You are correct that this issue has come up before. I presume you are
talking about physician shortage. Before you commit to a back up plan
please be sure that indeed the bottlenecks during high volume census are
due to physician shortage. It is my experience that there may be issues
like nursing shortage, laboratory delays, RT shortage, admission process
delays (room availability problems,floor resident team issues...
),discharge delays and last but not the least radiology delays, that tended
to play a significant role.
May I suggest to you, if you have not already, that during a representative
high volume census period, you do a "time motion" study either
retrospective or prospective in conjunction with administration. You may
be surprised at what you find and when you have some objective time data,
your case with administration will be stronger.
I believe there should be benchmarks/goals that every department should
meet. For eg, after a bed request has been made the patient should be up on
the floor in 30 minutes; All stat lab/radiology turnaround in an hour;
provider to evaluate every patient within 30 min of being in the room;
providers should have discharge capabilities from the room without always
having nursing paperwork added on after the discharge order is signed; fast
tracking every admission with orders within 30 minutes with full HNP done
on the floor......
An average ED would admit 10-20 % of their patients. This means 1 out of
every 5-10 patients could potentially hold up the room for hours if the
admission process is delayed!! It all adds up. I am not sure by adding more
providers the wait times are going to be automatically reduced.
Would love to hear the details of the issues in your ED since I work in a
free standing Children's Hospital myself.
Jay Pershad, MD
Le Bonheur Children's Medical Center
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