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Configuring Demand Manager Location Settings

Demand Manager is an optional Staff Manager application that measures, predicts, and tracks patient demand for services. It provides this data so that you can make better resource deployment decisions, especially when it comes to staffing.

Use the Location Settings page to configure the information required to generate Demand Target Staffing using Demand Manager. Each profile in Staff Manager has one or more locations defined for Demand Manager. The page has two tabs: Demand Settings and Options.

Configuring Demand Manager is a prerequisite for configuring the optional Outcomes-Driven Acuity application. If you have Outcomes-Driven Acuity, you should be aware that changes to Demand Manager Location Settings after the initial acuity configuration affect your acuity configuration. You should only change your Location Settings in coordination with a Cerner Clairvia Clinical Consultant.

The Demand Settings Tab Action Buttons

The buttons at the bottom of the Demand Settings tab apply to the data you enter on all its sub-tabs.

About the Demand Settings Save and Publish Button

Caution: If you are configuring locations with the optional Outcomes-Driven Acuity application, you should use Save and Publish only upon direction from your Cerner Clairvia Clinical Consultant.

Required boxes on the Demand Settings sub-tabs are shaded in yellow, and you must complete all required boxes before Demand Manager makes the Save and Publish button available. Once you click Save and Publish, a new window opens to let you select a Publish Date, either by using a list or a calendar menu. The configuration becomes effective on your selected publish date. The date that displays in the Save and Publish list is the publish date of the current configuration.

You have three options when selecting a publish date.

Once you click Save and Publish, Demand Manager processes patient data again if the selected publish date is the current or a past date. The application then tells you how many patients are affected by the change; data for patients who arrived in the location on or after the date selected have to be reprocessed. If a backdated configuration includes changes that affect the Target Staffing calculation, Demand Manager has to revise Demand Target values and patient assignment care hours for all of those patients. Because of this, you should consider the following factors when changing the configuration date:

Best practice is to select a publish date that:

Reprocessing patients delays the processing of new real-time registration transactions received during the reprocessing. Reprocessing begins immediately following the receipt and processing of an ADT message through the registration interface.

Publishing the configuration and recalculation of target staffing for a large volume of patients (either because the backdate covers a large span of time or because configurations for multiple locations are to be reprocessed at the same time) can be processor intensive. For this reason, it is best to publish large changes late at night to lessen the impact on application performance.

You should click Save and Publish to apply any change you make on the Demand Settings sub-tabs. You have to select a publish date for all changes, except changes to the mid-level acuity used by Outcomes-Driven Acuity for reporting purposes on the Acuity Settings sub-tab. Changes to the mid-level acuity are applied to the configuration selected in the Select Configuration date list.

If you click Save and Publish after working on a draft configuration, Demand Manager removes the draft configuration from the Select Configuration list and replaces it with the effective date of your newly published configuration.

Overview: Steps to Configure Location Settings

Demand Manager automatically adds Location Settings using default values for the Target and Budget Data and the Location/Service Patterns sub-tabs when your Clinical Consultant maps each location. The default settings are as follows.

You then need to complete the following steps.

  1. Complete the information on the Target and Budget Data and Location/Service Pattern sub-tabs.
  2. In the Calculated Values box on the Target and Budget Data sub-tab, click Update.
    1. If the HPPD Variance is greater than 0.5, save your configuration as Draft. Reassess the data entered for the Direct Care HPPD, the direct caregiver staffing distribution and the budgeted census. Consider if you have omitted caregivers (partial or full) or included them accurately in the staffing distribution and if the Direct Care HPPD includes direct caregivers only. Changes to the Direct Care HPPD, direct caregiver staffing distribution and or budgeted census affect this calculation. If the values are accurate or if the variance remains after adjusting values, contact your Cerner Clairvia Clinical Consultant for additional direction.
    2. If the HPPD Variance is equal to or less than 0.5, click the ADT-adjusted Demand Ratios link to review ratios by skill and time of day. These ratios should be consistent with the staffing patterns for an average patient on a typical day. Demand Manager generates Target Staffing using these ratios.
  3. Click Save and Publish to publish the configuration data.
  4. If the selected profile has more than one mapped location, you can copy the configuration data to the other locations and edit as needed.

Direct caregivers (that is, those to be included in the Direct Care HPPD) always include the staff who take patient assignments. Direct caregivers may also include staff who provide direct patient care but do not necessarily have a patient assignment. Examples of direct caregivers who do not take a patient assignment include, but are not limited to, Charge Nurses, Admission Nurses, and other nurses who assist as needed with patient care.

