District nurses' patients — issues of caseload management

Current pressures on all community services mean that practitioners must give more detailed attention to evaluation of patient outcomes and caseload review. District nursing caseloads in one health authority have been examined using a patient-focused approach. Random samples of patients who were either physically disabled, frail elderly, or elderly mentally infirm (n = 202) were examined for the distinctive and differing characteristics, if any, of recently referred and long-stay patients. Recently referred patients in our sample were either terminally ill, or had more chronic physical disorders. Patients who stayed on the books received either injections, general care from qualified staff or baths from nurse auxiliaries. Although covering similar areas of the health authority, nursing teams varied in the proportions of recently referred and long-stay patients, suggesting that individual nurses' caseload management is a crucial determinant of length of time on the books. In particular, nursing and medical review of all patients receiving vitamin B12 injections is urgently called for. In order for caseload monitoring to be facilitated, practitioners need relevant local and patient based data in order to make inter-team comparisons. The findings also have training and management support implications.