MDH Nurse Study Data Form
Instructions & Tip Sheet
Tip Sheet
1
Statutory Requirements
2013 Minnesota Laws Chapter 51—HF588 directs the Department of Health (MDH) to conduct a study of the
correlation between nurse staffing levels and patient outcomes at Minnesota hospitals. MDH will be securely
collecting data under its authority in Minn. Stat. 62J.301 to 62J.42 to fulfill obligations set forth by the 2013
Minnesota law.
2
Classifications of Data
The statutes above maintain the data classifications established by the Minnesota Data Practices Act, with
some exceptions. Under this act, data on institutions, unless otherwise defined, is considered non-public. If
hospitals chose to report disaggregated nurse data, the data would be considered private data on individuals.
In each case, MDH will apply rigorous safeguards of the data in transit and in rest.
3
Additional Formatting
a
Tips throughout the formset are highlighted in YELLOW.
b
Many hyperlinks also appear throughout the formset for ease of navigation.
c
All items in the form are REQUIRED.
4
Questions on Completing the Form
If you have any questions, please contact the Minnesota Department of Health (MDH) before you begin.
e-mail MDH
MDH Contact: Nathan Hierlmaier 651-201-3541
5
Calendar Year 2013 Data
Data are required for each day of calendar year 2013.
6
Unit Categories
Data must be submitted specific to care unit categories. Unit category includes the following eight aggregated
inpatient units, based on designations developed by the Labor Management Institute and used by MHA in 2014
nurse staffing plans and reports. Only the unit categories listed are required (critical care, step-down, and
general medical/surgical).
7
Providing De-identified Nurse Data
Staffing data can be reported rolled-up to the nurse license type (as shown in tabs) or, if preferred, in
unaggregated form, at a de-identified nurse level.
8
Nurse License Types
Staffing data must be reported for specific categories of nonmanagerial care staff: Registered nurse (RN),
licensed practical nurse (LPN), and unlicensed assistive personnel (UAP) which includes: nurse aides, patient
care technicians, and patient care assistants who perform non-managerial direct patient care.
9
Nursing Care Hours
Consistent with submission requirement for MHA's 2014 nurse staffing plan and reports, data is limited to time
spent by nurse care team member delivering direct patient care.
Nurse managers should be included if they work ≥50% on patient care.
Float staff hours worked should be included if they spend ≥50% in a unit category.
Contract/agency staff hours are required to be included.
10
Patient Census and Observation Hours
MDH Health Economics Program
Phone: 651-201-3550
Fax: 651-201-5179
Page 1
MDH Nurse Study Data Form
MDH Contact: Nathan Hierlmaier
[email protected]
Phone: 651-201-3541
Fax: 651-201-5179
The number of patients for each 24 hour period are required, as well as the number of observation hours for
each unit category. Patient census can be drawn from midnight census data tracking.
11
Deadline and Limited Extension
Data must be submited to MDH as indicated by September 1, 2014. A request for a limited extension may be
submitted in writing (e-mail is acceptable) two weeks before the due date and must include a reason for the
needed extension.
e-mail MDH
12
Submitting Completed Information
Completed data files may only be submitted via MDH's secure web submission application, which can be
accessed at:
https://apps.health.state.mn.us/mdh_upload/
Instructions can be found in the
Upload Partner Guide (PDF: 80KB/2pgs).
1. To use the upload portion,
File Upload Page.
2. Type in the cryptic word from the image displayed
3. Enter the email address to whom you wish to receive files as:
[email protected]
4. Enter a small, simple explanation of the file uploaded. These comments will appear in the email notification of
the uploaded file to help the receiver identify the context of the upload.
5. Enter your email address. This sender email address will appear in the email notification of an uploaded file
and will also be an identifying feature of the file in the download portion of the application.
6. Select a file from your local computer by clicking the ‘Browse’ button. Multiple files can be sent by selecting
them one at a time and adding them to the Web list.
