According to a recent study, the typical Emergency Department processes 64% of their daily volume from 10:00 a.m. to 10:00 p.m. Of course, there are always the “what-ifs” in emergency medicine that the department needs to be appropriately prepared for, but the reality is that ED volume has predictability that can be used to guide skill mix and staffing practices, especially during the off-shifts.
The Emergency Department is, by its very nature, often either over or under staffed with peak load crises inevitable. The real question is what is the capacity of your ideal staffing; how far do you bend before you break? There will always come a time when there is simply more than current staffing can handle, but a successful ED does not schedule for those scenarios on a regular basis.
Best practice organizations are using productivity tools to track departmental performance and identify time-of-day/day-of-week volume trends, scheduling staff based on these swings and the understanding of what can be tolerated from an acuity perspective. In doing so, most are noticing that the ED coverage they have been routinely scheduling on the later shifts is not necessary given the number of patients presenting after 10:00 p.m. and that adjustments can and should be made.
Many mid-sized, community hospitals are turning to Respiratory Therapists and Nursing Supervisors to supplement their night-shift Emergency Department staffing. Utilizing these well-trained patient care professionals is becoming a best practice tactic to keeping hours in line with volumes and personnel expenses down. Since these individuals are already being scheduled and are required to be in the building, they are the ideal choice for added support should the leaner ED night staff need it in the event of a volume influx. Additionally, these organizations are also moving to a hybrid Medical Assistant/Patient Service Representative role within the ED on the off-shift. These individuals can tackle both the check-in/registration function as well as provide direct care.
While these innovative methods are gaining traction, they are not the only solutions available. Many smaller Emergency Department’s have as much as 40% variation between their slowest and busiest days which leaves a great deal of opportunity for further creative staffing practices. Leaders should evaluate their unique circumstances (labor union restrictions, physical layout, quality of equipment, etc.) and identify workable strategies for improvement and related cost savings. Remember, Emergency Room patient flow is 80-85% predictable so it is critical to track volume patterns and mirror staffing accordingly in order to realize higher efficiencies!