What Is Hours per Patient Day (HPPD)? How to Optimize It

Healthcare facilities are constantly searching for ways to improve the efficiency of their operations. To do this, they use various metrics to help them measure and analyze their performance and take action when needed.

Hours per patient day (HPPD) is a pivotal metric for facilities in the following ways:

Analyzing their nursing workforce
Predicting patient census fluctuations
Informing operations budgeting
Assessing unit staffing needs
Improving staffing efficiency

What is ‘hours per patient day?’

Hours per patient day, or HPPD, is a metric that measures the number of hours of care every patient receives from nursing staff—registered nurses, licensed practical/vocational nurses, and certified nursing assistants—each day.

Pro tip: this metric is also commonly referred to as "hours per resident day"

It does not include paid sick time, vacation, education leave, etc.

HPPD also helps to monitor staffing levels. This allows facilities to maintain or adjust nurse-patient ratios to provide quality care.

How to calculate HPPD

Calculating the HPPD requires adding the total number of nursing hours worked in 24 hours and then dividing it by the patient census during that time period. (The patient census is the number of patients in the facility.)

HPPD = Nursing hours worked in 24 hours / patient census

Is there a “perfect HPPD” figure?

Unfortunately, there is no “correct” or “perfect” number hours per patient day. Many factors should be considered when trying to determine the ideal HPPD figure for your facility or unit. Consider the following:

Patients

The population a facility works with can affect the calculation of the HPPD. This is because some groups of patients need more attention than others.

For example, senior adults typically need more nursing care than middle-aged and younger adults. Similarly, pediatric populations also require higher HPPD.

Type of facility or unit

The ideal HPPD could be higher or lower depending on the type of healthcare facility or unit.

For example, one study found that total HPPD varied significantly between hospital units, showing higher acuity levels required higher HPPD as follows:

ICUs averaged 16.20 hours
Step-down units averaged 8.34 hours
Medical-surgical units averaged 7.17 hours

Data

Accurate data is vital to calculating the HPPD and looking for seasonal patterns. Therefore, data collection procedures are essential.

For example, facilities in California use the CDPH 530 Form to have a complete and accurate HPPD. Independent nurses or staff who do not normally carry out direct care responsibilities must complete the CDPH 530 form every shift they provide direct nursing care. Facilities add these hours to the hours direct care employees provide.

Why should facilities track the HPPD?

Tracking the HPPD is fundamental to facilities for different reasons, such as the following:

Maximize performance: HPPD can help facilities improve their workforce management. Facilities can analyze unit nurse staffing levels and make adjustments when necessary.
Increase cost-efficiency: HPPD helps facilities analyze the nursing care requirements per unit. Therefore, it is easier to make budget projections and have more control over operation costs.
Improve the quality of patient care: If the HPPD is too low, patient outcomes and satisfaction can be negatively impacted. Better staffing levels can improve the patient experience. Facilities can contract PRN staff to provide extra coverage.
Comply with regulations: Government or state regulations may require facilities to meet HPPD ratios. For example, California has a staffing ratio law that requires facilities to have minimum staffing levels in each hospital unit. Staffing ratios directly impact HPPD.

How to manage your facility’s nursing HPPD

There are different ways to manage your HPPD. Here are some strategies to manage your facility’s hours per patient day.

1. Assess patient care needs

Each facility or unit focuses on caring for patients with different healthcare needs. Understanding their patients’ needs can help facilities plan for the appropriate staffing levels. Appropriate staffing levels lead to optimal HPPD.

Facilities need procedures that allow them to have more control over staff utilization to provide the proper care. The HPPD metric allows facilities to examine how they are using their workforce and identify where to make adjustments.

2. Cross-train staff

Cross-training nurses can improve communication and coordination between colleagues and teams. Nurses with experience working in different units or teams help enhance the facility’s collaboration and efficiency in providing quality care.

Nursing staff with experience and training in various areas can also help facilities face staffing shortages by filling gaps in other care units.

Suppose a hospital’s medical-surgical unit is understaffed, but the labor and delivery unit has a low patient census. The hospital could use available staff from the labor and delivery unit to bring up the HPPD of the understaffed medical-surgical unit.

Cross-training is also a way to introduce variety into a nurse’s day, relieving feelings of burnout. In turn, limiting burnout may reduce nurse turnover.

3. Prepare for higher patient volumes

Managing patient census is challenging for facilities since a variation in the patient census may affect the operational budget in the following ways:

Extra staff when a facility has a low census increases its operating costs.
Insufficient staff when there is a surge can jeopardize patient care.

The hours per patient day metric can help facilities predict and prepare for seasonal surges. In addition, HPPD data can analyze the behavior and patterns of separate units. This information can be instrumental in projecting operational budgets and planning efficient staffing levels.

Furthermore, facilities should opt for flexible healthcare staffing options to provide quality care throughout the year. Flexible options provide responsive solutions without compromising the budget or patient care.

4. Use PRN staffing platforms for sudden changes in care demand

Preparing for high and low censuses can be difficult. Therefore, flexible nurse recruitment options are becoming more popular in facilities.

PRN staffing platforms and similar flexible staffing options are a great ally in maintaining low costs and providing quality patient care. For example, Nursa connects facilities with available PRN nurses to easily cover short-staffing and provide support as an external float pool without the costs of traditional healthcare staffing.

5. Monitor and adjust continuously

Collecting daily data with the hours per patient day metric helps facilities respond quickly when staffing levels are inappropriate. Continuously adapting to circumstances allows facilities to keep up with their patients’ demands and needs.

6. Increase the use of technology

Technology is a great asset for facilities since it can automate certain procedures to optimize productivity. The use of electronic health records, telehealth, and staff management software can help facilities maintain optimal HPPD.

How PRN staffing helps facilities optimize HPPD

Variations in a facility's census can directly affect its budget and cause difficulties. However, by working with Nursa’s flexible staffing platform, facilities can maintain adequate HPPD despite fluctuations.

Healthcare facilities can fill their shift openings by posting PRN shifts. Nursa has flexible and on-demand nursing clinicians. Contracting nurses on demand can reduce recruitment costs and time.

Not having middlemen makes the contracting process smoother. Furthermore, without hire-away fees, facilities can save on recruitment if they decide to hire a nurse or clinician whom they connected with via the app.

Staffing with Nursa can help facilities optimize and improve their HPPD since they can post shifts when needed. This helps facilities avoid overstaffing or understaffing their units. Adequate staffing helps facilities maintain their quality of care without compromising their budget.

Maximize Your Facility’s HPPD with Nursa

Nursa is the best solution for facilities that need to contract nurses. Healthcare facilities can post PRN shifts to efficiently increase hours per patient day. Contracting on-demand staff allows facilities to adapt their staffing to fluctuate alongside their needs. Using the platform, optimizing facilities’ HPPD is easy.

Facilities can post PRN jobs quickly and easily. They can also connect with a broad pool of talented clinicians to fill their open shifts without the stress of middlemen or higher costs.

Sources:

How to track and optimize nursing hours per patient day (HPPD)