Thursday, February 11, 2010

Improving Staff Productivity in Your Emergency Department

For the last two posts I have discussed patient throughput in the ED, now I want to move on to staff productivity. This is key to your overall success and is actually easier to address than you might think.

The traditional way to approach this is to look at consolidating activities. Bring in a team of time and motion engineers who look at wasted motions and staff you can exist without. Although this approach has merit, it is not where we find the greatest opportunity for saving in EDs. After all, most EDs have already thoroughly addressed this issue. But it is the right place to start. Are there staff in your ED who are not being fully utilized or doing functions that are no longer key to the functioning of the department today? If there are, they need to be reassigned somewhere they can be of real utility to the organization. Layoffs should only be used as a last resort. This sends a terribly negative message to the entire organization and certainly must be considered a failure by management to keep up with changes in the work flow and patient volume.

The real opportunity for increasing productivity in your ED is to focus on decreasing patient throughput using the steps I have discussed in the previous posts. If you do that effectively your productivity will automatically increase. To prove this to yourself, take a look at the number of rooms occupied in your ED during peak times. This number or something close to it is the basis of setting staffing levels for this shift. Now imagine that 30% is cut off the average time currently spent in the ED for all patients and look at the impact this will have on the total number of rooms operating during the peak period. The number of rooms to be staffed at peak volume drops substantially. By the way this will also delay the need to expand beds in your ED if you are running tight. One ED I have worked with had recently expanded beds to better meet the growing demand. They found that after implementing throughput improvements, they didn't need all the new beds they built.

So to effectively manage the process of improving staff productivity, you need to measure a baseline and tack progress. Paid Hours per Patient is the most effective measure for the ED and high performing EDs are keeping this number under 2.5. The hospital mentioned above had started at 4.2 paid hours per patient and lowered it to 2.5 largely by reducing throughput times.

We also find that by taking these measures, certainly the patients are much happier to get through the ED process faster, but staff are also happier. Dedicated staff will be happier not wasting as much time and focusing on delivering efficient, quality care to patients who are now more appreciative.

Tomorrow we will discuss building new business.

Mark Brodeur


  1. christ. Our productivity number is 1.73 hours per patient. That includes the director (no hands on), the secretary, and the 25 hours per week of the rn who manages our base station firefighters.

  2. Mark's stat is total paid, not just productive. Does your number include techs or scribes? Are you a trauma center? If your answer is yes to these, you may have a lot to be proud of. Finally, managing an ed is more than just productivity. Is you overall length of stay including admissions and holding hours under 3 hours? Is your ambulatory patient length of stay under 120 minutes? Those times begin when patients enter the waiting area, not at registration. And they end when patients leave the department. Is your combined Left Without Being Seen and Left Against Medical Advice under 1.5 percent? Patient sat ranking above 80 % ? Core measures at 100% compliance? Readmission Revisit rate within 72 hours under 2 percent? These are the most important things because they are measures of actual service. In combination with productivity, they represent value to your community.


Real Time Web Analytics