Thursday, April 28, 2011

Shock Absorbers in an ER

In an Emergency Room, it's pretty hard to control the volume and acuity of patients coming in the door.  Variation is inevitable.  It's like riding down an old dirt road--you have some smooth spots and some bumpy spots.  That's why our cars come with shock absorbers.

What is our shock absorber in an ER?
How do we mitigate the effect of variation in patient volume and acuity?  Sometimes, we take the wasteful but safe approach of over-staffing.  Or, we might look at the measures of central tendency and variability in our patient volumes and acuity, and come up with a staffing model that is both statistically reliable and much less wasteful than blunt force over-staffing.

Being able to absorb the shock of uncontrollable patient volumes and acuities is especially critical if an ER is attempting to go to a cellular flow model.  In this model, you might try to even out the variation by distributing patients to the multiple cells evenly.  This works well as long as the cells are equipped for all patient types.

If, however, a certain type of patient can only be seen in a certain cell, and a bunch of those patients come in at the same time, then we have a big problem.  In this circumstance, we need a different kind of shock absorber, perhaps flex resources (doctors, nurses, etc.) that are not assigned to a single cell, but that can flow to where they're needed.  Of course, in the long-term, we should try to even out the capabilities of the cells so that this whole issue is moot.

Whether it's through blunt force over-staffing, statistically sound staffing, level loading to cells, flowing flex resources to unleveled cells, or evening out of cell capabilities, we absolutely must have a way to ride over the bumpy spots in the road.  We have to have a shock absorber.