ANAHEIM, CALIFORNIA—A pilot program demonstrated that an acuity tool that accounts for more complex ambulatory infusion treatments allows nurses to increase their productivity. The research on this successful pilot was presented at the Oncology Nursing Society (ONS) 39th Annual Congress.

The infusions clinic at the James Cancer Hospital and Solove Research Institute in Columbus, Ohio, had expanded due to increased volume and increasingly complex patients, with many participating in clinical trials. Acuity was increased for patients on research protocols or with infusion complications (such as hypersensitivity reactions, new patients, and patients receiving blood products); however, the current productivity tool, which detailed billable units of service, did not accurately reflect this increased acuity, explained Penny Moore, MSN, RN, OCN®, and colleagues.

Administration and nursing had a disconnect over the level of staffing needed to provide the best care for patients. The current model was not able to capture unbillable vital nursing care, leading to an inaccurate picture of the workload and an inability to justify the need for additional nursing staff.

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Acuity models based on length of treatment were identified from a literature review. Infusion leaders, finance leaders, and frontline nurses reviewed the different models to create one that would fit the clinic. The model assigned acuity based on length of treatment, while accounting for patients enrolled in clinical trials, teaching, desensitizations, and when patients needed additional assistance to coordinate their care.

The new acuity model was piloted at an infusion location with a large number of clinical trial participants, and productivity was below threshold. Using the schedule and the acuity tool, an acuity value was assigned to each patient by the charge nurse. Then, the number of nurses needed for the day was predicted using a dashboard that culled the information provided. Next, staffing was adjusted based on this predicted target. Finance staff manually entered the acuity of the patients and the number of patients on clinical trials into the current productivity model, which then adjusted productivity based on the new tool.

Productivity was increased in the pilot unit from an average of 83% in fiscal year 2013 to 96% (target productivity is 100%). The charge nurse is better at anticipating staffing needs, and as a result, the need for additional nursing could be identified. The tool allowed the nurses to feel their work was more accurately accounted for, and it highlighted the need for flexible staffing.

All the ambulatory infusion units at this cancer center will be adopting the pilot model. Frontline nurses are educated and empowered by this model because its design allows nurses to have autonomy in regard to staffing decisions.


Moore P, Turner K, Chen T, Suwignjo R. How many nurses do we need? Developing an acuity tool for ambulatory infusion clinics. Presented at: Oncology Nursing Society (ONS) 39th Annual Congress; May 1-4, 2014; Anaheim, CA.

Prepared by Kathy Boltz, PhD, and Joyce Pagán