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American Family Children's Hospital

Management and Education Services for Healthcare (MESH) FAQ


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. The American Nurses Association (ANA) recommends that organizations explore the answers to the following questions when considering a patient acuity tool and our responses are included.


What is MESH?


Our multidisciplinary tool was developed to predict the relative amount of nursing care that a particular patient will require based on the unique characteristics of that patient. The patient classification measures and ratios of care within the tool are consistent for all facilities. What is unique to each unit of every hospital is their involvement to establish the direct care hour targets and incorporate the average acuity of the patients on that unit. The patient characteristics drive the classification and subsequently the relative amount of care the patient will require based on those unique care hours determined by the facility for each unit.


The following categories make up the tool:


  • Nursing assessment
  • Plan of care/teaching
  • ADLs
  • Infused medications
  • Vital signs and intermittent oximetry
  • Patient care


What is the philosophy on nurse staffing?

  • The nurse's primary commitment is to the patient, whether an individual, family, group, or community.
  • The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
  • The consequences associated when staffing is inadequate or unfavorable are harmful to both patients and nurses, as well as costly to organizations.

Can you identify how the software addresses the principles and captures the data necessary to include the criteria within the system?

  • MESH supports the nurse as the resident expert on his/her patient, for the nurse is responsible for maintaining and updating the Care Plan.
  • Evidenced-based best practice has been embraced as part of the foundation to MESH and is an essential component impacting the evolution of the system. 
  • Daily staffing, competency, and provider credentialing information are captured for utilization by finance, quality, and education.

How does software help a facility meet the staffing effectiveness requirements of The Joint Commission (TJC)?


The software speaks to how each individual organization has set targeted HPPD: Patient population (pediatrics, surgical, impoverished); patient acuity on each shift; educational preparation of staff/critical thinking skills; impact of skill mix (novice versus expert); census variability; shifts at minimum staffing; ancillary support services available to nursing (pharmacy, RT, lab, imaging, dietary, health unit coordinator); percent of care provided on each shift by RN, LPN, CNA, PCT.


Can you explain the role you see registered nurses playing in determining appropriate staffing?

  • The bedside nurse classifies the patient and determines the acuity level which is the key element used when making unit specific staffing decisions.
  • Basing patient/nurse assignments on acuity of patients allows nursing to determine ability to accept an admission, coordinate a discharge, or transfer a patient (IHI Initiative).
  • "Notes" section in the software captures Shift Projections and Actuals. Each unit has ability to require documentation of variances (positive or negative) from targeted staffing.
  • Empowers staff to "Tell YOUR Story" of what was anticipated vs. what was reality. (S-BAR format encouraged.)
  • Capture specific details reflecting staffing adequacy; useful for tracking & trending of incidents, near misses, etc. 

What departments within a hospital should be involved in evaluating the acuity software product?


MESH encourages the following participants within each organizational structure: Staff nurse, ancillary departments, nursing leadership, quality, finance, education, administration. Team building is the focus rather than retrospective directives.


Where is the information used in determining patient acuity derived?

  • Work sampling performed with correlation coefficient analysis and development of a key indicator model of patient acuity applied throughout the modules.
  • Indicators chosen on the acuity tool are supported by the clinical documentation in the medical record of each patient.
  • Evidenced-based best practice & regulatory compliance recommendations drive continuous evaluation and re-evaluation of definitions.
  • Multi-disciplinary care philosophy incorporated across continuums.

How is patient acuity determined?

  • The nurse utilizes the acuity tool and scores each indicator according to the MESH standardized definitions and most importantly the ongoing patient assessment.
  • The system allows the nurse to project the acuity of admissions and discharges as well as patients residing on the unit and finally enter the actuals at the end of shift.

How is skill mix determined?

  • Nursing leadership discussions at each individual organization to reveal current practice models on the specific units (i.e., regulatory compliance mandates an all RN staff on a unit).
  • Demo units are created to gather 30-45 days of data. This data collection period tells the story of current practice on each unit and each shift.
  • Reports utilized to review current practice – Staffing and Census Summary Report. Contains the following: Average patient acuity, hours per patient shift, hours per patient day, census variability, staff levels by shift, position description versus actual role of the staff member (LPN).

