Content of classroom

presentation on patient
classification system
and scheduling

Submitted by
Shefa Afrin
Roll no: 25
6th sem
 Patient Classification System

The patient classification system (PCS) is the method or

system of grouping patients. These are used to measure
nursing workload. Workload requirements are mainly
dependent on the dependency of patients on a certain
amount of care in performing basic activities of daily living
(ADL). There are many ways of grouping patients admitted to
hospitals. According to the available literature, the patient
classification system is for their diagnosis,
treatment, DGR, blood groups, demographic factors,
and value accessions on the basis of intensity or
severity of diseases. Patient classification system is
a method of categorizing patients admitted to the
hospital with specific criteria.
Definitions According to Giovannetti (1979),
patient classification is the
categorization of patients
according to the individual
assessment of their nursing care
requirements over a specified
period. It is the identification
and classification of patients
into various groups or categories
to measure or quantify nursing
efforts required. Patient
classification system is the
patient acuity system used to
manage workload and also to
quantify patient care needs to
estimate the number of staff
required for each patient (Saha,
 [Link] measure nursing efforts required to:
• Calculate the workload and develop
Objectives of workload index: quantification of levels of
PCS care.
• Identify the needs of patients according to
the severity of their illness.
• Calculate the number and level of staff
required to meet the diverse needs of
patients.
[Link] is a tool to assign totality, float staff.
[Link] helps us prepare and budget in long-term
planning.
[Link] is used for special management reports,
quality assurance, and utilization review.
[Link] is used to measure the efficiency of nurse
managers in matching workload
requirements on a daily, monthly, and
annual basis.
[Link] provides a rationale for nursing changes.
[Link] is used to assess the quality and quantity
 Characteristics of PCS

• PCS should be simple.

• It should be specific and need-oriented.

• It should be auditable and individualized.

• It should be service-bound.

• It should be reversible.
 Exploring Breakthroughs and
Challenges
Overview 01 Overview 02

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Overview 03 Overview 04
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Methods/Types of Categorizing
Patients:

A) Factor Evaluation System

In the factor evaluation system, a number of critical care
descriptors are identified, and patient’s care needs are selected
according to patient’s dependency levels. The descriptors are
also known as care elements which are divided into sub-
elements with a standard time being determined for
accomplishing each sub-element.

The descriptors used to measure a patient’s dependency needs

are activities of daily living – feeding, grooming, toileting, comfort
measures, and mobility. The requirement to assist a patient with
each activity is quantified from the least amount of time required
to the greatest amount of time required.
e.g. self-feeding vs tube feeding.
Methods/Types of Categorizing
Patients:

Measurement of Patient Classification System

NCH/PPD = Nursing care hours worked / Patient census

Common Care Descriptors

Hygiene, nutrition, medications, fluid management, skin and
wound care, respiratory care, circulatory care, elimination,
mobility, special diagnostic and treatment procedures, health
teaching, and daily activities of living.
After the care descriptors have been selected, the levels of care
are defined for each descriptor. The level is differentiated by the
amount of nursing time and frequency of each care measure.
The factor system is referred to as objective because specifying
particular indicators or factors associated with patient care helps
to ensure objectivity by the rater.
Methods/Types of Categorizing
Patients:

B) Prototype Evaluation System

In this, the symptoms of patients typical of each care category are
listed and patients are categorized on the basis of severity of categories
of patients in the prototype evaluation system.
Category I
Patients with acute illness wherein the disease has affected the body.
In self-care, these patients are either require intensive or moderate
care. They require nursing services 1–2 hours/day. Patients with acute,
chronic episodic disease, who will return to their pre-illness level of
functioning and for whom the goal of nursing is complete elimination of
present condition.
Category II
This category includes patients who need minimal care requiring 3–4
hours nursing care per day. For example, patients who are recovering
from a severe illness or surgery. The goal of care is management of
chronic health problem with treatment without ongoing nursing service.
Methods/Types of Categorizing
Patients:

