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Jan05
Emergency Department staffing
The Emergency Department (ED), sometimes termed Accident & Emergency (A&E), Emergency Room (ER), Emergency Ward (EW), or Casualty Department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention. In some countries, Emergency Departments have become important entry points for those without other means of access to medical care. Staff teams treat emergency patients and provide support to family members. The emergency departments of most hospitals operate around the clock, although staffing levels attempt to mirror patient volume, which in most ED's finds its nadir between 2:00 am and 6:00 am. Most patients seek the Emergency Department in the afternoon and evening hours, and staffing mirrors this phenomenon.
The vast array of people caring for patients in an emergency department can be quite confusing to the average health care consumer -- as confusing.
Additionally, most people are uncertain of the training and background necessary to become a member of the emergency-department team. Well, here's the scorecard.


Emergency Physician
Physician who specializes in the care of patients with acute injuries or with diseases that are an immediate threat to life or limb. A "board certified" specialist in emergency medicine is an emergency physician who has achieved certification by the American Board of Emergency Medicine (if an MD) or the American Osteopathic Board of Emergency Medicine
Emergency Nurse.
Nurses care for patients in the emergency or critical phase of their illness or injury. A specialist nurse who will independently assess, diagnose, investigate, and treat a wide range of common accidents and injuries working autonomously without reference to medical staff. They primarily treat a wide range of musculoskeletal problems, skin problems and minor illness, many are considered experts in wound management. They are trained in advanced nursing skills which though medical in nature - such as taking a full medical history and examination, x-ray interpretation, prescribing, suturing, & plastering, also encompass a holistic assessment of the patients needs, taking into account the need for health teaching and education, continuing care within the family and ongoing health support in the community.
PhysicianAssistant
Many emergency departments utilize physician assistants (PA). PAs work under the supervision of an emergency physician. They can examine, diagnose and treat patients (usually the less complicated ones) and review their findings with the physician.
EmergencyDepartmentTechnician
The tasks that performed may include taking your vital signs, drawing your blood, starting your IV, performing EKGs, transporting you to and from various tests, and providing aid and comfort to family and friends.
UnitSecretary
This essential member of the team is one you don't hear about very often. He/she often handles the communication needs of the ER. A few important examples of important communication needs include the emergency physician needing to speak to the patient's family physician, families calling about their loved ones, family physicians needing to inform the emergency department about patients being sent in, or patients calling in needing medical advice. Also, he/she coordinates the ordering of diagnostic tests.
Physicianintraining
An attending physician who usually has extensive experience in emergency medicine supervises these physicians. There are ways to bridge the nursing productivity gap, while improving staffing processes, improving efficiency, and creating a vision for the future. To improve staffing processes one has to increase forecasting accuracy, match staffing to demand, increase management vigilance, smooth the workload variation and enhance nurse efficiency in the emergency room.
In the hospital industry cost information plays a critical role in maintaining a competitive advantage. Strategic cost management allows us to provide low cost care. For example, reducing the cost of providing care by improving a process would allow the organization to reduce the cost to the patient, thus reducing customer sacrifice.
Managers will be forced to determine which activities are important if customer value is emphasized. The healthcare industry requires that managers be familiar with many functions of the financial end of business. Nurses have often looked the other way when it comes to finances and continually focused on patient care. In the year 2001 the attitudes and focus must shift to keeping the healthcare facility viable in the business world. Relating patient care, hours worked, and the number of nurses required to provide low cost, quality care is of extreme importance in today’s environment. This broader vision allows managers to increase quality, reduce the time required to service customers (both internal and external), and improve efficiency. Continuous improvement is fundamental for establishing a state of healthcare excellence.


Next-day productivity profiling holds each manager accountable for the outcome of his or her specific area and to manage his or her resources appropriately. Imprecise staffing standards and infrequent monitoring hinders flexing of staff and leaves managers unaccountable for productivity. The emergency department will be profiled daily on performance against productivity targets. They will use productivity standards and daily volumes to determine real-time, the amount of staff needed to meet the demand. In most cases, the core staff will already be in place, and only upward adjustments will prove necessary. Managers are being trained to look at the business, and to be able to forecast the needs of the units and react to the needs efficiently. It is the expectation that this process will become routine, requiring moderate effort to maintain.
To improve emergency department staffing a master schedule of worked hours is reviewed daily to determine the daily census and volume and the per shift census and volume. Then the total worked hours scheduled is evaluated along with the worked hours per shift per unit. Managers are actually evaluating labor on a shift-to shift basis. Real-time reporting of adherence to customized productivity standards enables more accurate matching of staffing to demand. This process prevents hiring unnecessary personnel and fosters a permanent focus on staff efficiency and cost control.
Study also shows that that between the hours of one am and ten am, historically the census is low and requires less staffing. The emergency department survey also reflected that the peak volume times in the emergency department were from 10am to 12 midnight and this has provided needed information on start times and these surveys were utilized in formulating the schedule. It is essential to obtain staff buy-in to effectively implement this process in any organization.
Implementation of the Emergency Department Productivity Profiling System will reduce the number of FTE'’ needed per shift. This will further reduce cost associated with labor, as staff will be utilized more efficiently during peak arrival times. Thus, allowing to accurately plan for core and flexible staffing needs. Managers will be held accountable to department-specific hours-per-unit targets for flexible staffing. In turn, managers will be provided with timely, structured feedback on their performance against these targets. The staffing matrix developed for the Emergency Department will be adjusted periodically to further improve performance and reflect process or technology changes should they be needed.

References

Alba, T. (2000). Next-Day Productivity Profiling. Healthcare Advisory Board (Ed.), Nursing Cost Advantage, (Volume III, pp. 43-49). Washington, D.C.: The Advisory Board Company.
Ansari, S. (2000, March). Activity Based Management. Retrieved June 19, 2001 from the World Wide Web: http://www.wku.edu/~aldricr/.
Bellandi, D., Kirchheimer, B., & Galloro, V. (2001). Overall, not so bad. Modern Healthcare, Volume 31, pp. 36-37.
Coates, K. (2001, June). Trickle-down Effect. Nurse Week, Volume 6, p.13.
Covey, S. (1991). Managing Expectations. In Covey, S. (Ed.), Principle-Centered Leadership (pp. 204-205). New York, New York: Franklin Covey Co..
Hansen, D., & Mowen, M. (2000). Current Focus of Management Accounting. In Sears, M. (Ed.), Management Accounting (5th ed., pp. 10-15). Cincinnati, Ohio: South-Western College Publishing.
Nelson, D., & Quick, J. (2000). Forces for Change in Organizations. In J. Szilagyi (Ed.), Organizational Behavior (Third ed., p. 602). Cincinnati, Ohio: South-Western College Publishing.
Parker, C. (2001, June 11). AHA report shows staffing shortages threaten access to quality health care. AHA News, pp. 1, 2.
Pearson, C., & Barton, L. (2001). Vacancy Review Council. The Healthcare Advisory Board (Ed.), Liberating Hospital Economics, Volume I, pp. 37-43). Washington, D.C.: The Advisory Board Company.
Shaffer, F. (2001). On the Front Lines: A scan of the organizations that influence practice. Curtain Calls, Volume 3, p. 3.
Solovy, A. (2001). Mission Makes Wall Street. Hospitals & Health Networks, Volume 75, p. 38.


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