Image Credit: ILLUSTRATION/PAUL JUESTRICH; PHOTOs shutterstock.com

There is considerable variation in the staff that provide patient care in American EDs. The Emergency Department Benchmarking Alliance (EDBA) has hosted three summits to develop the most effective definitions of staffing and markers of care. The definitions are completed and published and are being used in the annual EDBA survey.¹ The definitions developed by the EDBA consider four classes of ED staff: physicians, advanced practice providers (APPs), nurses (not differentiating the various levels of staff nurses), and the group composed of personnel who function in technical and clerical roles. For the computation of clinical performance, the EDBA collects data on daily staffing of these groups only counting those who are in a patient-care function.

For the last five years, the data have tallied the scheduled number of work hours in an average day for nurses, techs, clerks, physicians, and APPs. Counting the hours allows a calculation of productivity for each of these groups. All have been calculated using the same mathematical formula: number of ED patients visiting the ED on an average day divided by the number of scheduled hours for persons in a clinical role in an average day. It’s a common calculation for physician productivity.

Many emergency physicians have documented the loss of productivity and difficulties in patient flow when information systems do not support the role of physicians and APPs.

At the initiation of the EDBA studies 21 years ago, it was necessary to develop a formula that allowed comparison of staffing ratios where APPs were working in collaboration with emergency physicians (most patients seen with a physician rather than without). At that time, the shared role of ED patient management by physicians and APPs did not allow the same level of productivity of APPs as physicians. So in calculating the overall productivity of the licensed independent practitioners (physicians plus APPs) in an ED, the APP hours were assigned a factor of 0.5 the number of physician hours.

Example: An ED sees an average of 100 patients a day and uses 40 scheduled physician hours and 20 scheduled APP hours.

The calculation of physician productivity is 100 patients divided by 40 hours, or 2.5 patients per physician hour.

The calculation of licensed independent practitioner productivity is 100 patients divided by (40 physician hours + 20 APP hours multiplied by a factor of 0.5), or 100 divided by (40 + 10), equaling 2.0 patients per hour.