Direct care responsibilities may include, for example, medication administration, conducting admission assessments or ongoing assessments, assistance with procedures, or communication of new orders during the shift. These caregivers should be included in the staffing distribution on the days of the week and times of the day they typically have direct patient care responsibilities, even if they do not take a patient assignment. For example, if a Charge Nurse delivers direct patient care only on night or weekend evening shifts, the staffing distribution in Demand Configuration by Location should reflect this. If the Charge Nurse delivers direct care 50% of the shift and performs administrative tasks 50% of the shift, the Charge Nurse should be reflected as a 0.5 FTE for that particular shift and time of day. The staffing distribution should be set up to reflect the typical role, knowing that by exception the role of the Charge Nurse changes.

Using the Demand Settings Tab

  1. From the Configure menu, select Demand Manager > Location Settings. This opens the Location Settings page. The Demand Settings tab is active by default.
  2. If your organization has multiple facilities, there is a Facilities list on the right side of the page title bar. Select a facility from the menu. Profiles defined for the facility then are displayed in the Profile menu.
  3. Select a profile from the Profile menu. Locations defined for the profile then are displayed in the Location menu.
  4. Select a location from the Location menu.
  5. Select a Configuration: This list displays the dates for all configurations. Any draft configuration for the location is displayed in the list first. The list then displays configuration published dates in reverse chronological order, such as Published 08/15/2011. Each location can have one draft configuration and one future configuration at any time. Publishing a configuration removes the draft configuration from the menu. Data for each configuration date selected displays in the sub-tabs. The page refreshes data in all sub-tabs as you select dates in the Select Configuration list.
  6. Configuration Note: You can enter a note about the location configuration by clicking on the Cfg. Note icon . This opens the Location Configuration Note window. You can use notes to document and track data review and changes to the location configuration such as Fiscal Year 2015 HPPD, Staffing, and LOS updated. You can add, edit, or delete configuration notes in this window; it displays all configuration notes for the selected location.
  7. Make changes to the sub-tabs as described in the following sections.
  8. Click of the following action buttons. See the preceding section The Demand Settings Action Buttons for more information.

Using the Target and Budget Data Sub-tab

This sub-tab allows you to enter budgeted information about the location, the location's direct caregivers, and ADT Event data.

