Any data on workplace productivity?

[thegenius]

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Do you guys know of any data, any research that has drawn conclusions about what is considered a safe number of pt/hr seen in an ED? Meaning...if you see more than x pt/hr the research shows that there are more mistakes made, or more needless testing done, or longer wait times, things like that?

I've heard different things, but overall I've heard (but not read) that the average pt/hr in the US is 1.8 or 1.9. Across all ER's for all different organizations.

 

[southerndoc]

I think the average is more like 2.3-2.5 per hour at most places. However, this is highly variable. If you're seeing 75% level 5's, 10% critical care, and 10% level 4's, then 2.5 pph is unsafe. To my knowledge, I've never seen any data that links ESI level or E&M level with poor outcome and patients per hour.

 

[GonnaBeADoc2222]

I think ACEP quotes something like 2.1 or 2.2 as national average. Who knows how that is skewed by their CMG bias however.

Anecdotally, I feel like I can see somewhere around 2.0 safely under most circumstances. However I've found it interesting that this feeling is often dependent on other factors such as department flow and cooperation from the admitting hospitalist, ICU and consultants. When things are churning, I can see 2.3 no problem. However, I have had hellacious shifts where I've seen 1.7 because everyone decided to be a d*** that day.

I think that 2.5 and above is unsafe in any setting.

 

[BoardingDoc]

Do all of these pph numbers that you guys are quoting include mid-level patients that you're also seeing? Or just the patients you primary?

 

[southerndoc]

Do all of these pph numbers that you guys are quoting include mid-level patients that you're also seeing? Or just the patients you primary?

Just the doc.

 

[thegenius]

Most of us don't "see" midlevel patients, we just sign their charts. If I see a midlevel patient and spend more than a minute in the room, I usually put a chart in and get RVU credit for the patient (so to speak.)

 

[Hercules]

I think ACEP quotes something like 2.1 or 2.2 as national average. Who knows how that is skewed by their CMG bias however.

Anecdotally, I feel like I can see somewhere around 2.0 safely under most circumstances. However I've found it interesting that this feeling is often dependent on other factors such as department flow and cooperation from the admitting hospitalist, ICU and consultants. When things are churning, I can see 2.3 no problem. However, I have had hellacious shifts where I've seen 1.7 because everyone decided to be a d*** that day.

I think that 2.5 and above is unsafe in any setting.

I agree with you and think that no number stands in a vacuum. At my shop last month the average was 2.9 pph for doc patients. We actually see every midlevel patient as well. The average was 4.8 pph when including the midlevels. We have the most streamlined system I have ever been a part of. I moonlit at places where seeing half this many took more effort. Its all about a streamlined system (tight EMR, good scribes, good admitting teams, strong nursing, good ancillaries, helpful admin).

 

[BoardingDoc]

Most of us don't "see" midlevel patients, we just sign their charts. If I see a midlevel patient and spend more than a minute in the room, I usually put a chart in and get RVU credit for the patient (so to speak.)

Have never understood this and have never worked in a system like that. I have worked places where I work with mid-levels who present every single patient and I write a chart for every patient, and I've worked at places where I work with them and they present as they see fit. In the latter case, I have never been expected to sign a chart of someone I didn't also see. I don't know who is signing their charts, but it isn't me.

 

[TooMuchResearch]

Have never understood this and have never worked in a system like that. I have worked places where I work with mid-levels who present every single patient and I write a chart for every patient, and I've worked at places where I work with them and they present as they see fit. In the latter case, I have never been expected to sign a chart of someone I didn't also see. I don't know who is signing their charts, but it isn't me.

Yeah, we don't sign charts either. We either hear about and see the patients and write a note, or we don't.

 

[hundreddaysoff]

I guess we aren't counting FSEDs? When I'm working my FSEDs, I routinely see 4pph for the first 3--4 hours of my shift and then 2 or 3 pts the whole rest of the night. Feels safe to me even if I need to admit a couple.

Hardest shift I ever worked was 35 pts in one 12h shift at a solo rural place in residency, ~3pph nonstop for 12h, even though no one was particularly sick. 0 charts done on-shift and I wanted my mom by the end of it. I like to think I could tolerate that shift better now that I have more attending experience.

 

[turkeyjerky]

I agree with you and think that no number stands in a vacuum. At my shop last month the average was 2.9 pph for doc patients. We actually see every midlevel patient as well. The average was 4.8 pph when including the midlevels. We have the most streamlined system I have ever been a part of. I moonlit at places where seeing half this many took more effort. Its all about a streamlined system (tight EMR, good scribes, good admitting teams, strong nursing, good ancillaries, helpful admin).

Nice...are you hustling the entire time, or do you have time to actually talk to patients, take a piss, etc?

I assume it's stramlined, in that nurses/techs do things without (repeated) prompting, admitting docs take responsibility of patients so you're not having to call consultants, lab/rads throughput is good so patients aren't sitting around for hours generating extra work for everyone. Is this about right or are there any other secrets?

 

[GeneralVeers]

I usually see 4-5 per hour for the first 3 hours of my shift (a consequence of coming in at 5 when the ED is constipated) . Once I clear the blockage I see about 1 pt/hour for the rest of my shift and finish my charting.

 

[Hercules]

Nice...are you hustling the entire time, or do you have time to actually talk to patients, take a piss, etc?

I assume it's stramlined, in that nurses/techs do things without (repeated) prompting, admitting docs take responsibility of patients so you're not having to call consultants, lab/rads throughput is good so patients aren't sitting around for hours generating extra work for everyone. Is this about right or are there any other secrets?

Not hustling the whole time. Time to talk to patients, definitely bathroom breaks, almost always have time to sit down and eat for a little bit too.

Yes, most staff handles business without repeated prompting. Also, offloading of minor procedures (suturing, I&Ds, etc) to midlevels frees you up to see patients. Being an SDG where we have been able to set our own staffing level as well as having hiring/firing control of the midlevels helps us to optimize while also being able to adjust quickly.

Having a very supportive admin that values our contribution is probably a huge part of being able to function efficiently as well. In general, when we need something from the hospital they are quick to make it happen and they don’t add unnecessary tasks onto our plate that would slow us down.

 

[GonnaBeADoc2222]

Not hustling the whole time. Time to talk to patients, definitely bathroom breaks, almost always have time to sit down and eat for a little bit too.

Yes, most staff handles business without repeated prompting. Also, offloading of minor procedures (suturing, I&Ds, etc) to midlevels frees you up to see patients. Being an SDG where we have been able to set our own staffing level as well as having hiring/firing control of the midlevels helps us to optimize while also being able to adjust quickly.

Having a very supportive admin that values our contribution is probably a huge part of being able to function efficiently as well. In general, when we need something from the hospital they are quick to make it happen and they don’t add unnecessary tasks onto our plate that would slow us down.

Must be nice.