respiratory status
2. IV monitoring
3. Medications
4. Apnea/Bradycardia/Desaturations
5. Nutrition
6. TPN requirement
7. Teaching support
8. Lab draws
9. Transfusions
10. Weight
11. Irritability
12. Procedures (MRI, PICC placement, lines, etc)
13. Other (language barrier, wound care, new admission, etc.)
14. Requires 1:1 care?
15. Thermoregulation measures

3. Psychiatric Nursing Acuity Tool Sample

Alyssa Howver developed this tool for an inpatient psychiatric unit at Vanderbilt Hospital. It uses five parameters on which patients are each scored on a scale of 1 to 3, with 3 being the highest acuity. See the parameters for acuity scoring below:

1. Is the patient on protocols such as CIWA, COWS, etc?
2. What is their level of aggression, suicidality, self-injury, agitation, and homicidality?
3. Are they exhibiting unpredictable behavior such as catatonia, disorganization, or altered mental status?
4. Are they on precautions, such as needing to be within eyesight, 1:1, or elopement risk?
5. Are they a high utilizer, i.e., frequently symptomatic, frequently require PRN meds, non-adherent to treatments, have frequent visitors, show oppositional behaviors, or have intense family needs?

5 Tips for Using Acuity Tools for Nursing Assignments

1. Use facility-supported tools. For example, your facility may have a patient acuity toolin Epic or a similar electronic health record (EHR). If you’re unfamiliar with the tool in use at your facility, ask for an in-service or educational hour from your unit educator.

2. Ask for input. Most acuity tools require input from bedside nurses and CNAs because they’re the best experts on the current acuity of their patients. Ask for collaboration from staff whenever possible.

3. Balance acuity with experience. A tool may flag patients as “moderate,” but a new graduate may still find the workload challenging. Always factor in staff skill mix and comfort levels, and ask all staff if they need help throughout the shift.

4. Reassess frequently. Patient conditions can change over the course of a shift or an hour. Update acuity scores as needed to keep assignments safe and fair.

5. Document consistently. Acuity scoring is only as good as the data entered. Make sure documentation is accurate and timely so assignments reflect the real patient picture.

Great Nursing Jobs are Right Around the Corner

Sometimes you don’t need a patient acuity tool to know it’s time for a new assignment. If you’re looking for a fresh nursing opportunity, we’re here to help you find it. Learn about personalized job notifications that alert you to roles that fit your needs.