  1. Open the Location Settings page and select a location and configuration as described in the preceding section Using the Demand Settings Tab. The Target and Budget Data sub-tab is open by default.
  2. Enter the budgeted LOS (Length of Stay). You should base this value on all patients for the location. You can enter the LOS in Days or Hours. Demand Manager automatically creates the location-based progress pattern for each location using your entered LOS. Demand Manager also uses the budgeted LOS when calculating ADT Impact.
  3. Enter the location's Budgeted Census: Staff Manager uses this value to calculate the Calculated HPPD (Hours per Patient Day), ADT-Adjusted HPPD and ADT-Adjusted Demand Target Ratios and HPPS (Hours per Patient Shift).
  4. Enter the Direct Care HPPD for nursing staff, including RNs, LPNs, and UAPs for the budgeted census. Direct Care HPPD should include hours that vary based on volume and that are assigned to deliver care for one or more patients during a shift. Demand Manager compares the Direct Care HPPD value to the Calculated HPPD and displays the difference as the HPPD Variance.
  5. Enter the ADT Events data. Demand Manager uses the ADT percent occurrence, total minutes, and budgeted LOS to calculate the ADT Impact. You can select Do Not Calculate ADT Data, but only if you do not want Staff Manager to calculate the ADT Impact, meaning Staff Manager does not generate workload for ADT events in your selected location.
    1. Enter Percent values: This is the percent of patients who arrive to the location as an admission or transfer in and the percent of patients who depart the location as a transfer out or discharge. The % Admission (A) plus the % Transfer In (TI) must equal 100%; the % Discharge (D) plus the percent Transfer Out (TO) must equal 100%. Demand Manager automatically calculates the percent for the companion event option as you enter data.
    2. Enter Minutes/Skill values: Enter the average time in minutes, by global skill, for admission, transfer, and discharge events. You can enter event minutes for 1 to 4 global skills. Demand Manager displays the total minutes for each event as you enter data. If the Percent for an event is 0, the Minutes/Skill for that event must also be 0. Conversely, if the Minutes/Skill for an event is greater than 0, the Percent value for the same event must also be greater than 0.
  6. Complete the Direct Caregiver Staffing Distribution table: You use this table to enter the number of direct patient care staff for the budgeted census by global skill. This number includes staff who take full or partial patient assignments or who deliver care to multiple patients on the unit during the shift. Only include staff who provide direct patient care. Demand Manager uses the staffing distribution you enter to generate the Calculated HPPD, ADT-adjusted Demand Target Ratios by time of day, and ADT-adjusted Hours per Patient Shift (HPPS). Demand Manager compares the Direct Care HPPD value to the Calculated HPPD and displays the difference as the HPPD Variance.
    1. Select a Global Skill from the menu.
    2. Enter a Start Time and an End Time. Enter the time of day in increments to cover a full 24-hour day in military (24-hour) format, such as 0700 for 7:00 a.m. and 1900 for 7:00 p.m. You can make the start and end times the same as the shift category partitions or you can enter a time based on the time when the staff number changes for your selected global skill. For example, if your location needs five RNs to cover two 12 hours shifts during a day, you could have:
      • One RN row with a Start Time of 0000 (midnight) and an End Time of 0000 (midnight) to cover a full 24-hour day, or
      • Two RN rows, the first with a Start Time of 0700 (7:00 a.m.) and an End Time of 1900 (7:00 p.m.) and the second with a Start Time of 1900 and an End Time of 0700 to cover a 24-hour day.
    3. Enter the number of staff for each start and end time for All days in the week, or by each day of the week separately. If the same number of people are budgeted for every day of the week, enter the number in the All box and press TAB. Demand Manager automatically enters that number in the box for each day of the week. If no staff are budgeted for a time increment, enter 0 in the All box so that all hours of the day are accounted for.
    4. Minimums: You must enter a minimum staffing number the MIN column for each skill included in the staffing distribution table, even if the number is zero (0). Setting a minimum prevents demand from calculating target staffing below the minimum number of caregivers by skill. Minimums are most commonly set for a single skill (RN) using the same number for all times of the day.
      1. You must enter minimum staffing as whole numbers. Entering zero (0) is acceptable.
      2. Minimums are location-dependent and are cumulative within a profile. This means if you define the minimum at the profile level and you have multiple locations in that profile, you should either set the minimum in one location to the full minimum or divide the minimum between the locations. This makes the sum equal to the minimum at the profile level yet relevant at both the location and profile levels.
      3. If you want, you can use this setting on the Options tab: Honor Minimum Caregivers even when Census = 0. You would select this option if your minimum number of caregivers should be staffed even when there are no patients at that location. For example, a Labor and Delivery unit always needs one RN scheduled even when the census is zero to allow for admissions.
    5. Additional information:
      • Click Add Row to add rows for skills and time. Demand Manager automatically adds global skills to the Acuity Settings sub-tab (if enabled) as you add skills to the staffing distribution table.
      • Click the Trash icon to remove a row from the table. Demand Manager automatically removes global skills from the Acuity Settings sub-tab (if enabled) as you remove skills from the staffing distribution table.
      • You can sort the Global Skill and Start columns by clicking their headings.
  7. If your organization is in a state with a mandated ratio of caregivers to patients, select a State Mandated Ratio Skill. Demand Manager displays this skill on the Target Schedule page when you use a Ratio view.
    1. Once a State Mandated Ratio Skill is selected, you need to enter a Nurse: Patient ratio value. For example, if your state requires one caregiver to each four patients, you would enter 4 in the 1: box.

  8. Organizations subject to state mandated ratios usually define budgeted staffing as ratios, and budgeted ratios are typically lower than the state mandated ratios, which represent the highest ratio allowed. In the Budgeted Ratios table, select a Global Skill from the menu and enter a ratio in the format of caregivers:number of patients. For example, if your organization budgets one PCA for each 8.45 patients, you would select PCA as the Global Skill and enter 1: 8.45 as the Ratio value. The list of Global Skills displayed is determined by skills used in the Staffing Distribution table.

    1. Budgeted ratios are typically identical across locations. The copy function on the page can be used to copy all values across locations.
  9. In the Calculated Values section, click Update to have Demand Manager calculate the following values.
  10. Review the ADT-adjusted Demand Target Ratios.
    1. Click the ADT-adjusted Demand Target Ratios link to open the ADT-adjusted Ratios table. This table displays the ADT-adjusted Demand Target caregiver-to-patient ratios by global skill and time of day calculated as the Budgeted Census divided by the ADT-adjusted weighted average number of caregivers from the Direct Caregiver Staffing Distribution table. Demand Manager uses these ratios to generate Target Staffing for Demand-only locations. The ADT-adjusted Hours per Patient Shift (HPPS) table displays the distribution of hours for all skills starting with the anchor partition of the default shift category, by shift, calculated as the number of ADT-adjusted weighted average caregivers multiplied by the duration in hours of the shift category partition. The resulting value for each shift category is divided by the Budgeted Census. Cerner Clairvia Clinical Consultants use this information when configuring Acuity Settings for locations that have implemented Outcomes-Driven Acuity.
  11. Save your changes by clicking one of the following action buttons.