B) Prototype Evaluation System

Category III
This category patients require intermediate care, nursing service 5–6
hours per day. For them, the care goal is rehabilitation to a maximum
level through continuous nursing care.
Category IV
Patients who are sick or acutely or severely ill and who have high level
of dependency come under this category. They need close supervision.
For example, patients who are admitted in intensive care units or
patients in unstable condition requiring close supervision.
Category V
This category includes the very end stage of illness and for them the
goal of nursing care is assurance and comfort throughout the terminal
stage of illness.
 According to this method, patients are classified for their C) ADL (Activity
dependency level from the least category-I to the most
dependent (Category-V). Common uses for their ADLs include
activities like mobility, dressing, getting in and out of bed or
of Daily Living)
chair, using the toilet, and grooming. The hygiene, bathing,
dressing, toileting, and feeding care are basic needs so each
Method
nursing service was given tools and rating scales developed to
measure the dependency level of patients based on ADLs

Barthel Index is one example of categorizing

patients. This scale has 6 activities: bathing,
dressing, toileting, transferring, continence,
and feeding. It is scored from 0 = for
independency and 6 = high (patient very
dependent).

Manjet and Yati (2005) developed a

self-care deficit assessment scale
related to ADL related to personal
care. It is another example of
categorizing the dependency level.
 Category Category
Category I Category III Category V
II IV

Needs
Needs Completely Totally
Bathing Independent assistance with
supervision dependent dependent
equipment

Requires Needs complete Needs full Cannot

Dressing Independent
help help assistance perform

Bedpan/
Occasional Needs
Toileting Independent Dependent catheter
assistance significant help
dependent

Minimal Tube feeding Regular tube

Feeding Independent IV dependent
supervision occasionally feeding

Score 4 8 9–12 13–16 >16

Moderate–
Moderate Complete
Selfcare Independent complete self- Total care
self-care care
care
Personal Care Scale & Nursing Care
Intensity Method
The scale has four subactivities of personal care, i.e., feeding, bathing, dressing, and toileting
(defecation). These areas of personal care are the indicators of patient's dependency for
requiring care. Each area of care further comprises four determinants each to categorize
patients' self-care deficit.

Patients' self-care deficit or degree of dependency for nursing care ranges from 1 to 4. The
patient may fall from 1 to 4 against each component. Thus, total score for all components ranges
from 4 to 16.
Based on the scores, the patient can be categorized as follows:
 D) Nursing care intensity L

method l
Patient grouping is according to the amount of A sample of patient classification tool for
nursing care required based on the individual neurological patients developed by Kaul &
caring needs of the patients daily. Many scales Yat (2005), based on Hunter's adult and
are developed to quantify Nursing Care children ADL and critical care classification
Intensity (NCI) on selected parameters. dependency tool.
Significant components of scores to assess the It has 6 components:
amount of nursing care requirements are:
• Personal care • Level of consciousness
• Feeding • Nutrition
• Observation • Risk of developing
• Ambulation bedsores
• Others • Personal hygiene
• Elimination
• Mobility
 Patient Classification Tool (for
Neurological Patients)
A. Level of B. Nutrition
Consciousness [Link] feeds himself independently on
[Link] responds spontaneously
solid/liq
[Link] responds but takes a long
[Link] can feed himself but needs
time
supervision
[Link] responds to painful stimuli
[Link] help and assistance to eat and drink
[Link] does not respond at all
[Link] on care for eating and drinking
(Ryle’s tube feed/intravenous)
C. Risk of Developing
Bedsores

[Link] risk (ambulatory patient)

[Link] risk (needs assistance in changing
position)
[Link] risk (bed every 2 hrs skincare)
[Link] having bedsores
 Patient Classification Tool (for
Neurological Patients)
D. Personal Hygiene E. Elimination
[Link] takes bath independently
[Link] the toilet/commode chair
[Link] assistance in taking a bath
independently
[Link]/relative sponges the patient,
[Link] help in using the toilet
but patient follows directions
[Link] assistance in passing urine and stool
[Link] effort by the patient when the
in bed/on bedpan
nurse sponges patient (needs two
[Link] is incontinent/catheterised
carers)

