Taking into consideration the three measures of ADT intensity, I believe that the Admission, Discharge, and Transfer Work Intensity Index is the best way to measure unit intensity for an emergency department setting. First, I want to explain why I believe that the other two forms of measurement would not be as accurate for an emergency department setting to measure intensity. The midnight census is not a strong form of measurement for an emergency department due to the busy times for the unit not usually occurring throughout the middle of the night. Through working both day shift and night shift, I have found that our busiest times in the emergency room occur throughout the day and typically get slower throughout the middle of the night. The inverse length of stay considers the turnover of a same hospital bed within a 24-hour stay. This could be beneficial to measure the intensity of the ER, but with recent holds becoming the new normal, this is not an accurate measure for workload intensity since it is not considered. A good example of this is an ICU hold that stays in the ER for days on end. This patient is requiring a ton of resources and is nearly needing 1:1 nurse staffing. The i/LOS does not take the workload of that patient into consideration.
The Admission Discharge and Transfer Work Intensity Index would be most accurate in an emergency department setting because it considers all admissions, discharges, and transfers in a 24 hour period when calculating workload intensity. This is very important to capture the active movement of patients either discharging home or being admitted to the unit in a busy ER setting. This can also be measured during the busiest time of day to help provide adequate staffing when it is needed in the department. (Waxman, 2018, p. 75-78).
Waxman, K.T. (2018). Financial and business management for the doctor of nursing practice (2nd ed.). Springer Publishing Company.
I agree that the ADT method is probably the best measure for staffing the ED. It seems like by your reports the busiest time is during the day or evening when the midnight census is not a fair measure for staffing needs. The ED has a dynamic and often unpredictable census with varying levels of acuity and that workload needs to be reflected in the way the unit is staffed. it seems like there is a need for different types of staff for this unit and the right type of delegation by licensed staff to make everything run smoothly. The ADT method seems to offer the most flexibility for the ED especially with the ‘hold’ patients who utilize resources and take beds in the ED. Patients in this category seem to cause stress on the ED especially if they are 1:1 which is not a normal ratio for an ED. Having the correct number of staff on shift can help to engage employees and help to reduce burnout (Bayoumy, 2019). The ADT method combined with understanding which type of staff is required for each patient care task can ensure the correct number of licensed and unlicensed personnel needed for the ED.
Bayoumy, S. A. (2019). Relationship between job characteristics and work engagement among nursing staff. International Journal of Nursing Didactics, 9(01), 24-29.
Savanna Long, you are correct in selecting the admission, discharge, and transfer (ADT) work intensity as the best way to measure intensity for the emergency department because the midnight census and inverse length of stay would not accurately reflect the number of patients seen and treated by the emergency room staff. It is for these reasons that I agree with your selection. You are also correct about the emergency department (ED) having to hold patients for hours or days because other units where they need to go are at capacity. That along call for an extra nurse or two to care for patients who are boarding in the ED so other nurses can take care of the patients that are coming, receiving treatment, and being discharged. So since ADT adds the total number of patients being admitted, discharged, and transferred then divided by the twenty-four-hour period, it is a more accurate measure of unit intensity or business (Bradley University, n.d.). Using ADT in this situation increases calculated nurse staffing requirements, so staffing should be adjusted to accommodate this pattern of activity within the unit.
Bradley University (n.d.). Budgeting, scheduling, and daily staffing for acute nursing units. [Media Presentation]. Retrieved from
One of the concepts described in this lesson was unit intensity, which measures the “Business” of a unit. In the lesson, three measures of ADT intensity were given: midnight census, inverse length of stay (LOS), and the ADT work intensity index.
Given the type of unit you work in or have worked on, what do you believe is the best measure of unit intensity? Explain why.
Respond to the initial posts of two of your peers and provide a reason why you support their response. Alternatively, supply the unit intensity you believe is more aligned to their example. Explain your replies.
Post your initial and follow up responses and review full grading criteria on the page.