Using the Location/Service Patterns Sub-tab

This sub-tab allows you to enter the data Demand Manager uses to create patient progress patterns by location and location and service combination.

Editing the Default Location Pattern

Staff Manager automatically creates a location-based pattern using the budgeted LOS in days and hours you enter on the Target and Budget Data sub-tab. You can edit some of the basic data for this default location pattern.

  1. Open the Location Settings page and select a location and configuration as described in the preceding section Using the Demand Settings Tab. The Target and Budget Data sub-tab is open by default.
  2. Click the Location/Service Patterns sub-tab to make it the active sub-tab.
  3. Enter an abbreviation for the pattern in the Abbr box. See the following section About Pattern Abbreviations and Descriptions for more information.
  4. Enter a description for the pattern in the Description box.
  5. Save changes by clicking one of the following action buttons.

Caution: Demand Manager uses the default acuity score of each pattern to calculate the Target Staffing for patients in Demand-only locations and for patients in Outcomes-Driven Acuity locations who do not have a completed acuity assessment recorded. You cannot edit the Default Acuity Score for a Demand only location; Demand Manager automatically gives the location a Default Acuity Score of 1.00. Cerner Clairvia Clinical Consultants define the Default Acuity Score for locations using Outcomes-Driven Acuity; you should enter a default acuity score only if directed to do so by your Cerner Clairvia Clinical Consultant.

Creating a Location/Service-based Pattern (Optional)

You can create service-based patterns for patients in the selected location, but you should only add service-based patterns under the following conditions.

  1. Open the Location Settings page and select a location and configuration as described in the preceding section Using the Demand Settings Tab. The Target and Budget Data sub-tab is open by default.
  2. Click the Location/Service Patterns sub-tab to make it the active sub-tab.
  3. Click Add Row. This adds a blank row to pattern table.
  4. Select a Service from the menu. The Service menu includes only those services the registration interface sends to Demand Manager.
  5. Enter an abbreviation for the pattern in the Abbr box. See the following section About Pattern Abbreviations and Descriptions for more information.
  6. Enter a description for the pattern in the Description box.
  7. Select whether to enter the TLOS (Total Length of Stay) in Days or Hours, and then enter the value in the Days or Hours box. Demand Manager automatically completes the value for the other box. For example, if you select Hours and enter 78, Demand Manager completes the Days box with the value 3.25.
  8. If applicable, enter a Default Acuity Score. Demand Manager automatically sets the default acuity score to 1.00 for Demand-only locations. The default acuity score for locations with Outcomes-Driven Acuity is automatically the same as the location-based pattern. Because of the importance of this data, you should enter a default acuity score for the pattern only if directed to do so by a Cerner Clairvia Clinical Consultant.
  9. Save changes by clicking one of the following action buttons.

Removing a Pattern

  1. Open the Location Settings page and select a location and configuration as described in the preceding section Using the Demand Settings Tab. The Target and Budget Data sub-tab is open by default.
  2. Click the Location/Service Patterns sub-tab to make it the active sub-tab.
  3. Click the Trash icon at the end of the desired row. This removes the pattern so that no one can assign it to patients in the selected location.
  4. Save changes by clicking one of the following action buttons.

The Show History Button

Clicking Show History opens the Progress Pattern History window, which displays a list of all location and location-service patterns users have configured for the current selected location. The pattern history is sorted by effective date and displays the TLOS in days and hours, the service (if applicable), and the default acuity score. You can return to the Location/Service Patterns sub-tab by clicking Close.

About Pattern Abbreviations and Descriptions

Demand Manager displays the pattern abbreviation (Abbr) you entered on the Location/Service Patterns sub-tab in the patient pattern bars of the Demand Manager Patient Pattern Management page. The abbreviation should be no more than 8 characters long, but it should provide enough information so that you can understand the pattern assigned. The abbreviation should reference the location of the patient and, if applicable, the service. If someone has copied the location/service pattern data from another location, you need to enter an abbreviation and description for each pattern copy. Each pattern abbreviation must be unique.

For example, assume you are configuring Demand Settings for the 6 West Medical profile. You can enter an abbreviation for the location-based pattern such as 6W, with the pattern description of 6W Medical. Then you could define an Oncology service-based pattern for 6W Medical location by clicking Add Row, selecting ONC from the Service list, entering the abbreviation 6W Onc, and including the pattern description 6W Medical Oncology. Users going to the Patient Pattern Management page and viewing the 6 West Medical profile would then see patient pattern bars in 6 West Medical reading 6W (for patients assigned the default location-based pattern) or 6W Onc (for patients assigned the 6 West Medical/Oncology service pattern).

