Every emergency department (ED) faces the challenge of having the right number of staff in place at the right time. To help children's hospitals model successful staffing plans, CHA analysts compared four staffing criteria from PROSPECT, a financial and operational children's hospital data program, to identify high-performing pediatric EDs.
While organizations don't know when patients will need ED services, high-performing hospitals have developed strategies to identify trends for staffing needs and how to react when the unpredictable happens. Managing an ED with the appropriate level of staffing not only helps employees deliver quality care, it also helps them maintain resilience in their high-pressure work environment.
Use historical data. Make staffing decisions based on volumes projected from historical data and reassess every four hours. Charge nurses manage productivity at Dell Children's Medical Center of Central Texas in Austin, and Lisa Earp, RN, M.S.N., S MEMS, director, emergency services says that is the most important part of her team's success.
The charge nurses refer to historically based volume grids to determine staffing numbers and necessary skill mix. During daily assessments, the charge nurses make real-time decisions about volume and can determine whether flexing staff is necessary. Flexing can include moving a staff member to another unit or leaving early from a shift. To match the volume need and preferences for staff, charge nurses can also offer varied shift lengths ranging from four, six, eight, to 12 hours.
Be willing to leave. At CHOC Children's in Orange, California, leaders support decision makers who flex staff schedules when necessary and encourage employees to embrace the practice of leaving if census doesn't require as many staff. Training at CHOC Children's emphasizes that flexing scheduled work time with census variation is important for several reasons: Time away from work can be time spent with family; staff can leave the hospital to refresh and return mentally and physically ready to deliver care.
ED staff do not float to work on a different unit and staff from other areas of the hospital without ED experience do not float into the ED. As needed (PRN), part-time staff, and travelers are assigned to cover census variations.
Prepare for highs and lows. Respond to daily increases in volume by adding staff based on if numbers decrease, allow staff to fill in other areas. During a low census period, nurses at Children's Hospital of Philadelphia can work in areas where they can gain new skills and experience. “We ensure nurses are practicing at the highest scope,” says Jane Lavelle, M.D., associate director of the emergency department. “We support a culture of lifelong learning, and it's important nurses embrace the opportunity. I rely on their knowledge because every day they direct me to the patient I need to see next.”
The flu season is an expected high-volume period but predicting when the season will start is difficult. Once that high-volume period begins, managers expect to need extra physician moonlighting and additional hours for staff to cover the influx of patients.
Share the data. Important unit metrics including volumes, left without being seen, time to door, time to doctor and time to admission are a few of the measure displayed on a visual management board for staff and patients to view at Ann & Robert H. Lurie Children's Hospital of Chicago. Every morning, staff huddle at the board to discuss the previous day's data and plan for the day. The ED operation committee reviews data weekly to identify volume trends.
When managers are aware of trends, expected or unexpected, they can use the data to make informed decisions on adjusting schedules. “Our philosophy supports a collaborative environment and shared-decision making,” says Dan Skarzynski, manager operations. “Leadership and staff need to be involved and understand the big picture.” Skarzynski says managers' decisions to adjust staffing patterns are done in tandem with physicians, nursing and in cohesion with faculty.
Managing productivity in the ED is a year-round challenge. Read more about the strategies that are helping these four hospitals staff efficiently and effectively.