7. Click Continue.
MDH Health Economics Program
Phone: 651-201-3550
Fax: 651-201-5179
Page 2
MDH Nurse Study Data Form
MDH Contact: Nathan Hierlmaier
[email protected]
Phone: 651-201-3541
Fax: 651-201-5179
MDH Nurse Study Data Form
Hospital Contact Information
Hospital Identification
HCCIS ID
NPI
Hospital Name
Address
This is the unique ID assigned to your facility for the HCCIS data collection. Please
click on the HCCIS ID link, select your ID from the list, and enter it here.
Please provide the National Provider Identifier for the acute care facility of
#N/A
the hospital
Administrator's
#N/A
e-mail address #N/A
Hospital's
#N/A
#N/A
Website
P.O. Box
#N/A
City
#N/A
Zip Code
#N/A
County
#N/A
Facility Phone #
#N/A
Facility Fax #
#N/A
Administrator's Name
#N/A
Administrator's Title
#N/A
CFO's Name
#N/A
System Affiliation: Name of
#N/A
system(s), e.g., Allina,
#N/A
Contact Information
Preparer
Name of person completing this form
Title
Address (if different than Hospital)
E-mail
City (if different than Hospital)
Direct
Phone#
State (if different than Hospital)
Fax#
Zip Code (If different than Hospital)
County (if different than Hospital)
Courtesy Contact 1
Courtesy Contact 1 Name
Title
Address (if different than Hospital)
E-mail
City (if different than Hospital)
Direct
Phone#
State (if different than Hospital)
Fax#
Zip Code (If different than Hospital)
County (if different than Hospital)
Courtesy Contact 2(Optional)
Courtesy Contact 2 Name
Title
Address (if different than Hospital)
E-mail
City (if different than Hospital)
Direct
Phone#
State (if different than Hospital)
Fax#
Zip Code (If different than Hospital)
County (if different than Hospital)
MDH Health Economics Program
http://www.health.state.mn.us/healtheconomics
Phone: 651-201-3550
Fax: 651-201-5179
Page 3
MDH Nurse Study Data Form
MDH Contact: Nathan Hierlmaier
[email protected]
Phone: 651-201-3541
Fax: 651-201-5179
MDH Nurse Study Hospital Data for Calendar Year 2013
CRITICAL CARE
Please enter daily nusing hours, patient census and observation hours.
DATE
RN_HOURS
LPN_HOURS
UAP_HOURS
1/1/2013
1/2/2013
1/3/2013
1/4/2013
1/5/2013
1/6/2013
1/7/2013
1/8/2013
1/9/2013
1/10/2013
1/11/2013
1/12/2013
1/13/2013
1/14/2013
1/15/2013
1/16/2013
1/17/2013
1/18/2013
1/19/2013
1/20/2013
1/21/2013
1/22/2013
1/23/2013
1/24/2013
1/25/2013
1/26/2013
1/27/2013
1/28/2013
1/29/2013
1/30/2013
1/31/2013
MDH Health Economics Program
Phone: 651-201-3550
Fax: 651-201-5179
Page 4
MDH Nurse Study Data Form
CENSUS
OBS_HOURS
MDH Contact: Nathan Hierlmaier
[email protected]
Phone: 651-201-3541
Fax: 651-201-5179
MDH Nurse Study Hospital Data for Calendar Year 2013
STEP DOWN
Please enter daily nusing hours, patient census and observation hours.
DATE
RN_HOURS
LPN_HOURS
UAP_HOURS
CENSUS
1/1/2013
1/2/2013
1/3/2013
1/4/2013
1/5/2013
1/6/2013
1/7/2013
1/8/2013
1/9/2013
1/10/2013
1/11/2013
1/12/2013
1/13/2013
1/14/2013
1/15/2013
1/16/2013
1/17/2013
1/18/2013
1/19/2013
1/20/2013
1/21/2013
1/22/2013
1/23/2013
1/24/2013
1/25/2013
1/26/2013
1/27/2013
1/28/2013
1/29/2013
1/30/2013
1/31/2013
MDH Health Economics Program
Phone: 651-201-3550
Fax: 651-201-5179
Page 5
MDH Nurse Study Data Form
OBS_HOURS
MDH Contact: Nathan Hierlmaier
[email protected]
Phone: 651-201-3541
Fax: 651-201-5179
MDH Nurse Study Hospital Data for Calendar Year 2013
GEN MED-SURG
Please enter daily nusing hours, patient census and observation hours.
