Getting the Right ED Staffing Mix: Facility Guide and FAQ

Emergency department (ED) staffing is a critical issue impacting a healthcare facility’s revenue, staff satisfaction, and patient outcomes. Employing and scheduling the right mix of staff is often challenging because of systemic issues affecting ED operations, coupled with unpredictable patient demands.

Suboptimal staffing in the ED can cause a costly waste of resources, unhappy staff, and missed and delayed treatments — potentially resulting in patient mortality. The good news is that improving staffing practices in the ED can have an immediate positive impact on your facility and the patients you serve.

This guide addresses the importance of adequate emergency room staffing, with answers to common questions about staffing challenges and strategies. We’ll discuss the key performance indicators (KPIs) that drive staffing decisions, strategies for determining the appropriate mix of staff, how to track the right metrics, and more.

The Importance of Adequate ED Staffing

An ED, also called emergency room (ER), is often a facility’s unrestricted entry point for patients seeking medical services, sometimes for life-threatening conditions. Adequate staffing is a critical issue because of the high-stakes nature of emergency care. Health problems such as sepsis, stroke, and ST segment elevation myocardial infarction (STEMI) require time-sensitive interventions. Inadequate staffing can delay interventions, leading to higher morbidity (illness) and mortality rates.

Emergency Department Staffing: FAQ

Finding the right mix of staff for an ED is critical for the wellbeing of patients, but it can be extremely challenging. If you’re struggling with your scheduling model, you’re not alone. This is widely regarded as one of the most complex staffing challenges in the healthcare system, and optimization is neither simple nor easy. Let’s tackle some of the most frequently asked questions, as a way of coming to a better understanding of this complex issue.

What are the key concepts involved in staffing an emergency room?

There are a number of interconnected concepts involved in ED staffing. Here are four issues that managers must contend with and integrate when scheduling staff.

What are the critical KPI’s for determining and tracking ER staffing needs?

Analyzing your department’s staffing demands will likely involve setting up a system to automatically gather data on an ongoing basis. EHR systems with built-in reporting tools are a primary source for this useful data. Measuring and monitoring the following KPIs can give you insights and steer your staffing decisions.

What is the relationship between an ED’s labor costs and profitability?

In the ED, ensuring an adequate staffing mix involves finding a balance between labor costs and quality of care. While it may seem that cutting back on labor costs would simply increase revenue, the issue is complex and in some respects, the opposite is true: Reducing the number of staff can have a negative overall effect on profitability.

For example, insufficient staffing can lead to long wait times and rises in LWBS rates, resulting in lost revenue. In addition, within the value based care payment model, poor patient outcomes can result in lower reimbursement rates and a decrease in overall revenue.

How does whole-hospital patient flow impact ED staffing models?

Unless you’re managing a standalone ED, your department is impacted by your entire facility’s capacity to process patients. Patients coming into the ED will either be discharged, admitted, or transferred. When admitted, the amount of time they spend in the ED depends on availability of beds and services elsewhere in the hospital.

For example, a backup of patients on a med-surg floor due to delayed discharges would decrease the amount of available inpatient beds and increase boarding times in the ED. Longer patient boarding times cause an increased demand on ED staff.

If your hospital has systemic operational deficits, the ED quickly becomes a bottleneck with high staffing requirements. Optimizing staffing in your ED may depend on working with whole-hospital leadership to fix systemic issues. Consider facility-wide patient flow when analyzing your staffing requirements.

How does fast tracking impact a staffing mix?

Fast tracking is the strategy that can be applied to low acuity patients to move them efficiently to the point of final disposition. This strategy impacts a manager’s decisions about staffing mix because the staff resources dedicated to the fast-track (FT) system within the ED are targeted to lower-acuity patients.

Fast-tracking impacts emergency department physician staffing models by assigning patients to one of two pathways, which influences the number of physicians on staff versus the number of APPs. For example, a patient with an ankle sprain could be seen by an NP or PA instead of a physician. This method also influences nursing and support staff. Having dedicated FT resources can be a cost-saving strategy because it ensures higher-paid resources are working at the upper limit of their credentials and available for treating more complex or critical cases.

What tools and resources can help set the right ER staffing mix?

An important resource for ER managers is a high-quality EHR system. Many of the market-leading EHRs are equipped (or compatible) with tools that can generate predictions about staffing needs. Using technology in this manner helps managers move away from reactive scheduling and toward proactive, data-driven staffing practices.

Curious About Other Staffing Strategies?

Ensuring an appropriate ED staffing model is in use at your facility might involve integrating new technology, onboarding new staff, or dialing in your recruitment strategies. Keep current with industry-leading staffing best practices, and more, with our latest healthcare insights and recommendations.