F. Mobility
Total score: _______
Category: _______
[Link] patient is independent – attendant
Ratings:
present • Score < 7: Category 1 – Independent
[Link] help in using the toilet • Score 7–11: Category 2 – Between
[Link] carers needed to help the patient walk dependent and independent
or move around • Score 12–19: Category 3 – Dependent
• Score > 19: Category 4 – Fully dependen
E) Diagnosis-
DRGs is a prospective payment system.
Related Groups It has a predetermined price for patient

(DRGs) hospital care for medical prescriptions

according to the patient’s placement in
1 of 467 DRGs.
The DRG system is a strategy for
grouping patients according to
demographic, diagnostic, and
therapeutic categories that correlate
with their use of hospital facilities.
Under this prospective payment system:
• Hospitals receive a fixed rate for
services.
• If cost < rate → hospital profits.
• If cost > rate → hospital loses.
• This system provides incentives for
early hospital discharge, but the
quality of care is affected.
F) Hospital
Canadian Hospital System Study Group
System Study (HSSG) PCS provides an objective method

Group PCS of bodily categorizing hospitalized

patients.
Classification of patients is based on the
need of patients for nursing care.
It comprises four major components:
Personal care, Feeding, Observation and
Ambulation
The other two parts:
Incontinence, Need for surgery
These components of nursing care are the
indicators of patients’ classification for
the requirement of nursing care.
Each element is categorized into
sublevels to classify patients' dependency
for nursing care.
After getting information, classify patients
F) Hospital
a) Category 1 (Self-care/minimum care):
System Study The patient is fully capable of caring for

Group PCS himself but requires minimal support plus

treatments for monitoring.
(b) Category 2 (Average/moderate
care):
The patient requires an average amount
of nursing care and medical support.
(c) Category 3 (Above
average/maximum care):
Patient requires higher than usual care
and continuous care and medical support,
and use of special equipment.
(d) Category 4 (Intensive care):
The patient requires very frequent to
continuous intensive nursing care and
close supervision by medical personnel
with support from electrical equipment.
G) Oulu Patient
Classification
Developed based on HSSG patient
classification in Finland.
It has 6 subscales:
• (a) Planning and coordination of
nursing care
• (b) Breathing, blood circulation,
and symptoms of disease
• (c) Nutrition and medication
• (d) Personal hygiene and
secretion
• (e) Activity, sleep and rest
• (f) Teaching, guidance, follow-up
care, emotional support
G) Oulu Patient
Classification
Each subarea is scored 1–4:
[Link] A (1 point): Patient who
manages relatively well on his or
her own
[Link] B (2 points): Patient
who requires nursing care
occasionally
[Link] C (3 points): Patient
who manages but has repeated
need for care
[Link] D (4 points): The care
needs of the patient who cannot
manage unaided at all
Total score ranges between 6 and 24
points.
To calculate Nursing Care Intensity
(NCI):
 RAFAELA Patient Classification System
H) RAFAELA Based on tools of the research team who developed the
Patient system (team names undisclosed).
It comprises 3 measurement tools:
Classification [Link] patient classification based on individual care
needs of patient daily
System [Link] data of nursing resources that include number of
nurses per day (one nurse = 8 hrs/day)
[Link] assessment of optimal nursing care
intensity level (PAONCIL scale)
• PAONCIL assesses the value of optimal care intensity
by asking staff to rate each shift (1 month)
• Three-point scale:
⚬ 0 = Optimal
⚬ <0 = Below optimal
⚬ 0 = Above optimal
Calculate daily NCI value per nurse and compare it with
average NCI value of the same day.
Calculate optimal NCI per nurse for the ward using linear
regression analysis, incorporating:
• Length of stay
• Diagnosis
• DRGs
 Patient Dependency-
Related Approaches
Dependency–Activity–Quality (Acuity–
Quality) Method
• Used to assess staffing needs in nursing wards
where occupancy and workload fluctuate.
• Goal: Match nursing hours with demand during Advantages:
peak and non-peak times. • Ideal for inpatient settings.
Key Components: • Applicable to both adult and pediatric
• Patient Dependency: Grouping patients by needs. medical/surgical units.
• Nursing Activity: Pairing dependency with • Uses three key indicators: patient dependency,
required nursing time. activity, and quality.
• Quality of Care: Evaluating care delivery • Helps calculate required nursing hours (WTEs).
effectiveness. Weaknesses:
• Complex compared to traditional staffing tools.
• Requires accurate, local data on daily minutes
per dependency group.
• Needs computer software for data entry and
calculation.
 Patient Dependency-
Related Approaches
The Regression Method
• Predicts nursing requirements based on the level of patient
activity.
• Dependent variable: nursing hours; Independent variable:
factors like patient type, hospital type, etc.
Advantages:
• Suitable for predicting staffing needs.
• Useful in planning for extra demands.
• Less resource-intensive than time–task studies.
• More reliable and valid.
• Allows easy validation of staffing plans
Weaknesses:
• Requires statistical expertise for data analysis.
• Needs high-quality data on interval/ratio scales.
• Data design and methodology must be appropriate for
valid results.
 Patient Dependency-
Related Approaches
The Regression Method
• Predicts nursing requirements based on the level of patient
activity.
• Dependent variable: nursing hours; Independent variable:
factors like patient type, hospital type, etc.
Advantages:
• Suitable for predicting staffing needs.
• Useful in planning for extra demands.
• Less resource-intensive than time–task studies.
• More reliable and valid.
• Allows easy validation of staffing plans
Weaknesses:
• Requires statistical expertise for data analysis.
• Needs high-quality data on interval/ratio scales.
• Data design and methodology must be appropriate for
valid results.
 Scheduling