DATE
RN_HOURS
LPN_HOURS
UAP_HOURS
CENSUS
1/1/2013
1/2/2013
1/3/2013
1/4/2013
1/5/2013
1/6/2013
1/7/2013
1/8/2013
1/9/2013
1/10/2013
1/11/2013
1/12/2013
1/13/2013
1/14/2013
1/15/2013
1/16/2013
1/17/2013
1/18/2013
1/19/2013
1/20/2013
1/21/2013
1/22/2013
1/23/2013
1/24/2013
1/25/2013
1/26/2013
1/27/2013
1/28/2013
1/29/2013
1/30/2013
1/31/2013
MDH Health Economics Program
Phone: 651-201-3550
Fax: 651-201-5179
Page 6
MDH Nurse Study Data Form
OBS_HOURS
MDH Contact: Nathan Hierlmaier
[email protected]
Phone: 651-201-3541
Fax: 651-201-5179
MDH NURSE STUDY DATA COLLECTION INPATIENT UNIT CATEGORIES
Unit Categories
Go back to Tip Sheet
Only critical care, step-down and general medical/surgical unit categories should be included. Other unit
categories are listed below the solid line.
Unit Category
CRITICAL CARE
Go to critical care
tab
STEP DOWN
Go to step-down
tab
Unit Type
Bone Marrow
Transplant
Burn Unit
Coronary
Care
CardioVascular ICU
Critical Care
(M/S)
Neuro ICU
Trauma ICU
Transplant
Special Care Adult
Step Down
Telemetry
Bariatric
Surgery
Cardiac Care
GEN MED/SURG
LMI Code
Unit Type Definition
BMT
Adults requiring intensive care during and after bone marrow
procedure.
BURN
All levels of burn/wound care requiring intensive care.
CCU
Adult intensive care providing observation, care and treatment to
patients with acute cardiac problems (e.g., acute myocardial
infarction, unstable angina or recovery from post interventional
procedures).
CVICU Adult cardiovascular surgical procedures requiring intensive care.
ICU
Adults requiring intensive care - medical/surgical.
NEU/ICU Adults requiring intensive care for Neuro-surgical procedures or
trauma.
TICU
Adults requiring intensive care from penetrating / blunt trauma.
TRANSP Adult patients with heart or multiple organ transplant acute care.
SPC
Adult patients requiring intermediate care - ventilators 1:3 ratio.
SD
TELE
Adult post intensive care.
Adult requiring telemetry monitoring post procedures and surgery.
BARI
Adults requiring non-intensive or intermediate Bariatric Surgical
care.
CARD
Adults requiring non-intensive or intermediate cardiac care
without monitoring.
Diabetic
DIAB
Adults requiring non-intensive or intermediate diabetic care
Geriatric
GERI
Frail elderly adults requiring non-intensive or intermediate
medical/surgical care
Hospice/
PALL
Adults requiring non-intensive or intermediate oncology
Palliative
treatments & care in a hospice or palliative environment.
Medical
MED
Adults requiring non-intensive or intermediate care for medical
diagnosis.
Med/Surg
M/S
Adults requiring non-intensive or intermediate care for
medical/surgical diagnoses.
Medical/
MED/TELE Blended unit of adult medical patients and Adults requiring
Telemetry
monitoring and non-intensive or intermediate care.
Neurology/Ne NEURO Adults requiring non-intensive or intermediate care for
uro-Surg
neurological and neuro-surgical diagnoses.
Oncology
ONCOL Adults requiring non-intensive or intermediate care for oncology
diagnoses and treatments.
Oncology with ONCOL/TE Adults requiring monitoring but non-intensive or intermediate care
Tele
LE
for oncology diagnoses and treatments.
Orthopedics
ORTH
Adults requiring non-intensive or intermediate care for
orthopedic/joint diagnoses.
Respiratory
RESP
Adult pulmonary patients with treatments.
