Staffing and Provider Productivity in the Emergency Department

Emergency clinician output in a district hospital emergency centre: a cross-sectional analysis

“…EC clinician output has traditionally been described as patients consulted per hour (PPH) or in more recent years in some high-income countries as relative value units per hour (RVU/h), a resource based all-encompassing measure used to assist with billing for a clinician's services. The RVU was developed to estimate a clinician's work per patient based on patient acuity and diagnosis, practice costs and malpractice expense for a given intervention or service [ 8 , 9 ]. Several shift, clinician and workload factors affect clinician output and an understanding of these variables and the interaction between them will allow for a better balance between under- and over-staffing, an optimal patient-to-clinician ratio and provide critical information to inform staff rosters and surge planning [8] .…”

“…The RVU was developed to estimate a clinician's work per patient based on patient acuity and diagnosis, practice costs and malpractice expense for a given intervention or service [ 8 , 9 ]. Several shift, clinician and workload factors affect clinician output and an understanding of these variables and the interaction between them will allow for a better balance between under- and over-staffing, an optimal patient-to-clinician ratio and provide critical information to inform staff rosters and surge planning [8] .…”

Understanding Demand and Capacity Mismatch in an Academic Emergency Department Using a Staircase Model of Provider Capacity and Staggered Shift Start Times

“…As an ED's annual visits increase, more provider coverage becomes necessary and the variability of staffing models increases. Even low-volume EDs must have 5 full-time equivalents on staff to provide 24-hour, 7 day a week coverage and account for vacation ( 1 ). Once volume is > 20,000 yearly visits, EDs can estimate needing approximately 2.8 additional full-time employees for every 10,000 additional patient visits ( 1 ).…”

“…Even low-volume EDs must have 5 full-time equivalents on staff to provide 24-hour, 7 day a week coverage and account for vacation ( 1 ). Once volume is > 20,000 yearly visits, EDs can estimate needing approximately 2.8 additional full-time employees for every 10,000 additional patient visits ( 1 ). Even with a larger workforce, there are often still prolonged wait times and long door-to-provider metrics.…”

The Other Side of Immediate Bedding: A Call to Action to the Research Community

“…6,7 Appropriate staffing can increase throughput, improve flow, and decrease costs; and solely focusing on productivity can compromise quality of care. 8 The Emergency Nurses Association 9 confirms that adequate staffing has contributed to the reported success of prior initiatives regarding pull-until-full/direct-bedding practices, but this cannot be validated until research that examines this intake practice includes staffing levels and other vital information in its analyses. In their most recent investigation to establish research priorities for the Emergency Severity Index, Wolf and Delao 10 found the work environment and its effect on triage accuracy and processes to be the lowest priority focus.…”