Coverage question

[TrumpetDoc]

Just would like to get a general feel for other busy ERs and your coverage scheme.

I now work in a shop where we are currently seeing around 183 patients per day on average. Of course, this is a winter upsurge.
We currently have six physician shifts and five mid-level provider shifts. We recently instituted a weekday provider in triage shift from noon to 9 PM.

Of course as most of you can likely relate the hospital is placing blame on the physician group for increased wait times. And their thought is we increase coverage

In my experience this is about as thick of coverage shop as I have ever worked in.
We are seeing a comfortable amount of patients per hour. Several other places staff to the 3+/hr range.

I'm just wondering if anyone else works in the shop averaging steadily around 179-180 visits per day if your coverages thicker than ours?

Our shifts are 9 hours.

Not trying to solve anything but would love to have a few real world examples of general physician staffing at similar volumes.

Thanks

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[hypnix]

How many doctor hours is that per day as well as mid-level?

 

[OccupyTheED]

At my last shop we had slightly less volume than that, typically around 160-165 visits daily, 4 physician shifts (38.5 hours), 3 midlevel shifts (32 hours). Admin consistently was on our back about door to doc times on the busier days, never mind that you can't meet any metric when it takes 3 hours to place someone in a room. It sounds like your shop is more than adequately staffed imo.

 

[TrumpetDoc]

How many doctor hours is that per day as well as mid-level?

54 physician hours
50 MLP hours
Plus 9h of PIT M-F.

 

[Hercules]

54 physician hours
50 MLP hours
Plus 9h of PIT M-F.

We see 150-155 average.
Physician coverage is 4 eight hour shifts (32 hrs) on weekdays and 3 ten hour shifts (30 hrs) on weekends

MLPS coverage is 3 nine hr shifts (27 hrs) everyday.

For being not much busier than we are, I would say you are very heavily staffed. Your site sees 30 more patients/day but has 20+ hrs of additional physician coverage and 20+ hrs of midlevel coverage.


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[DissocativFugue]

We see 190-200 per day. 7 physicians x 8 hours. No midlevels/APPs


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[Groove]

Sounds like an identical shop. 5x Physician shifts that are 10 and one 9 hour shifts with overlap for 49h MD coverage. 4 MLP shifts, one of which is dedicated 12h MSE/Triage shift during peak hours (10a-10p). One is RTA/Fast Track and the rest work in the main ER, FT or both for total of 42h.

It doesn't sound like lack of coverage is your problem. You need to identify your bottlenecks and address them. Having a dedicated provider on the front end decompress the WR, MSE and start work ups can dramatically improve your metrics as well as decrease LWOTs. We have a a RAZ/MSE area with a dedicated nurse and tech and a treatment room where a MLP can screen, examine and start a work up. Blood can be drawn, EKG obtained, etc.. Sometimes, it's as simple as moving the screened pt's to a different part of the WR or an old office with seating and a tv where labs can be drawn and they can be gotten for XR. It provides the pt a sense of progression and will reduce LWOTS,Eloped,LWBS especially when combined with your MSE provider putting in some basic orders and testing. The provider can then pick up when they drop into FT or the main ER.

Lab delays, radiology delays, nurse staffing ratios, daily nurse/ancillary grid of expected vs actual to get a good sense of what is impacting throughput. If you can hold meetings monthly with all the requisite departments who can provide stats and be held accountable for delays will go far in giving you traction to move the needle in the right direction.

I'm sure you probably do a lot of this already but the typical C-suite "see more patients...faster...or else!" can have so many influencing variables outside your immediate control. It's rarely as simple an issue as Physician/MLP coverage. We were in a similar spot a few years ago and added another MD shift and it did absolutely nothing except staff the ED with a bunch of hungry, bored docs who were constantly sniping and stealing pt's from each other and contributed to a very tense environment. (We're 100% RVU)

 

[The White Coat Investor]

Just would like to get a general feel for other busy ERs and your coverage scheme.

I now work in a shop where we are currently seeing around 183 patients per day on average. Of course, this is a winter upsurge.
We currently have six physician shifts and five mid-level provider shifts. We recently instituted a weekday provider in triage shift from noon to 9 PM.

Of course as most of you can likely relate the hospital is placing blame on the physician group for increased wait times. And their thought is we increase coverage

In my experience this is about as thick of coverage shop as I have ever worked in.
We are seeing a comfortable amount of patients per hour. Several other places staff to the 3+/hr range.

I'm just wondering if anyone else works in the shop averaging steadily around 179-180 visits per day if your coverages thicker than ours?

Our shifts are 9 hours.

Not trying to solve anything but would love to have a few real world examples of general physician staffing at similar volumes.

Thanks

We have 5 eight hour doc shifts and 1 10 hour PA shift for about half your volume. So yea, we're thicker. But we're admittedly a little too fat. Our rate limiting step is certainly not physician coverage.

 

[hypnix]

We have 5 eight hour doc shifts and 1 10 hour PA shift for about half your volume. So yea, we're thicker. But we're admittedly a little too fat. Our rate limiting step is certainly not physician coverage.

That seems reasonable to me. That's about 2.25pts/hr without factoring in your PA. What's the national average?

The shop I am at is like OPs volume and we have less coverage. Providers are definitely feeling stretched thin.

 

[Apollyon]

We see 190-200 per day. 7 physicians x 8 hours. No midlevels/APPs


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190/56 = 3.39!

