Elsevier

Computers in Biology and Medicine

Volume 45, 1 February 2014, Pages 67-71
Computers in Biology and Medicine

Using HL7 in hospital staff assignments

https://doi.org/10.1016/j.compbiomed.2013.11.003Get rights and content

Abstract

Hospital staff assignments are the instructions that allocate the hospital staff members to the hospital beds. Currently, hospital administrators make the assignments without accessing the information regarding the occupancy of the hospital beds and the acuity of the patient. As a result, administrators cannot distinguish between occupied and unoccupied beds, and may therefore assign staff to unoccupied beds. This gives rise to uneven and inefficient staff assignments. In this paper, the hospital admission–discharge–transfer (ADT) system is employed both as a data source and an assignment device to create staff assignments. When the patient data is newly added or modified, the ADT system updates the assignment software client with the relevant data. Based on the relevant data, the assignment software client is able to construct staff assignments in a more efficient way.

Introduction

Hospitals in Chicago required a nurse assignment application able to perform nurse assignment as well as keeping records of patient name, address, nurse information and acuity levels in its own database. They required the following software requirements for the application:

  • The software is for the automation of staff assignments.

  • It maintains two types of user: administrator and user.

  • The application includes patient details.

  • The administrator can manually change the assignments.

The previous methodology in these hospitals was simply to assign the beds to the nurses, without knowing whatever beds were occupied or not, even though this information already existed in their admission–discharge–transfer (ADT) systems. These hospitals therefore needed software to combine bed occupancy information and the patient acuity values in order to improve and simplify nurse assignment. Visual C# was used to create the assignment client with the MS SQL Server 2008, and was used for the database recording of patient details.

There are many papers which present several constraint programming models to solve staff scheduling problems in healthcare [1], [2], [3]. At the University of Virginia hospital, a software application was developed in which the medical residents and interns enter their preferences, and holidays online [4]. The Gurobi linear solver was then employed to optimize schedule generation. For future work, they claim that the system can easily be applied to all proposed hospitals across US with only minor changes. Although many different approaches have been proposed in these papers, it still remains a challenge to successfully apply any given solution to any given hospital. In this paper, a software solution called assignment client is presented based on HL7 bed and patient information, which is utilized to find the most effective staff assignments for any given hospital. The assignment client developed in this paper collects the data from the ADT system avoiding the need for nurses to enter their data online. It uses a very simple algorithm to perform the nurse assignment.

The assignment client employs the Health Level 7 (HL7) standard to communicate with the hospital information systems to maintain the hospital bed occupancy. The HL7 standard was established by an organization of hospital computer system vendors [5], who published specifications that fully describes the requirements of the standard. This standard has changed since its inception, and great care has been taken to maintain backward compatibility in succeeding versions of the standard. The assignment client that was developed supports versions 2.2 and 2.3 of the standard.

Bed occupancy information shows the number of occupied beds while patient acuity gives the severity of the patient's condition. This information directly corresponds to the amount of staff time required to properly care for each patient. For example, an unoccupied bed requires no staff time, while a bed occupied by a patient with high acuity requires substantial amount of time. Therefore, assigning equal number of occupied beds to each staff member may not create an efficient staff assignment because the patient acuity levels may change among these beds and thus, the necessary amount of staff time will fluctuate among the assigned beds. However, if the patient acuity levels are considered when constructing staff assignments, the administrator can distribute the workload among the staff members more evenly. At the end of the assignment process, this staff assignment will produce an equally spread workload, despite an unequal number of beds being assigned to each staff member.

It is very desirable for the hospital administrators to have an application which performs assignments using both the bed occupancy information and the patient acuity levels, in addition to keeping patient detail records such as patient name, address and nurse information in a database. This application will help the administrators both to save time and create a more efficient staff assignment. The next section presents the assignment client, its database, and the security needed to access the database. Finally, Section 3 contains the conclusion and considers the future work.

Section snippets

The assignment client

During the patient admission, the admitting physician assigns an acuity level to the patient. In HL7, this value is kept inside the data field, called Admission Level of Care Code. This data field is included in the HL7 segment called Patient Visit Additional Information (PV2). Suggested values are given in Table 1.

An example of PV2 is also given below

PV2|||^abdominal pain|||||||||||||||||||||||||||||||||||||CR| <cr>

where CR is critical (Table 1) and <cr> is the carriage return (which

Conclusion and future work

As nurses are the foundation of any nurse call system, it is very important to create effective staff assignments for nurses in a hospital. Currently, the administrators simply assign each staff member an equal number of beds, regardless of whether it is occupied. This produces an unequal workload for the nurses since unoccupied beds require no staff time. Moreover, all patients have different needs, and depending on their acuity levels, require different amounts of attention. This paper

Conflict of interest statement

I did not at any time receive payment or services from a third party for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis, etc.). I do not have any financial relationships regardless of amount with any entities. The author declares that he has no conflict of interest.

References (16)

  • S. Bourdais, P. Galinier, G. Pesant, HIBISCUS: A Constraint Programming Application to Staff Scheduling in Healthcare....
  • S. Abdennadher, H. Schenker, INTERDIP – an interactive constraint based nurse scheduler, in: Proceedings of the First...
  • P. Chan, K. Heus, G. Weil, Nurse scheduling with global constraints in CHIP: GYMNASTE, in: Proceedings of the...
  • K.A. Ryan, S. Pruksaritanon, A.W. Reber, P.G. Aman, K.P. White, M.C. Smith, Sung Nam Hwang, Preference based scheduling...
  • HL7 Standards....
  • Bob Beauchemin, SQL Server 2008 R2 Security Best Practices – Operational and Administrative Tasks, SQL Server White...
  • Database Encryption in SQL Server 2008 Enterprise Edition, SQL Server Technical Article, Microsoft, February...
  • Richard W. Selby

    Enabling reuse-based software development of large-scale systems

    IEEE Trans. Softw. Eng.

    (2005)
There are more references available in the full text version of this article.

Cited by (0)

View full text