This staffing calculator specifies the number of providers (physicians and non-physicians), nurses, and technicians necessary to staff comprehensive emergency departments (EDs), freestanding emergency departments (FEDs), and immediate care centers (ICs) based upon four primary inputs.
The staffing level outputs are based on the several assumptions that are used in background calculations. Most of these assumptions can be changed.
Using WLH rather than RVUs to measure productivity promotes practice efficiency (turnaround time for discharged patients) and judicious ordering. For instance, a patient with chest pain and a low HEART score may be sent home by one physician after a basis work up and admitted by another after an extensive workup. These patients would have the same WLH yet different RVUs may be generated. Incenting productivity using WLH helps providers shift from a fee-for-service to a population management mindset.
The recommended number of providers is reported in tenths so that the need for shift overlaps is appreciated. For instance, 2.5 providers is accommodated by staffing two during the entire shift and a third during the busiest 4 hours.
Users can change the calculation assumptions and use the RESTORE button to return to the original values.
Please share your thoughts on the staffing calculator with the Auscura developers (info@auscura.com).
- Enter the site volume as either the daily or the annual number of cases.
- Enter the PX and SX performance goal - high, average, or low - using the drop-down list.
- Enter the shift being analyzed - day, evening, or night - using the drop-down list.
- Enter the site setting - ED, FED, or IC - using the drop-down list.
The staffing level outputs are based on the several assumptions that are used in background calculations. Most of these assumptions can be changed.
- For EDs and FEDs, it is assumed that there are 8-hour day, evening, and night shifts. And, that the patient influx follows a “bell curve” such that one-third of patients are seen during the day, one-half during the evening, and one-sixth at night. This distribution is configurable. For ICs, a 12-hour shift each day with evenly spread volume is assumed.
- The emergency severity index (ESI) is a system that triages patients into emergent (ESI 1 and 2), urgent (ESI 3), and non-urgent (ESI 4 and 5) groups. Since ESI 1s and ESI 5s are sparse, these are grouped with ESI 2s and 4s (respectively). Proper application of the ESI rules is expected. One can infer ESI accuracy by combining admission and transfer rates. The expected ranges are 40-50% for emergent cases, 15-25% for urgent cases, and 1% for non-urgent cases.
- An ESI “weighted average” is a metric whereby a lower value represents higher acuity. Typical levels are 2.9 for EDs, 3.3 for FEDs, and 3.8 for ICs. These values are configurable.
- Workload units (WLU) represent the relative effort to care for a patient, based 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. 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 effort as two ESI 4 cases. These values are configurable.
- The maximum workload per hour (WLH) for providers correlates with PX and SX. WLH above 2 degrades PX and SX. These values are configurable.
- Once provider staffing is determined, the number of nurses and technicians flows from recommended staffing ratios. These ratios are configurable. The ratio of nurses to technicians is fixed at 2:1.
Using WLH rather than RVUs to measure productivity promotes practice efficiency (turnaround time for discharged patients) and judicious ordering. For instance, a patient with chest pain and a low HEART score may be sent home by one physician after a basis work up and admitted by another after an extensive workup. These patients would have the same WLH yet different RVUs may be generated. Incenting productivity using WLH helps providers shift from a fee-for-service to a population management mindset.
The recommended number of providers is reported in tenths so that the need for shift overlaps is appreciated. For instance, 2.5 providers is accommodated by staffing two during the entire shift and a third during the busiest 4 hours.
Users can change the calculation assumptions and use the RESTORE button to return to the original values.
Please share your thoughts on the staffing calculator with the Auscura developers (info@auscura.com).
ESI Distribution Examples
ED - 214 daily visits, 2.9 ESI
FED - 100 daily visits, 3.3 average ESI
IC - 73 daily visits, 3.7 ESI