Surgical
SURG
Adults requiring non-intensive or intermediate post surgical care.
Nursing Unit
MDH NURSE STUDY DATA COLLECTION INPATIENT UNIT CATEGORIES
GEN MED/SURG
Unit Categories
Go back to Tip Sheet
Only critical care, step-down and general medical/surgical unit categories should be included. Other unit
categories are listed below the solid line.
Unit Category
Unit Type
LMI Code
Unit Type Definition
Surgical
SURG/TELE Adults requiring monitoring and non-intensive or intermediate post
Telemetry
surgical care.
Operating
OR
Patients that require surgical intervention.
Room
Anesthesia
ANES
Anesthesiologist and support/on call staff.
Anesthesia
ANES/PO Patient assessment/prior to surgery.
Pre-Op
Post
PACU
Recovery of patients from surgical procedures and anesthesia.
Anesthesia
Post
PACU/DIS Recover of patients who are discharged (same day center
Anesthesia/
surgery).
Discharge
Same Day
SDS
Limited inpatient surgical cases to be admitted/ discharged in
Surgery or
same day. Also known as Ambulatory Surgery.
Ambulatory
Go to general
Surgery
medical/surgical
Ambulatory
AMB/PO Pre-operative preparation of surgical case.
tab
Pre-Op
Gynecology
GYN
Women post gynecological surgery.
Ante-partum
AP
Mother's requiring intense monitoring
Post Partum
PP
Mother's post delivery
Mother/Baby
PP/NRSY Mother's post delivery with infant
Labor/Del
LD
Mother's in various stages of delivery
Labor/Del/Re
LDR
Mother's in various stages of delivery with recovery time
covery
Labor/Del/
LDRP
Mother's in various stages of delivery with recovery time and post
Rec/PP
partum.
Labor/Del/
LDRPN Mother's in various stages of delivery with recovery time, post
Rec/PP/Nrsy
partum care & newborn nursery; Mother and infant (one
room/birthing-center concept)
OBGYN/PEDS
Newborn
NBN
Healthy newborn (birth to 28 days) infants requiring general
Nursery
medical care.
(Level I)
Nursery Level
SPC/N Infants > 28 days requiring monitoring but not intensive care
II
Neonatal ICU
NICU
Infants requiring intensive care and monitoring
Level III
Pediatrics
PEDS
Children needing general medical/ surgical care
Pediatrics
PICU
Children requiring intensive medical/surgical care. RN ratios
ICU
usually 1:1 - 1:2.
Pediatric
PEDS/ONC Children needing care for oncology-related diagnoses.
Oncology
BEHAV. HEALTH Adolesc
ADOL/PSY Young adults a juvenile between the onset of puberty and maturity
Psych
(e.g. 6-19 or 21 based on state statutes) requiring mental health
treatment.
Chemical
CDEP
A dedicated unit treating inpatients requiring non-intensive or
Dependency
intermediate Chemical Dependency Treatment/Therapies.
Treatment
MDH NURSE STUDY DATA COLLECTION INPATIENT UNIT CATEGORIES
Unit
Categories
BEHAV. HEALTH
Go back to Tip Sheet
Only critical care, step-down and general medical/surgical unit categories should be included. Other unit
categories are listed below the solid line.
Unit Category
Unit Type
LMI Code
Unit Type Definition
Mental
MH
Adults (Age 20+) requiring non-intensive or intermediate mental
Health/ Psych
health assessment and treatment.
Mental
Health/
Geriatric
Mental
Health/ High
Security
Rehabilitation
SNF/REHAB
Skilled
Nursing
Long Term
Acute Care
Acute Dialysis
Cath Lab
Endoscopy
OTHER
Infusion
Center
MH/GERI Geriatric adults (relating to senior citizens) requiring non-intensive
or intermediate mental health assessment and treatment.
MH/HS
Adults (Age 20+) requiring intensive or intermediate mental health
assessment and treatment.
REHAB
Adults requiring daily therapies and assistance for rehabilitation.
SNF
Adult requiring treatments, monitoring post-acute care.
