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The goal of the Benchmarking Alliance Group’s study was to determine an optimal staffing mix for the ED, giving credit to actual services needed. First, a list of tasks performed in the ED was established. "We included everything from who was seeing patients to the parking lot to who was transporting patients up to the floors, and how much time housekeeping spends cleaning rooms in the ED," says McClay. "Then we determined how many hours per 24 hours each of those personnel spent in the ED."
Next, it was determined what tasks were performed by which job title. Salary ratios were then factored in. "We needed to determine if physician extenders are providing additional coverage to reduce the number of hours required by physicians or RNs and if non-registered nurses reduce the number of RNs needed," says McClay.
A spreadsheet was developed so facilities can plug in staffing ratios to see how they compare to other EDs. "We wound up being able to compare EDs by determining their relative costs in each type of personnel," McClay notes. "We can find out if some physician groups are more productive than others, and, if so, how are they doing it? One way was looking at how they distributed the tasks in the department. If they had medical technologists doing some of the things that RNs would be doing, that may be the solution to reducing your personnel costs."
The group also determined the actual number of staffing hours required to take care of a patient. "It might be a tenth of an hour for housekeeping, or two hours for social services," says McClay. "We wanted to know how many patients per hour can a physician or nurse see, and what the different staffing mix is." The group found that the number of total personnel hours needed per patient was grossly underestimated by most of the benchmarking surveys, he says.
The group is currently working on determining acuity adjustment to factor in the needs of different patient populations. "We’re developing a uniform way of comparing systems," McClay reports. "We’d like to come up with a standard acuity adjustment, which now tends to be self-reported by nursing staff with various acuity rankings."