Healthcare Staffing Decisions Made Easier

Frequently Asked Questions About

California’s Title XXII and Staffing Ratios

How can Catalyst Systems help with Title XXII and staffing ratio compliance?

Catalyst Systems is the healthcare industry’s leading source for proven patient classification systems and staffing system implementation, as well as the assessment of staff utilization. Giving its clients the tools they need to make evidence-based decisions, Catalyst offers enterprise-wide evaluation of workload, staffing, and patterns of care delivery for all clinical disciplines. As the first company to provide a flexible framework for patient classification system (PCS) based staffing, Catalyst Systems offers three data-driven solutions for improving the precision of staffing related decisions, and meeting Title XXII and staffing ratio requirements. These include the EVALISYS® Patient Classification System (PCS), EVALISYS® PCS Staffing Matrix™, and EVALISYS® Patient Classification/Staff Activity Study® (Study).

What is the current Title XXII language regarding patient classification systems?

In addition to minimum staffing ratios, licensed general acute care hospitals are required to have a valid and reliable PCS in place so that actual staffing will match patient care needs on a shift-by-shift basis. Title XXII stipulates than an RN will perform PCS ratings and that there will be variance reporting for each shift. Other Title XXII requirements include the monitoring of validity and reliability, as well as an annual review process that includes input from all involved staff.

How can EVALISYS PCS products and services help us comply with California's Title XXII?

The EVALISYS PCS offers workload measurement, validity, and reliability monitoring; PCS-related staffing recommendations; and an annual evaluation approach — all requirements of licensure under Title XXII. The EVALISYS Study offers an objective, in-depth process to validate actual workload and verify the patterns of staff activity. It enables organizations to objectively assess workload by PCS level and ensures that all levels of staff are being utilized in the most appropriate way.

What are the hospital requirements of California’s staffing ratio law?

California’s new staffing ratio law requires general acute care hospitals to have both minimum staffing ratios for licensed nurses and a patient classification system. In fact, the staffing ratio law validates the need for patient classification systems as described in Title XXII. The basic tenet of the legislation is that the ratios will identify the staffing “floor,” while the patient classification system will define the amount of additional staff needed over and above that minimum ratio level. When properly implemented, the EVALISYS PCS is fully compliant with Title XXII PCS and staffing ratio reporting requirements.

Does the staffing ratio law apply to all of the clinical areas covered in Title XXII?

The new staffing ratio law reinforces the need for a patient classification system in every clinical area, and actually extends the requirements for patient classification systems to several new clinical departments not currently identified in Title XXII. These clinical areas include the post-anesthesia service area; the emergency department; the operating room; and labor and delivery.

If a hospital is compliant with Title XXII, will they automatically be in compliance with the staffing ratios?

Because the staffing ratio law identifies new clinical areas not currently covered by Title XXII, hospitals compliant with Title XXII may not be in compliance with all the ratios. Though hospitals may be meeting minimal staffing requirements, they still must have a valid, reliable patient classification system in place for all identified clinical areas. Remember, the staffing ratio legislation seeks “wall-to-wall” staffing ratios in general acute care hospitals, with the ability to increase staff in accordance with the patient classification system.

How can staffing ratios be used with patient classification systems?

In California, staffing ratios define minimum licensed nurse staffing levels for a given clinical area. These staffing ratios and Title XXII give hospitals the directive to staff higher than the minimum when patient care requirements increase. This means that a valid and reliable patient classification system must be in place in order to document increased patient care needs. Title XXII ratio and PCS requirements also assume hospitals use a flexible staffing methodology that is population based. For units using a prospective PCS, the EVALISYS PCS Staffing Matrix offers a flexible approach to staffing that determines both minimum staffing ratios and higher staffing levels based on patient classification system data for a given patient population. And, the EVALISYS PCS Staffing Matrix methodology works with virtually any patient classification system.

What else does Catalyst offer?

In addition to offering innovative solutions for patient classification and staffing system needs, Catalyst Systems also provides support and consultation in multidisciplinary care redesign, financial management, outcomes measurement, and custom program evaluation.

For more information call us at 415-893-7600 or visit our website at www.catsys.com.