Introduction
Nurses being an integral part of the health team have a significant
contribution in providing the nursing care throughout 24 hours of a
day. They need to work in shifts. The pattern of shift vary from one
hospital to another depending on the need of the institution. Usually
the hospitals follow three shifts, i.e., morning, evening and night
shifts. Staff scheduling is a challenging job for a nurse manager due
to a shortage of nursing personnel and to keep the unit productive
and nurses’ morale high. It has become essential to create optimized
schedules to keep nurses happy and content with their shift
assignments.
Definition
Scheduling is an aspect of the staffing function. It is a time plan of
on and off duty hours for nursing personnel in a particular unit,
section or division. It is a method of arranging the time plan for the
staff to work.
 L

• A schedule is a timetable showing planned work days and

shifts for nursing personnel.
• Staff scheduling consists of drafting hours of work plan of
work and duty rotation for a group of worker over weeks
and months. It includes a length of shift and the type of
• A
rotation.
schedule/roster is a plan showing on and off duty periods
for staff within a defined area, such as a nursing ward or
community locality. Duty rostering is about matching staff
to workload needs, and the plan should therefore reflect
the peaks and troughs of expected workload, ensuring
staff is available at the times they are required.
Importance of
Scheduling
Scheduling and shift patterns are an extremely
significant aspect of managing any team or
Purposes
• Ensure quality care and manage
workload.
department (Wyckoff et al, 2008). According to Lee • Distribute off-duty fairly.
(2007), to adjust the "off duty", can be one of the • Enhance job satisfaction and teamwork.
most stressful and time-consuming tasks to a • Improve staff preparedness.
nurse manager. Adequate staffing in all shifts • Meet goals of management.
influences the quality of care of patients. • Help manage emergencies.
Scheduling affects patient care and welfare of Principles of Planning Duty Roster:
staff. Placing the right number of staff and skill mix • Coverage – 24/7 nursing availability.
at the correct times is vital to the smooth and safe • Continuity – Consistent staffing for
running of a nursing ward or department. quality care.
• Flexibility – Accommodate preferences
and changes.
• Stability – Consistent off-duty and
rotation patterns.
Types of
Scheduling
Based on Authority / decision-making
Centralised Scheduling Based on structural approach:
In a centralised scheduling system, the nurse • Master schedule / Master Rotation
administrator prepares the schedule in their office Plan
and is responsible for scheduling both the staff → A master plan for nursing services shows
unitwise, shiftwise and time-wise scheduling
members who are permanently assigned to each
in case of a centralised scheduling plan.
unit and also required on major call at the time of
→ In decentralised, the head nurse prepares
need in other units. Float (on-call) staff has to be
coordinate master plan depicting the
there to fill in wherever there is a shortage. distribution of staff for each shift/day and
• Decentralised Scheduling unitwise.
Here the head nurse for each unit or supervisor of • Operational Plan
each section prepares time schedules for the → The operational plan is word duty roster
nurses assigned to that unit that is independent of or rotation plan. The head nurse prepares a
personnel schedules prepared by other head rotation plan for the staff allocated to that
nurses. In this system, it is difficult to equalize staff particular ward as per shift duty pattern
across the unit so the central nursing office followed in the hospital.
provides and maintains a pool of "float" (on-call)
Types of
Scheduling
Based on Shift Arrangements

