Resource utilization is the amount of a good or service consumed or the pattern of use of a good or service within a specified time. The basic resources needed to provide a good or service are financial, human, technological, and physical.

Appropriate resource utilization in health care is everyone’s responsibility. A nurse, as a major healthcare provider, is increasingly held accountable for resource use and the costs of patient care. Nurses have a key role in determining healthcare resource needs, obtaining those resources, and often participating in the allocation of scarce resources. Quality care remains the goal in health care, and outcomes-focused plans of care have been shown to contain resource utilization and to enhance quality. Resource utilization is a dynamic process; nurses and other healthcare providers must be able to identify the costs of care or the costs of an illness in order to identify necessary resources and to manage resource utilization in health care (Dunham-Taylor & Pinczek, 2006).

Over the years, the healthcare system has been challenged with resource utilization and with, as the standard states, “providing services that are safe, effective, and financially responsible.” The development of Medicare’s
prospective payment system or diagnosis-related groups in 1983 was the first attempt to contain costs and to address healthcare resource utilization by spe-cifically targeting length of stay. Nurses should consider several recent models of healthcare delivery that have focused on resource utilization by trying to achieve an appropriate balance of cost, resources, and quality.

Managed care focused on resource utilization, coordination of appropriate care, attention to preventive health care, and conservation of resources through the management of care by a healthcare provider or insurer. Case management, another technique that focuses on resource utilization, is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client’s health and human services needs. It is characterized by advocacy, communication, and resource management, and it promotes quality and cost-effective interventions and outcomes (Commission for Case Manager Certification, 2011).

The stated goal of case management is to coordinate patient care resources. The Institute of Medicine (IOM, 2001) report titled Crossing the Quality Chasm: A New Health Report for the 21st Century described the U.S. healthcare system as “poorly organized to meet the challenges at hand.” In addition, it discusses the system’s cumbersome processes and waste of resources that lead to safety concerns, lack of appropriate care, and loss of information. The report recommended six aims for improvement—all with a critical resource utilization foundation—that are built around the need for health care to be safe, timely, effective, efficient, equitable, and patient-centered.

The latest and evolving innovation in healthcare resource utilization is the accountable care organization (ACO). The ACO, a group of providers of services and suppliers who work together to manage and coordinate care, will be responsible for the patient’s entire episode of illness across the continuum. Nurses will have a major role in the evolution of those ACOs. Their expertise in resource identification and care coordination will be valuable to the success of the ACO (Center for Medicare and Medicaid Services, 2012; Gold, 2011).

All nurses must participate in resource utilization in health care. This critical knowledge is important in everyday nursing practice for clinical decision-making. As patient advocates, the registered nurse (RN) has an important role in assessing the healthcare consumer’s and family’s needs, identifying desired outcomes, and assisting them to negotiate and navigate resources for their health care across the continuum. This role includes evaluating the evidence and determining and securing the appropriate level of care and services necessary to meet the consumer’s desired outcomes. The nurse advocates for
appropriate evaluation and use of therapeutic procedures and technologies to reduce costs and improve outcomes. This evaluation of procedures and technologies includes consideration of costs, risks, and benefits for each plan of care. Nurses also have a responsibility to be knowledgeable about principles of financial management, including understanding the costs associated with patient care, the reality of scarce resources in health care, and the need for cost control and cost efficiency.

The graduate-level specialty nurse or advanced practice registered nurse (APRN) is accountable for monitoring resource utilization across settings for patient care and for evaluating cost efficiency in the delivery of nursing care. The graduate-specialty nurse or APRN, specifically the nurse manager and executive, has additional resource utilization responsibility for financial management of departments, organizations, and systems of care, including personnel, equipment and supplies, technology, and physical design.