Guidance for the use of CHPPD specialty ranges

Introduction

Care Hours Per Patient Day (CHPPD) measures staffing levels in relation to patient numbers on inpatient wards. CHPPD provides a picture of staff deployment and productivity: enabling a comparison of ward’s CHPPD figure with other wards that share similarities either within the trust or across other organisations.


CHPPD calculation

Every month, the hours worked during all shifts by registered nurses and midwives and by non-registered clinical staff are added together.

Each day, the number of patients occupying beds at midnight (23:59) is recorded. These figures are summed up for the whole month and divided by the number of days in month to calculate a daily average.

Then the figure for total hours worked is divided by the daily average number of patients to produce the rate of care hours per patient day.



Example:

Total day hours worked by Registered Nurses for the month = 800

Total day hours worked by Healthcare Assistants for the month = 300

Total night hours worked by Registered Nurses for the month = 700

Total night hours worked by healthcare assistants for the month = 300

Total hours worked for the month = 2,100

Daily average number of patients at midnight during the month = 300

CHPPD rate: 2,100 divided by 300 = 7.0

 

The comparison lends more insight when wards within the same specialty are compared. Therefore, we have developed ranges for four specialties: Cardiology, Geriatric Medicine, Obstetrics and Gynaecology, and Trauma and Orthopaedics. The ranges provide trusts with an opportunity to understand where the organisations CHPPD lies for a particular specialty compared to other organisations.


Data used for ranges development

To develop CHPPD speciality ranges we used CHPPD data from May 2016/17 onwards. We applied the following selection criteria to remove outliers. Therefore we:

  • removed CHPPD values greater than 50
  • included only nursing CHPPD
  • all months were analysed collectively
  • non-specialists and specialists have been analysed separately due to wide variance in CHPPD distribution


Methodology

Our raw data were skewed to the left. As a result, we had to apply mathematical transformation, take natural logarithm, to scale down very large values and prevent existence of negative ranges without impairing the analysis of variation. The data were not normally distributed, thus we calculated specialty ranges based on middle 95% of observations.


Acute non-specialist wards

 

CHPPD Values

Specialty

Low

High

Trauma and Orthopaedics

4.82

14.18

Cardiology

4.71

21.81

Geriatric Medicine

4.69

11.23

Obstetrics and Gynaecology

4.23

15.77


Acute - Specialist wards

 

CHPPD Values

Specialty

Low

High

Trauma and Orthopaedics

5.61

26.27

Cardiology

5

39.26

Geriatric Medicine*

N/A

Obstetrics and Gynaecology

3.53

30.85

* No specialist trusts deliver this type of activity


What CHPPD tells us:
CHPPD includes total staff time spent on direct patient care as well as activities such as preparing medicines, updating patient records and sharing care information with other staff and departments. It covers both temporary and permanent care staff but excludes student nurses, midwives and staff working across more than one ward. CHPPD relates only to inpatient wards.


Interpreting the results:
If a ward’s CHPPD lies outside the specialty range,  investigation may be warranted such as  staffing mix and numbers. However, CHPPD does not reflect the total amount of care provided on a ward nor does it directly show whether care is safe, effective or responsive. It should therefore be considered alongside  other measures of quality and safety.

 


Please note

CHPPD is calculated based on “Staffing nursing midwifery and care staff (NStfFil)” data submitted by Providers on monthly basis via SDCS portal (https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-collections/staffing-nursing-midwifery-and-care-staff-nstffil)  

CHPPD data can be found under the 'People' lens within the Nursing & Midwifery compartment of the Model Hospital.


Providers own the data and are responsible for the quality of submitted data.


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