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Release Notes:
Measure Information Form
Version 2010A1

Measure Information Form

Measure Set: Health Care Staffing Services(HCSS)

Set Measure ID: HCSS-2

Performance Measure Name: Do Not Return - Professional


Rationale: Health care staffing services (HCSS) are contracted to fill vacancies that health care organizations are unable to fill with currently employed staff. Health care organizations requested coverage for 8,000 vacant positions each day in 2003. A study of Medicare cost reports over a nine-year period found that short-term acute care hospitals have increased their use of contract labor from 1.3% of personnel expense in 1997 to more than 3% by the end of 2005. The Bureau of Labor Statistics, U.S. Department of Labor projects that the temporary employment industry, comprised primarily of staffing services, will grow at an average annual rate of 3.8% from 2004 to 2014, adding nearly 1.6 million new jobs. Coupled with the current health care staffing shortage of nurses, physicians, and technologists, the demand for healthcare staffing services is expected to continue to increase.

The Joint Commission’s 2007 Comprehensive Hospital Accreditation Manual states in standard LD.3.50: “Services provided by consultation, contractual arrangements, or other agreements are provided safely and effectively.” Compliance of performance with this standard is demonstrated by:

  • The hospital or HCSS client evaluates the contracted care, treatment and services to determine whether they are being provided according to the contract and the level of safety and quality that the hospital expects.
  • The hospital or HCSS client retains overall responsibility and authority for services furnished under a contract.

According to the National Student Nurses’ Association Code of Professional Conduct, student nurses should maintain the highest standard of personal and professional conduct. Nurses, as do other health care professionals, have strong responsibilities to demonstrate behavior that is ethically and legally appropriate at all times. It is the responsibility of HCSS firms to address employee events of professional misconduct as they occur. In order to deal effectively with professional conduct issues, the HCSS firm must have ongoing and open communication with the organizations that they contract with, especially when dealing with a report of “Do Not Return.”

In a study of agency nursing in acute care settings, health care staffing services indicated that they valued constructive and open communication with hospitals with the ultimate aim of insuring quality practice. The importance of hospitals acknowledging their responsibilities in the whole process was highlighted. Targeting problems so they are addressed and corrected when valid, could significantly enhance the working relationships between organizations and improve quality of care.

Type of Measure: Outcome

Improvement Noted As: Decrease in the rate

Numerator Statement: Occurrences of Do Not Return attributed to professional events
Included Populations: Not applicable

Excluded Populations: Reasons for Do Not Return unrelated to professional conduct or behavior. A reason for Do Not Return is not specified by the client or cannot be determined by the HCSS firm.

Data Elements:

Denominator Statement: Total hours worked

Included Populations: Hours Worked

Excluded Populations: None

Data Elements:

per 1,000 hours*
*The denominator will be calculated by using the denominator basis of 1,000 hours: Number of hours worked / 1,000 = denominator

Risk Adjustment: .

Data Collection Approach: Retrospective. For purposes of determining the denominator, the total number of hours worked by active clinical staff is to be recorded for the reporting month. The HCSS firm must be able to identify the documents or database used to calculate this number. In addition the HCSS firm is advised:

  • To keep track of the calculation method for monthly hours worked.
  • That the same documents / database should be used for each reporting period.
  • That the documents / database should be available for purposes of review.

For purposes of determining the numerator, the HCSS firm will total the number of occurrences of Do Not Return for professional reasons.

Data Accuracy:

Measure Analysis Suggestions:

Sampling: No.

Data Reported As: Aggregate rate generated from count data reported as a ratio .
Setting: Health Care Staffing Services
Report Period: Quarterly with monthly data points

Selected References: The Joint Commission. 2007 Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Oakbrook Terrace, IL: Author. 2007.

American Staffing Association. Annual Economic Analysis. Alexandria, VA: Author. 2007.

Shoemaker, P, Schuhmann TM. Trends in Hospitals’ Use of Contract Labor. Healthcare Financial Management, April 2007.

NSNA Code of Professional Conduct, 1999. Retrieved June 29, 2007 from the World Wide Web: http://www.jsu.edu/depart/nursing/JANS/page3.html.

American Nurses Association. Code of Ethics for Nurses With Interpretive Statements, 2001. Retrieved June 29, 2007 from the World Wide Web: http://www.nursingworld.org/mods/mod580/cecdefull.htm.

Manias, E, BPHARM, MPHARM, M NursStud, PhD, RN, FRCNA, Aitken, R, Bed, Med, RN, Peerson, A, BA, Phd, RN, Parker, J BA, AM, PhD, RN, Wong, K, BA ,MPH, RN. Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers. Journal of Clinical Nursing. 2003;12:457-466.

2004 Market Analysis and Executive Summary: Temporary Healthcare Staffing. Retrieved July 2, 2007 from the World Wide Web: http://www.healthleadersmedia.com/print.cfm?content_id=60699&parent=103.

Stiehl, RR. Quality Assurance Requirements for Contract/Agency Nurses. JONA’s Healthcare Law, Ethics, and Regulation, 2004;6(3): 69-74.

Warren, IB, MSN, RN, Rozell, BR, DSN, RN. Supplemental Staffing Nurse Manager Views of Costs, Benefits, and Quality of Care. JONA.1995;25 (6):51-57.

Measure Algorithm:

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Related Topics

Measure Information Form HCSS-2
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)