“Finding the Emergency Department Staffing "Sweet Spot" through use of Benchmarking”

Purpose:
Achieving optimal staffing levels in the emergency department (ED) is difficult due to the many factors involved in determining the proper number and level of staff required. Through benchmarking with similar hospitals, comparisons can be made to help develop an ED staffing plan.

Significance:
Proper ED staffing is a patient a safety issue. Inadequate staffing, or having less capacity than demand, can lead to lack of ability to provide timely care to critical patients and poor patient satisfaction. Over staffing the ED, having more capacity than demand, leads to additional staffing cost.

Strategy and Implementation:
After a large construction project and shifting in volumes and acuity, there was an increased concern from the nursing staff regarding staffing for the volumes, acuity and physical space of the new ED. Additionally, initial benchmarking received from the finance department determined that the ED staffing was not in line with other children's hospitals and that the ED was actually overstaffed in spite of the perception of understaffing by nursing. In order to determine proper staffing levels, an analysis was performed utilizing visit statistics and one-on-one interviewing with children's hospital ED Directors nationwide using a template of questions. The information was gathered and evaluated by ED leadership to develop a new ED staffing plan. The new plan addressed shifts in volume and acuity by time of day and shifts in required skill levels of staff. Additionally, working with finance, a new peer group was determined for staffing benchmarks and financial performance metrics.

Evaluation:
Staffing evaluation is ongoing. Nurse interviews to determine satisfaction and staffing level comfort shows more satisfaction and less concern of staffing safety issues. Staff perceptions are tracked by NDNQI and IWPS-R surveys. ED volume and acuity trends are evaluated to determine demand shifts.

Implications for Practice:
Maintaining adequate staffing in the ED without overstaffing leads to increased nursing job satisfaction and decreased patient events. Additionally, keeping staffing levels on par with demand can decrease overall staffing cost and improve departmental margin.