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Achieving Operational Excellence:
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  • Writer's pictureEmma Gaulter

Acuity Based Rostering – the importance of rostering to patient needs, rather than just numbers!

Updated: Jul 4, 2023


Acuity Based Rostering

Historically NHS ward rosters were created based on the number of patients on the ward but it soon became obvious that this wasn’t a good enough measure. A patients clinical needs vary massively and it was soon realised that this should be taken into account when looking at staffing numbers.

Patient acuity and dependency calculations have been around for decades and especially came to the fore-front of rostering in the 1990’s. They would be used as a base calculation to estimate the staffing levels needed for the next year based on the average needs of the patients of the previous year. This was great from an annual financial planning perspective but didn’t use the calculations to their fullest potential.

So how does patient acuity scoring work and how has it now moved on to be involved in daily staffing decisions?

On the surface it is quite simple, a qualified member of staff scores the patient using the Safer Care Nursing Tool on the intensity of nursing care needed by that patient (this is for adult general health, there are separate tools for Mental Health and Paediatrics). These scores are as follows:

  • Level 0

  • Level 1a

  • Level 1b

  • Level 2

  • Level 3

There are varying caveats to each score depending on the type of ward but loosely speaking a Level 1 patient requires very little nursing intervention other than basic needs and medication where a level 3 patient is in ICU requiring 1 to 1 nursing care.

In the past 10-12 years software companies realised that building a system to calculate the above scores and run them alongside existing rostering systems would be hugely beneficial to organisations.


Like our system, Panda, here at Premier IT, nursing scores are entered 3 times daily and the system bases the staffing needs on those scores on a daily basis.

Panda takes the scores of the patients for a ward area, looks at the staff that are currently available on that ward and let’s the organisation know whether there are too little, too many or just the right amount of staff.

This is hugely beneficial to the senior management team that in the past have spent hours phoning individual wards asking if they can spare someone for another area and then updating rosters to reflect these changes. In Panda, there is a huge colourful graphics screen with a donut graph representing each ward area. Each colour tells the staffing story of the ward, Red for too little staff, Blue for the correct amount, Green for a surplus of staff etc. Decisions can then be made on moving staff from a red to a green area with very little manual process.

Once the decision is made to move the member of staff it can all be done from the Panda tool and all changes are reflected directly in the roster in our Zebra system, without any manual changes needed to be made.

As with all acuity based software, it is important to keep professional judgement within the control of the staff using it. You can therefore compare skill mix and asses staffing levels in real time before making any decisions to move staff.

Zebra also has an incorporated staff bank system, if there are no surplus staff to move then shifts can be easily sent out to bank for staff to pick up. Again all manual process is negated due to the smooth integration and interaction of the systems.

Using acuity and rostering software in the ways mentioned above improves patient safety and reduces risk by having a real-time live view of staffing needs on an hour by hour basis.


Now not only can organisations get a more accurate yearly forecast for staffing levels during their financial reviews, they can use the software to run reports that give weekly, daily and even hourly data snapshots.

If anyone would like a demo of our Rostering system Zebra or our Acuity system Panda, please contact Zaheer Khan at zkhan@premierit.com.

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