LTAC
Adult patients requiring long-term specialized acute care for
medically complex patients who are critically ill; have multi-system
complications and/or failures requiring hospitalization, averaging a
length of stay of 25 days or more. (e.g., respiratory or ventilatordependent conditions or other complex medical conditions
requiring aggressive and continuous acute care services.
A/DIALY
A dedicated unit treating inpatients requiring dialysis during
hospitalization.
CATH
A dedicated unit treating inpatient cardiac patients receiving
cardiac treatments and non-evasive treatments.
ENDO
A dedicated unit treating inpatients receiving endoscopy
procedures.
INFUS/IP A dedicated unit treating inpatients with infusion procedures or
treatments. Typically, “infusion therapy” means that a drug is
administered intravenously, but the term also may refer to
situations where drugs are provided through other non-oral
routes, such as intramuscular injections and epidural routes.
ND/LAB A dedicated unit treating inpatients with neuro-diagnostic and
EEG studies as ordered by physicians.
NeuroDiagnostic
Lab
Non-Invasive
NILAB
A dedicated unit treating inpatients providing non-invasive lab
Lab
procedures.
Source: Adapted from the Labor Management Institute's 2013 Perspectives on Staffing & Scheduling Survey of
Hours Benchmark Report
Nurse Study Data Form Hospital List
HCCIS ID
100
34
150
102
142
42
13
84
90
143
148
44
39
71
164
64
85
63
191
180
2
59
185
103
120
145
135
132
86
151
141
163
74
167
168
118
27
187
186
NPI
1346258100
1164424305
1659390706
1801870191
1568415974
1245217520
1568427383
1316904287
1033153895
1801835970
1457393035
1699752915
1821066499
1093713372
1083672950
1669426631
1356321699
1154302487
1225272552
1447218482
1760446256
1407897309
1013994359
1851344907
1649246828
1841266194
1578520045
1043269798
1649220724
1629006457
1134186273
1457319485
1538138003
1083617120
1275608457
1619064193
1295789352
1356309322
1083692941
Hospital Name
Mayo Clinic Health System - Albert Lea
Douglas County Hospital
Mayo Clinic Health System-Austin
Sanford Bemidji Medical Center
St. Joseph's Medical Center
Fairview Ridges Hospital
Cambridge Medical Center
Mercy Hospital
SMDC Medical Center
St. Luke's Hospital
St. Mary's Medical Center
Fairview Southdale Hospital
Mayo Clinic Health System - Fairmont
Lake Region Healthcare Corporation
Unity Hospital
Grand Itasca Clinic and Hospital
Fairview University Medical Center - Mesabi
Mayo Clinic Health System - Mankato
Maple Grove Hospital
St. John's Hospital
Abbott Northwestern Hospital
Hennepin County Medical Center
University of Minnesota Medical Center - Fairview
North Memorial Medical Center
Mayo Clinic Methodist Hospital
Saint Marys Hospital
St. Francis Regional Medical Center
St. Cloud Hospital
Park Nicollet Methodist Hospital
Regions Hospital
St. Joseph's Hospital
United Hospital
Lakeview Memorial Hospital
Virginia Regional Medical Center
Ridgeview Medical Center
Rice Memorial Hospital
Winona Health Services
Woodwinds Health Campus
Fairview Lakes Regional Medical Center
MDH Health Economics Program
Phone: 651-201-3550
Fax: 651-201-5179
Page 10
MDH Nurse Study Data Form
City
Albert Lea
Alexandria
Austin
Bemidji
Brainerd
Burnsville
Cambridge
Coon Rapids
Duluth
Duluth
Duluth
Edina
Fairmont
Fergus Falls
Fridley
Grand Rapids
Hibbing
Mankato
Maple Grove
Maplewood
Minneapolis
Minneapolis
Minneapolis
Robbinsdale
Rochester
Rochester
Shakopee
St. Cloud
St. Louis Park
St. Paul
St. Paul
St. Paul
Stillwater
Virginia
Waconia
Willmar
Winona
Woodbury
Wyoming
MDH Contact: Nathan Hierlmaier
[email protected]
Phone: 651-201-3541
Fax: 651-201-5179