Using the Acuity Settings Sub-tab

The Acuity Settings sub-tab is only available when you select Enable Acuity Settings on the Location Settings Options tab. Cerner Clairvia Clinical Consultants enable acuity settings and enter the data required on this page during the implementation of Outcomes-Driven Acuity. Since Staff Manager uses the information on this page to calculate Target Staffing for the location, you should enter data on this page only if directed by your Cerner Clairvia Clinical Consultant for Acuity.

  1. Open the Location Settings page and select a location and configuration as described in the preceding section Using the Demand Settings Tab. The Target and Budget Data sub-tab is open by default.
  2. Click the Acuity Settings sub-tab to make it the active sub-tab.
  3. Select Acuity Levels. Minimum and maximum acuity levels should be consistent for all profiles across a facility.
    1. Select a Minimum acuity level from the menu.
    2. Select a Maximum acuity level from the menu.
  4. Enter the time to apply ratios (hhmm). Staff Manager uses this value to designate the time associated with the ratios entered by global skill for each acuity level. In most cases, the Cerner Clairvia Clinical Consultant enters the time of day with the highest HPPS; this may be the anchor time or the first shift of the day, such as 0600 or 0700. You should enter the value using the 24-hour HHMM format (Hour Hour Minute Minute). For example, to select 7:00 a.m., enter 0700; to select 3:00 p.m. enter 1500.
  5. Select the Mid Level Acuity by clicking the button beside the value you want. This denotes the mid-level acuity for each location, which aligns to the average patient. Demand Manager uses this value to calculate projected Demand Target staffing into the future when the projected census is less than the eight-week historical average.
  6. Enter a Min Score for each acuity level. Demand Manager automatically completes each Max Score based on your Min Score entries. These are the minimum and maximum acuity assessment scores for the selected location for each acuity level. For example, if the min score for acuity level 5 is 3.30 and the max score is 3.72, an assessment score of 3.40 generates an acuity level of 5 for a patient in this location. The minimum score for the minimum acuity level is automatically set to 1.00; the maximum score of the maximum level is automatically set to 5.00. Assessment scores for the acuity level must be greater than or equal to the minimum score and less than the maximum score. In the preceding example, an assessment score of 3.30 is acuity level 5, an assessment score of 3.72 is acuity level 6.
  7. Enter a Global Skill Ratio: After completing the data array analysis, the Cerner Clairvia Clinical Consultant enters the caregiver:pt ratio (1:xx) for each global skill by acuity level to achieve the expected ADT-adjusted HPPD alignment across the facility. For example, if each caregiver with the RN skill can take care of 4 patients at the Acuity Level 5, enter 4 in the column for Acuity Level 5. Demand Manager automatically creates a column for each global skill entered in the Direct Care Staffing Distribution table on the Target and Budget Data sub-tab and adds or removes columns based on changes to skills in the table. For example, if the only global skill in the Direct Care Staffing Distribution table is RN, you only see the column RN Ratio on the Acuity Settings sub-tab. If both the RN skill and the UAP skill are in the table, you see one column called RN Ratio and one called UAP Ratio on the Acuity Settings sub-tab.
  8. ADT-adjusted Demand Target Ratios: Click this link to see the ADT-adjusted caregiver/patient ratios and HPPS calculated using the location and staffing data you entered on the Demand Settings tab.
  9. Save changes by clicking the Save button.

Using the Options Tab

The Options tab is where you select which options Staff Manager uses in the Demand Manager views.

  1. From the Configure menu, select Demand Manager> Location Settings. This opens the Location Settings page. The Demand Settings tab is active by default.
  2. Click the Options tab to make it the active tab.
  3. Select whether to Honor Minimum Caregivers even when Census = 0. If your selected location needs a minimum number of caregivers staffed even when there are no patients, you should select this check box. For example, a Labor and Delivery unit always needs one RN scheduled even when the census is zero to allow for admissions.
  4. Select whether to Enable Acuity Settings: If you check this box, Staff Manager displays the Acuity Settings sub-tab on the Demand Settings tab. This option is for locations that have implemented Outcomes-Driven Acuity. Once someone has published a configuration with more than one acuity level, you cannot change this option (that is, the check box cannot be deselected).
  5. Select whether to show Census Only: You should select this box for profiles that have not implemented Demand Manager but that have selected Census Source is HL7 in the Workload tab of the Edit Profiles window in Staff Manager Administrator.
  6. Save changes by clicking the Save button.

You can click Reset to undo any edits made since you last saved the configuration.

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