How many client hospitals are currently using the staffing system?


We are currently providing services at 30 organizations of all sizes in Wisconsin, Illinois and Minnesota.


What is the average length of time your client hospitals have used the product?


Client utilization ranges from 25-plus years to only a few months.


What do your clients find most beneficial about the software system?

  • Staffing based on patient acuity rather than nurse/patient ratios.
  • MESH continues to be centered around the patient/family and what makes each patient's care unique.
    Evidence-based best practice is the foundation.
  • Regulatory compliance tracking/monitoring can be created for individual unit needs.
  • Customize hours per patient shift to organizations and specific unit cultures / care philosophies.
  • Budget preparation and monthly variance reports.
  • User input is valued and often results in enhancements to the software.

What have clients who chose not to use the software system seen as shortcomings?


Clients have not expressed concerns with the software knowing that 70 percent of patient acuity staffing systems are currently not electronic. Clients have discontinued using MESH for reasons including their MESH champion leaving the organization and/or turnover within key leadership positions.


What additional benefits result from using the staffing system?

  • MESH is the "translator."
  • Data entered into the system is translated into numerical format for use by those away from the bedside: Finance (midnight census versus actual census with variability), quality/performance improvement, nursing leadership, administration.

How much training is involved in using the software system?

  • Super User training is eight hours in length. Super Users then train staff.
  • Organizations can then establish training sessions based on unit schedules (three-hour sessions).
  • Staff members must participate in practice audits and achieve the minimum target scores established by the MESH Advisory Board.
  • 30-45 day data collection period is initiated.
  • The education associated with implementing the acuity system can be tracked on the shift record under education. The hours are entered by job category in Other Fixed Indirect (OFI) which is part of the worked hours calculations.

Who provides the training to use the software system and who receives the training?

  • MESH nurse consultants provide the Super User training sessions.
  • Each unit identifies key individuals to be Super Users.
  • During implementation phase, nurse consultants are available to provide additional on-site services. Phone consultation is available during business hours Monday-Friday, 8am-5pm.

What does the software training encompass?

  • History of MESH
  • ABCs of MESH
  • Roles and responsibilities (contracts utilized in some organizations)
  • Definitions and self-learning packets
  • Acuity tool and classifying the patient
  • Practice audits (competency validation)
  • Entering information onto shift record
  • Reviewing the Missing Data Report

What is the average start-up time for the software system?

  • Organizations drive the implementation based upon staff training schedules.
  • An implementation Gantt chart is developed collaboratively with the organization to ensure a realistic timeframe.
  • Identify a MESH champion within your organization and implement the system on that unit(s) first.
  • Recommend large organizations provide an implementation plan regarding their specific needs.

What software is and is not compatible with the software system?

  • An interface can be created between MESH and an existing software utilized within your organization for an additional cost. 
  • MESH will facilitate the interface discussions to ensure no proprietary infringements occur.

How reliable/ valid is the software system? How often is this measurement completed? How does the system measure for reliability and validity?

  • MESH requires user facilities to participate in semi-annual audits to ensure inter-rater reliability and for benchmarking purposes.
  • Audits are taken online (January and July).
  • Organizations do have the option of requiring practice audits throughout the year.
  • 28-day in-depth data collection periods occur on a semi-annual basis for benchmarking purposes internally and externally.

What patient and nurse outcome data does the software collect to evaluate trends in staffing sufficiency?

  • Various staffing reports specific to each module include information on: acuity, census variability, staffing under or over targets, length of stay, shifts at minimum, skill mix on the shift.
  • Unit-specific "User Defined Fields Report" organizes specific hospital/unit chosen quality indicators into a format inclusive of targeted care hours per patient shift, actual variances, and census variability. 
  • Reports enable managers to drill down by shift, day of week, specific nurse or provider and identify opportunities for improvement using the risk cause analysis framework.

Where is the information gathered during the classification process stored?

  • All data is stored on a sequel server at UW Hospital and Clinics for this web-based software program.
  • Facility ITS department participation is limited to the following:
    • Notify MESH of IP address and any changes to address.
    • Provide icons on the desktops where data will be entered.
    • Making MESH a trusted site on the computers.
    • Removing the pop-up blockers

MESH supports the web-based system, not the client.