Predicting the effect of nurse-patient ratio on nurse workload and care quality using discrete event simulation.

AIM: A novel nurse-focused discrete event simulation modelling approach was tested to predict nurse workload and care quality.
BACKGROUND: It can be challenging for hospital managers to quantify the impact of changing operational policy and technical design such as nurse-patient ratios on nurse workload and care quality. Planning tools are needed-discrete event simulation is a potential solution.
METHOD: Using discrete event simulation, a demonstrator "Simulated Care Delivery Unit" model was created to predict the effects of varying nurse-patient ratios. Modelling inputs included the following: patient care data (GRASP systems data), inpatient unit floor plan and operating logic. Model outputs included the following: nurse workload in terms of task-in-queue, cumulative distance walked and Care quality in terms of task in queue time, missed care.
RESULTS: The model demonstrated that as NPR increases, care quality deteriorated (120% missed care; 20% task-in-queue time) and nursing workload increased (120% task-in-queue; 110% cumulative walking distance).
CONCLUSIONS: DES has the potential to be used to inform operational policy and technical design decisions, in terms of impacts on nurse workload and care quality. IMPLICATIONS FOR NURSING MANAGEMENT: This research offers the ability to quantify the impacts of proposed policy changes and technical design decisions, and provide a more cost-effective and safe alternative to the current trial and error methodologies.