• 10-hour shifts (4 days/week) with overlapping hours for

meetings
• 12-hour shifts (3-4 days/week) with alternating weeks
• Premium vacation night: extra days off for extra low night
shifts
• Flexible role scheduling: adjusting roles based on workload
• Weekend alternative: alternating weekends off
• Team Rotation: coordinated team-based scheduling
• Premium day weekend: extra day off for voluntary extra work
• Cross training: staff trained across units for flexibility
Duty Roster
Specific Scheduling Policies
In nursing management planning, the duty in Duty Roster
roster is an important requirement to
Department policies should guide managers in distributing
implement quality nursing services. desirable and undesirable work hours equitably among
Basically, because proper planning and employees. Several issues need to be addressed, such as:
executing of the duty roster will directly 1.A policy for a person, by title, who is responsible for
affect the functioning efficiency and job producing the roster
satisfaction. Scheduling the duty roster is [Link] time period to be covered by each schedule
defined as assigning the duty when in [Link] number of weeks or days in advance that the roster
patient units. should be posted
[Link] total of on-duty hours for each employee
[Link] beginning and ending hours of each shift and break
times
[Link] number of shifts between which each employee must
rotate: days off, weekends, off per month, and minimum
days off
[Link] number of paid holidays and vacation days; vacation
scheduling
[Link] procedure for handling emergency requests and
number of required work days
Steps in Planning the Duty
Roster
• A skeleton plan is made in pencil to allow
alterations Specific Scheduling Policies
• List the names in order of priority.
in Duty Roster
• Put special requests in early to avoid eraser
• Insert days off, noting busy days. It is important [Link] nurse in charge should be aware of the
not to have too many nurses off duty at the same holiday allotted to each of the staff nurses,
time who should also be fully aware of the
• When placing days off in the schedule, refer to holidays allotted to him/her
previous roster so that days off were reasonably [Link] should be encouraged to plan their
spaced and weekend offs were shared holidays ahead of time
• Add the shifts, balancing number of nurses on [Link] a certain number of staff should be
each shift, ensuring that one nurse is on duty to allowed to take their holidays without
take charge and that the trained nurses are evenly
approval. This number is usually decided
distributed
between the charge nurse and the nurse
• Total the number of staff on duty for each shift
administrator
• The roster may be planned weekly or monthly or it
may be a fixed one
 Role of a Nurse Manager /
Supervisor in Preparing a
•Schedule
Identify staff skills and patient needs
• Consider holidays, sick leave, training and absences when
scheduling
• Draft reasons for staff absences to plan better
• Review scheduling with staff and address critical issues
• Optimise the scheduling process
• Create a procedure for updating and sharing the master
schedule
• Allow flexibility for shift swaps and provide clear rules
• Set up a vacation request system
• Establish a process for backfilling vacancies, both
planned and last-minute
 bibliography
•Vati, jogindra, nursing management
and administration, 2nd edition, mohali,
Jaypee brothers medical
publishers,2013, pg-296-301
•Clement, I. "Textbook of nursing
management and leadership", 4th

Conclusion
edition, New Delhi, Elsevier publishers,
2021, pg no-136-142, 304-308
•M.R., Beena, G. l. Krishna, Hari & J. C.,
kiruba, Textbook of Nursing
Patient classification and
management and services, 2nd edition,
proper scheduling are key to
New Delhi,CBS publisher and distributor
providing quality care and pvt Ltd,2022, pg-70-72
managing nursing resources
effectively. They help balance •Carol J. Huston leadership roles and
workload, support staff, and management functions in nursing
improve patient outcomes, (theory &application), 9th edition,
making them essential in Philadelphia,wolters kluwer
healthcare. publication,2018,pg-443-459
Thank you for your
attention