At the 2024 JADPRO Live Meeting in Grapevine, Texas, Joanne Lang, ARNP, BMT/Immunotherapy APP Inpatient Manager, Fred Hutch Cancer Center, Seattle, Washington, presented findings from the utilization of a workload index (WLI) to address staffing needs across the organization. 

“Oncology Advanced Practitioners (APs) are often primary providers for high acuity patients, managing complex medical issues, providing emotional support, and coordinating care. Tracking inpatient census or outpatient clinic slot utilization fails to capture much of this important work,” explained Lang. 

In order to better capture the true workload of their APs, the Inpatient Bone Marrow Transplant/Immunotherapy Service at a large academic center developed and utilized the WLI to help guide staffing. Each day, APs submitted a WLI score for each patient based on an objective scale including points for medical complexity and care coordination. The data was compiled and analyzed by AP leadership.

The WLI demonstrated that the Inpatient Bone Marrow Transplant/Immunotherapy Service was consistently under resourced. Workload data was used to justify additional staffing and approval of a new inpatient team, promoting patient safety and preventing AP burnout by illustrating the value of accounting for complexity versus census alone. 

Given the initial success of this tool, the WLI was further implemented among other teams at the academic center: the Inpatient Hematology/Oncology AP Service, the Acute Clinical Evaluation and Infusion Service APs, and the Outpatient Bone Marrow Transplant/Immunotherapy Clinic.

The Inpatient Hematology/Oncology AP Service utilizes 2 WLI values: end-of-day and anticipated next-day workload. The anticipated next-day value enables surge staffing to be driven by either census or high acuity and facilitates redistribution of patients to balance workload. The end-of-day WLI retrospectively illustrates the appropriateness of daily staffing, providing valuable feedback on the efficacy of our predictive staffing system and highlighting changes in staffing needs over time through trend analysis. 

The Acute Clinical Evaluation and Infusion Service APs provide urgent services and episodic care across several sites. This team adopted the WLI to evaluate and support necessary staffing changes to account for variable and unpredictable patient care needs. WLI points are given for: assessments, medication/transfusion reactions, rapid responses, procedures, triages, and teaching. As the service expands to meet patient access demands, the WLI has been used for longitudinal staffing predictions to support operational and strategic goals. 

The Outpatient Bone Marrow Transplant/Immunotherapy Clinic tracks WLI weekly, capturing billable and non-billable activities, including complex medical and psychosocial care, patient communications, order entry, and clinical vacancies coverage. This team modified the WLI to include a subjective scale which helps provide real-time resources to APs and balance panels. The goal is to equate a WLI score that is both representative and predictive of the amount of work on a clinical team.

“The applications of the WLI are broad, including use in supporting daily and longitudinal staffing needs as well as for operational and strategic planning. It has improved morale by helping APs demonstrate productivity not captured by usual methods,” explained Lang.

“Next steps might include application of the WLI at other centers to further validate the tool,” she concluded.

Source:

Lang J, Patterson C, Johnson M, et al. Workload Index: A Simple, Translatable, and Actionable Tool to Optimize Advanced Practitioner Resourcing. Presented at the 2024 JADPRO Live Meeting. November 14-17, 2024; Grapevine, Texas. JL1249C.