Staffing Calculator by Shift
This staffing calculator helps determine the number of providers (physicians and non-physician practitioners), nurses, and technicians necessary per shift to staff comprehensive emergency departments (EDs), freestanding emergency departments (FEDs), and immediate care centers (ICs) based on four primary inputs.
INPUTS
INPUTS
- Enter the site volume as the daily or the annual number of cases.
- Enter the patient experience (PX) and staff experience (SX) performance goals - high, average, or low using the drop-down list.
Note: After clicking 'PX/SX,' you will see an arrow that, when hovering, that reads 'Expand Data Validation List' (see red circle below). Click the arrow to view the drop-down list. - Enter the shift of interest - day, evening, or night - using the drop-down list.
- Enter the site setting - ED, FED, or IC - using the drop-down list.
ASSUMPTIONS
The staffing level outputs are based on several assumptions used in background calculations. These (highlighted in pink) can be changed.
- For EDs and FEDs, it is presupposed that shifts—morning, afternoon, and overnight—each span eight hours. Patient arrival patterns are anticipated to distribute as follows: one-third during the day, one-half in the evening, and one-sixth overnight. This patient arrival distribution is adjustable to suit different operational needs. In the case of Immediate Care centers (ICs), a uniform 12-hour shift daily is assumed, with patient volume evenly distributed throughout.
- The Emergency Severity Index (ESI) is a classification system designed to triage patients into five levels of acuity. Given the relative rarity of ESI level 1 and 5 cases, this model emphasizes the significance of adhering to ESI guidelines accurately. The reliability of ESI application can be assessed by examining rates of admission or transfer. Expected admission rates are as follows: 40-50% for emergent cases (combining ESI levels 1 and 2), 15-25% for urgent cases (ESI level 3), and approximately 1% for non-urgent cases (ESI levels 4 and 5 combined).
- The "weighted average" derived from the ESI serves as an indicator where a lower score signifies higher patient acuity. Standard benchmarks are set at 2.9 for Emergency Departments (EDs), 3.3 for Freestanding Emergency Departments (FEDs), and 3.8 for Immediate Care centers (ICs). These values are configurable.
- Workload units (WLU) quantify the relative effort to care for a patient based on the assigned ESI. A one-year analysis at a Chicago-area hospital system used charges to determine the relative workload by ESI. These values were verified by a large academic hospital in North Carolina verified these values in North Carolina. This investigation demonstrated that emergent cases have a workload of 1.4, urgent cases of 1.0, and non-urgent cases of 0.7. So, on average, one ESI 2 case requires the same work effort as two ESI 4 cases. These values are configurable.
- The maximum workload per hour (WLH) that providers can effectively manage is directly linked to PX and SX. A WLH exceeding 2 adversely impacts both PX and SX. These values are configurable.
- Following the determination of provider staffing levels, the requisite number of nurses and technicians is calculated based on the recommended ratios, which are configurable. These ratios are subject to modification. Specifically, the nurse-to-technician ratio is fixed at 2:1
Anchoring productivity to the Emergency Severity Index (ESI) enhances practice efficiency (turnaround times for discharged patients), and judicious diagnostic ordering. For example, two physicians might manage a patient presenting with chest pain and a low HEART score differently: one discharging the patient after a basic evaluation, while the other opting for a comprehensive workup. Despite these differing approaches, both scenarios result in identical WLH and estimated RVU/hour. Utilizing actual RVUs, derived from billing and coding practices, might misleadingly suggest lower productivity for physicians who admit less frequently. Hence, incentivizing productivity based on WLH or estimated RVU/hour aligns more appropriately with the transition from fee-for-service to population management models.
OUTPUTS
The table displays the optimal staffing levels for a specified 8-hour shift, tailored to the site type and desired outcomes in terms of volume, and patient/staff satisfaction objectives. It quantifies providers (physician and non-physician practitioners) in tenths, allowing for a more precise allocation through shift overlaps. For example, a requirement of 2.5 providers can be met by deploying two providers for the full shift and an additional provider for the peak four hours.
Users can modify the underlying assumptions of the calculation. Clicking the Restore button restores the original values.
OUTPUTS
The table displays the optimal staffing levels for a specified 8-hour shift, tailored to the site type and desired outcomes in terms of volume, and patient/staff satisfaction objectives. It quantifies providers (physician and non-physician practitioners) in tenths, allowing for a more precise allocation through shift overlaps. For example, a requirement of 2.5 providers can be met by deploying two providers for the full shift and an additional provider for the peak four hours.
Users can modify the underlying assumptions of the calculation. Clicking the Restore button restores the original values.
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