I hope there is a LOT of 5's! Even 3 lacs a shift, unless your nurses do EVERYTHING but sew, will slow that right down (or substitute LP, intubation, critical care, or other time consuming issue).

Alternately, unlike me, you're a bunch of total superstars!

 

[DissocativFugue]

190/56 = 3.39!

I hope there is a LOT of 5's! Even 3 lacs a shift, unless your nurses do EVERYTHING but sew, will slow that right down (or substitute LP, intubation, critical care, or other time consuming issue).

Alternately, unlike me, you're a bunch of total superstars!

Our nurses do infiltrate and set everything up. We do progressive scheduling. 2 physicians taking acute workups and the 3rd doc at the end of their shift only sees 4s/5s. About 1/3 of our patients are 4s/5s.


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[DissocativFugue]

190/56 = 3.39!

I hope there is a LOT of 5's! Even 3 lacs a shift, unless your nurses do EVERYTHING but sew, will slow that right down (or substitute LP, intubation, critical care, or other time consuming issue).

Alternately, unlike me, you're a bunch of total superstars!

Also, I must have over estimated our daily census. We average between 2.9 to 3 patients per hour.


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[Apollyon]

Also, I must have over estimated our daily census. We average between 2.9 to 3 patients per hour.


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Wow! Still, that's busy, man!

Anyways, happy new year, brother!

 

[namethatsmell]

Also, I must have over estimated our daily census. We average between 2.9 to 3 patients per hour.


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And you're happy with this?

Scribes and excellent dictation software? Attendants handing you espresso and chocolate every 30 mins? Consults and hospitalists who call themselves? What's the secret?


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[namethatsmell]

Sorry missed the part where 1/3 are 4/5s.


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[RustedFox]

I never see a "5" on the tracking board. Hardly ever.

Even "Toothache" gets classed as a "4".

"5" at my shop = med refill, suture removal, and.... that's all I can remember.

I'm turn'ip. Whooooo. Happy new year.

 

[fahimaz7]

Just would like to get a general feel for other busy ERs and your coverage scheme.

I now work in a shop where we are currently seeing around 183 patients per day on average. Of course, this is a winter upsurge.
We currently have six physician shifts and five mid-level provider shifts. We recently instituted a weekday provider in triage shift from noon to 9 PM.

Of course as most of you can likely relate the hospital is placing blame on the physician group for increased wait times. And their thought is we increase coverage

In my experience this is about as thick of coverage shop as I have ever worked in.
We are seeing a comfortable amount of patients per hour. Several other places staff to the 3+/hr range.

I'm just wondering if anyone else works in the shop averaging steadily around 179-180 visits per day if your coverages thicker than ours?

Our shifts are 9 hours.

Not trying to solve anything but would love to have a few real world examples of general physician staffing at similar volumes.

Thanks

We are seasonal here, but on a busy day we see 100+ with 4 docs (7-3, 11-7, 1-9, 9am-7am). The day docs are all over 3+/hour when we're busy. I saw 33 tonight in 9 hours of seeing patients.

 

[The White Coat Investor]

That seems reasonable to me. That's about 2.25pts/hr without factoring in your PA. What's the national average?

The shop I am at is like OPs volume and we have less coverage. Providers are definitely feeling stretched thin.

Something is wrong then. We average nowhere near 2.25, but then again we usually don't count the PA patients. I think we're much closer to 1.3-1.4, which is ridiculously fat.

 

[DissocativFugue]

And you're happy with this?

Scribes and excellent dictation software? Attendants handing you espresso and chocolate every 30 mins? Consults and hospitalists who call themselves? What's the secret?


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We actually do have scribes and excellent dictation software. I wish there was espresso and chocolate attendants. That's why I settle for cocaine lines. As for consultants I wish it was set up like emergentmd where I could just text them.

Our efficiency mainly lies in front loading our shift where we see a ton of people before things start coming back and then you have to update/admit/discharge. It's not a bad set up. I'm easily able to do 4 or 5 shifts in a row before I become temperamental. I honestly think I'd be bored at WCI's pace. But to each their own. I suppose at that pace you might have time to oh ya know blog or plan rock climbing/mountaineering.

 

[emergentmd]

54 physician hours
50 MLP hours
Plus 9h of PIT M-F.

180/dy divided by 104 hrs = 1.73/hr. You guys are overstaffed IMO and has nothing to do with throughput.

Our ED is 160/dy. We have 6 shifts, 7 hr shifts = 42 doctor hrs. 20 hr Midlevel/dy. or 2.5/hr. I feel we are adequately staffed and I usually go home right when the next doc comes in. I see close to 3/hr b/c I am fast and chart quickly. Our Midleves are great and see just as many pts as the docs/hr but less acuity.

Any shift for me that is 2/hr seems slow. 2.5 is about right. 3/hr is starting to push me.

My Locums we see about 160/dy. We have 40 hr (4 x 10) doctors and 24 hrs midlevel. So about the same. But Our APC here sucks and I see 3+/hr b/c the docs also are of slower/lower quality.

 

[Arcan57]

You're understaffed a little bit. Most CMGs count an MLP as half an MD in terms of productivity. That puts you at 79 adjusted doc hours which is at 2.4 pts/hr. That's not unreasonable but optimal metrics are probably going to be more in the 2.1 pph range. This doesn't count PIT since that in most setups that's a close to zero productivity shift that you suck up for the LWBS and D2Doc metric benefits.