Website spotlight: Ensure correct HPPD for best patient care

Staff Development Weekly: Insight on Evidence-Based Practice in Education, March 2, 2012

Determining and agreeing on how many hours per patient day (HPPD) it takes to care for your patient population is a challenging aspect of our work as nurse leaders. HPPD is not the total number of staff needed on the unit, but a measurement of the average number of hours needed to care for each patient on the unit. Unlike the unit census, this number takes into consideration several factors that drive the need for care hours. Let's look at the variables that make this comparison so difficult.

Patient care unit-related variances

  • Number of patients: Larger units will require a higher number of staff; however, they may deliver that care at a lower HPPD than smaller units caring for the same type of patients. At some point, smaller units have fixed costs that are there no matter how many patients are on the unit. A good example of this is the monitor technologist or the unit secretary. These positions may be able to support many more patients than a smaller unit has, but are necessary even if the unit census is much lower.
  • Levels of intensity of the patients for whom care is being provided: This is what we in nursing call acuity. Obviously, the more care needed by the patient, the higher the HPPD will need to be in order to provide this care.
  • Contextual issues: What a difference architecture and technology makes when nurses have to go to get linen, medications, and supplies; answer phones; access patient information; and so on. Designing the unit so that these functions require the least amount of travel time will lower HPPD.

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