Creative ED Staffing Model:

Physician-Nurse Teams

Darin Pangalangan, MD, FACEP

Introduction

As volumes increase in Emergency Departments, all resources, nurses, physicians, lab, radiology, etc. are pushed to new limits. Often increases in volume can reach a point where current systems can no longer keep up with the demands despite ongoing efforts to modify and adapt. Under such circumstances it is sometimes necessary to change the infrastructure of a system to accommodate the changing environment.

The concept of using teams to facilitate efficiency and productivity is not new. Different applications of the team concept are used throughout the military, in business, as well as in hospitals. Applying it to the dynamic environment of a busy Emergency Department with the complex interactions of multiple physicians, nurses, and technicians can add a sense of order and continuity to an otherwise hectic environment.

 

Objectives

  1. Evaluate the shortcomings of traditional Emergency Department staffing
  2. Discuss the evolution and implementation of the team concept through team trials
  3. Present practical application of team concept in Emergency Department staffing
  4. Review the process and benefits of team concept

Discussion

  1. Evolution of concept results from limitations of traditional system
  2. Traditional staffing by geographic zones
    1. Nurses caring for patients of up to 3 physicians
    2. Accountability an issue among nurses, technicians
    3. Patient care plan is difficult to communicate
    4. Physician may have up to 14 different nurses caring for patients
  1. Introducing the "team concept"
    1. Effort to improve communication
    2. Advocate patient care
    3. Facilitate patient flow
    4. Improve job satisfaction
    5. Mandatory orientation
  1. Team concept barriers
    1. Physician practice styles
    2. Nurse practice styles
    3. Personalities
    4. Culture
  1. Team Trial #1
    1. One physician
    2. Three overstaffed nurses
    3. One shift
  1. Team Trial #2
    1. Two physicians
    2. Six overstaffed nurses
    3. Two consecutive shifts
  1. Team Trial #3
    1. Three physicians
    2. Normal nurse staffing
    3. Three concurrent shifts
    4. Entire department in teams
  1. Team Trial #4
    1. Six physicians
    2. Normal nurse staffing
    3. 24 hour period
  1. Team Trial #5
    1. Seven physicians
    2. Normal nurse staffing
    3. 24 hour period
    4. Modified, coordinating physician and nurse shifts

Summary

  1. Team concept beneficial in ED environment
  2. Cultural issues difficult barrier, gradual introduction
  3. Team player capabilities quickly exposed
  4. Improved patient care, flow, and physician-nursing efficiency and communication
  5. "Don’t want to work the old way anymore"

 

CONTACT INFORMATION

Darin Pangalangan, MD, FACEP

Miami Valley Hospital ETC

1 Wyoming St.

Dayton, OH 45409

(937) 208-3356