Rethinking acuity adaptability

April 1, 2008
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Within six months of the Parker Adventist Hospital opening in Parker, Colorado, administrators noticed a significant increase in nurse turnover. The reason for the increase: the hospital's bed units were planned as acuity-adaptable units (figure). They revised that approach accordingly. Today, staff retention is up and the acuity-adaptable nursing model is out.

In the universal room at Parker Adventist Hospital in Parker, Colorado, medical gases on each patient bed provides easy access for caregivers, but…

Controversial findings about the universal room and the acuity-adaptable nursing model were disclosed during a recent exploratory study conducted by HKS and Herman Miller. The study, dialoguing with leaders from top community hospitals nationwide, found that implementing the acuity-adaptable nursing model has not been easy from an operational standpoint. A perception of inadequate care, an inability to maintain intensive care nurse competencies, and lack of adequate support space are just a few of the issues raised by the nurse managers, directors, and administrators interviewed.

Over the past decade, hospitals across the United States have invested millions of dollars in inpatient infrastructure that supports the acuity adaptable nursing model. Supporting the additional capital investment are a host of projected favorable patient and staff outcomes, including reduced patient transfers, medical errors, falls, patient dissatisfaction, and staff stress. The study's findings, however, advocate a rethinking of this model and the architectural design response that it requires.

Original adaptability thinking

Noted healthcare planner and registered nurse Ann Hendrich originated the acuity-adaptability model in the 1990s. The model is based on the concept of patients spending their entire length of stay, from admission to discharge, in the same room. Universal patient rooms were designed with sufficient space and provision for equipment, medical gases, and power capacity to accommodate any level of patient acuity.

This paradigm shift warranted a radically different approach to nursing. Since different acuity levels demand different levels of skill and expertise, implementing the acuity-adaptable nursing model was based on cross-trained registered nurses and a different type of patient room design.

As noted, several potential advantages exist favoring the acuity-adaptable nursing model over traditional models of care. Patient transfers, lengths of stay, and medical errors are reduced, while nurse and patient relationships are enhanced. Nevertheless, research suggests that pitfalls to implementing the acuity-adaptable nursing model may outweigh these opportunities. For example:

Cross-training staff. The acuity-adaptable model requires nurses who are cross-trained (or willing to be cross-trained) to address all levels of acuity. This is a challenge because nurses typically have preferences for a certain type of care environment, in level of acuity, as well as in type of illness or injury.

Collaboration, peer support, and mentoring. Intensive care requires teamwork and support at a moment's notice. A mix of cross-trained staff on acuity-adaptable units creates less opportunity for mentoring and support of other intensive care nurses. Intensive care patients are not congregated, but are separated from other intensive care patients, sometimes by six or seven rooms. As a result of the separation, intensive care nurses may not have the opportunity to support one another during a shift. Newer intensive care nurses are isolated from others who have the ability to informally mentor and support throughout the shift.

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