Q&A
Staffing ratios and models in H+H emergency rooms
1:52:40
·
4 min
Dr. Birnbaum explains H+H's approach to staffing in emergency departments, highlighting the use of data-driven models for both nursing and physician staffing. Council Member Narcisse presses for specific ratios, but Dr. Birnbaum provides general information about the staffing models.
- Nursing staffing model implemented in 2022 considers factors like time of day, patient acuity, and expected length of stay
- Physician staffing uses a 'staffing to demand' model based on arrivals per hour and provider capacity
- Staffing varies by facility and may include a mix of attending physicians, residents, and advanced practice practitioners
- Dr. Birnbaum states the models are working and have been validated, but specific ratios are not provided
Mercedes Narcisse
1:52:40
And prevent overburden the ear.
1:52:42
Exactly.
1:52:44
Staffing ratio.
1:52:45
What are the average doctors to patient and nurse to patient ratios across the h and h emergency room?
Adrienne Birnbaum
1:52:52
So we have a nursing staffing model that's based on that was rolled out in 2022, which takes into account many factors, so including the time of day and arrive that patients are arriving to the emergency department, their level of acuity, the length of stay that's expected based on that level of acuity.
1:53:16
And that staffing model has been used by our nursing leadership to make calculations about what the appropriate staffing is based on all those factors, including seasonality because we have significant variations based on the season.
Mercedes Narcisse
1:53:33
Mhmm.
1:53:34
Thank you for the answer, but I would like for you to be a little more specific because let's say, so it depends of the time of the day.
1:53:42
It depends of so all those data have been giving.
1:53:44
Right?
1:53:45
We are aware of the data.
1:53:46
So can you roughly tell me, like, in a midday or early in the morning or in the evening whether that you have an increase?
1:53:55
What's the ratio look like for nurses?
1:53:58
Before we get to the doctors.
Adrienne Birnbaum
1:53:59
I mean, we would have to get back to you on that specific information.
Mercedes Narcisse
1:54:03
And for the doctors as well.
Adrienne Birnbaum
1:54:05
Well, doctors, we also have a staffing a staffing to demand model, and we are constant both the nursing and the physician models.
1:54:13
We're continuously reapplying them and adjusting our staffing appropriately.
1:54:19
For the physicians, we have a model that uses arrivals per hour and capacity of the providers that are working in the emergency department to be able to treat those patients.
1:54:32
And we relate that to our needs in terms of physician and other advanced practice practitioner staffing.
Mercedes Narcisse
1:54:44
So in any given time, do you have, like, PA?
1:54:49
Do you consider them in the level of the doctors?
1:54:52
What how that work now?
Adrienne Birnbaum
1:54:54
It varies to some extent by facility.
1:54:57
We when we always have attending physicians in all our facilities, but we do use advanced practitioners as well.
1:55:04
Partly, the distribution might depend on whether there's a an emergency medicine residency training program and other residents working in the emergency department.
1:55:13
But if not, then we certainly supplement with advanced practice practitioners.
1:55:17
And even in those situations where we do have residents working there, we often supplement using advanced practice practitioners, always supervised by by emergency medicine.
1:55:28
Physician.
Santa Morales
1:55:29
Okay.
Mercedes Narcisse
1:55:30
So, in a roughly, on the time of shift, how many attendant physicians you have?
1:55:35
You have each for each different department or you just want to cover the whole ER or 2 to cover the whole ER?
Adrienne Birnbaum
1:55:41
Well, it really depends on the facility and the volume and also to some extent the geographic the geographics of the individual department, but we base our staffing models on the knowing in that particular facility the number of patients that are expected to arrive on average, and we really base it looking at every single day of the week and the time of arrivals when we, you know, the the we know when our busiest times are, and we we map it out you know, down to the hour of the day and staff according to that, and then that calculates we use that to calculate the number of providers that we we would need to staff.
Mercedes Narcisse
1:56:22
So the model that you're referring to, is that a name for the model or just who collaborate with the model or is the model that within in?
Adrienne Birnbaum
1:56:32
It's it's a it's a model that literally takes the number of arrivals per hour and every day of the week, the average number of hours Mhmm.
1:56:40
It uses the capacity based on the number of providers, physicians, residents, APPs that are present during that hour of the day.
1:56:53
And we use that to calculate whether there are any gaps, and we base our staffing calculations on that.
Mercedes Narcisse
1:57:04
So for now, you it's working.
1:57:06
That's what you're saying.
Adrienne Birnbaum
1:57:08
It has it has it's working and it has been validated in multiple situations in which we've applied it, so we do have confidence in the model.
