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American Family Children's Hospital

History of MESH


Jeff Ulrich RN, BSN

(608) 279-1654

Management and Education Services for Healthcare (MESH) is a patient- and family-centered acuity classification and staffing system designed to identify what makes each patient's care unique.


MESH's History


The concept of classification of inpatients and correlating that with the amount of time required for nursing care was originated at San Joaquin (CA) Hospital as part of a DHEW (Department of Health Education and Welfare) funded project in the 1970s by four nationally-renowned PhD-trained nursing professors with expertise in categorizing and quantifying nursing practice at the bedside and with a variety of different patient types. The system collected data on patient characteristics and also collected data on actual nurse work sampling showing how much direct and indirect care was provided to each patient of each class over several shifts.


In 1980, five hospitals in Wisconsin, which included Reedsburg, Stoughton, Richland Center, Mauston and Sauk Prairie, made a request to the University of Wisconsin for an acuity based-staffing system. Development of the product was initiated by Dr. Margaret Williams, who was a Professor at the UW-Madison Nursing School and one of the professors who had worked with the San Joaquin initiative. Dr. Williams in turn consulted with the UW Hospital and Clinics industrial engineering department led by Richard Reynolds, MS and MHA.


Together they developed a system which they later called MESH. Dr. Williams, Richard Reynolds and their team collected work sampling data from the five hospitals. Nurses documented the classification of patients (which at that time was limited to classes 1–4 using the DHEW system). The study tracked the amount of nursing time spent with each patient during the validation study thereby confirming and substantiating the original premises of the San Joaquin project. They were able to validate that the indicators developed in the DHEW study were valid outside of San Joaquin, and bore the same accuracy in the five Wisconsin hospitals. This work sampling data also created actual nursing hours of care in ratios for the class 1–4 patients and validated the consistency of these ratios across all five hospitals. As healthcare has evolved, the system has grown and has required refining with additional work sampling to assure continuity and validation of the revisions and the original concepts.


Inter-rater Reliability


Inter-rater reliability, which is the key to success for any acuity-based staffing tool, has been measured by MESH since 1985 through the auditing process. As each new facility begins using the software, staff is educated on the classification tool and definitions and classifies actual patients using the standard template. All MESH clients participate in semi-annual audits which substantiate inter-rater reliability.