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Benchmarking ED staffing: ENA’s new database helps
GuestEditorial Benchmarking EDstaffing: EM’s newdatabase helps George D. Velianoff,
I
am happy to respond to the request from the Journal of Emergency Nursing to explain ENA’s justreleased ED staffing benchmark and guide. In today’s world of the Balanced Budget Act, staff reductions, competition, and evidence-based outcomes, any benchmarking data that provide health care organizations with some guide to measure their performance on quality, productivity, and efficiency measures are welcome,d. Many benchmark databases consist of small data sets with widely varied sample departments, and trying to compare your department with others in those databases has been quite difficult, .until now. In October 1999, at its Annual Meeting, ENA released the National Emergency Department Benchmark Database and StaITing Guide to help emergency departments justify and preserve quality and efficiency outcomes. The database comprises results from a research-based survey that gathered data from more than 1500 emergency departments across the United States. Data were drawn from facilities of every size-from small rural hospitals to large tertiary care urban medical centers. The database contains a wealth of information about full-time equivalent (FTE) positions, skill mix, patient mix, length of stay, size of departments, average registered nurse (RN) hours per visit, and total direct care-worked hours per visit. In addition, a staffing guideline and formula chapter were created and added to the book to help emergency departments compare their own department with other comparable emergency departments on the basis of FTEs and skill mix. Examples of how to calculate the number of nurses needed per day-FTEs of RNs, George D. Velianoff is Deputy Executive Director of Nursing vices, ENA, Des Plaines, Ill. J Emerg Nurs 2000;26:5. Copyright 0 2000 by the dmergency Nurses Association. 0099-1767/2000 $12.00 t,d 18/81/103736
Ser-
RN, DNS, CHE, Des Plaines, .
111
aides/technicians, and licensed vocational nursesare given, with step-by-step instructions. In addition, the guidelines explain how to compare your results with those of other similar emergency departments. The benchmark data and staffing guideline included in this book are just a start. They do not, .of course, answer the question, “Is this enough staff?” This question can only be answered by a study involving several emergency departments nationwide that would look at numbers of staff members and staff mix. Through a research project, an objective, scientific approach could be applied to the question of appropriate staffing. We know that each department is different, each locale is different, and each population served is different, but we could set parameters to determine appropriate staffing for various environments. Such a project would not be a short or simple study. In the meantime, ENA has compiled a valid database that can offer some help in guiding determination of ED staffing numbers. The National Emergency Department Benchmark Database and StaIiFing Guide and the National Emergency Department Database Report (the latter is the entire unabridged survey results) are available from ENA. Summarizing the entire database and the staffing guide in an editorial is difficult, but in my role as the Deputy Executive Director of Nursing at ENA, I am always available to discuss our data, the formulas used, or the methodology with any ED nurse manager, vice president for nursing, or chief financial officer. I can be reached at the national office ([800]900-9659) or through E-mail at gvelianoffQena.org. I would like to finish by quoting one finding from the survey: “Waiting time to treatment increases as the number of RNs decreases. Even when ancillary, unlicensed personnel numbers increase, wait times are still longer than those with higher RN numbers.” Is anyone interested in patient satisfaction with wait times?
February 2000 5
I
am happy to respond to the request from the Journal of Emergency Nursing to explain ENA’s justreleased ED staffing benchmark and guide. In today’s world of the Balanced Budget Act, staff reductions, competition, and evidence-based outcomes, any benchmarking data that provide health care organizations with some guide to measure their performance on quality, productivity, and efficiency measures are welcome,d. Many benchmark databases consist of small data sets with widely varied sample departments, and trying to compare your department with others in those databases has been quite difficult, .until now. In October 1999, at its Annual Meeting, ENA released the National Emergency Department Benchmark Database and StaITing Guide to help emergency departments justify and preserve quality and efficiency outcomes. The database comprises results from a research-based survey that gathered data from more than 1500 emergency departments across the United States. Data were drawn from facilities of every size-from small rural hospitals to large tertiary care urban medical centers. The database contains a wealth of information about full-time equivalent (FTE) positions, skill mix, patient mix, length of stay, size of departments, average registered nurse (RN) hours per visit, and total direct care-worked hours per visit. In addition, a staffing guideline and formula chapter were created and added to the book to help emergency departments compare their own department with other comparable emergency departments on the basis of FTEs and skill mix. Examples of how to calculate the number of nurses needed per day-FTEs of RNs, George D. Velianoff is Deputy Executive Director of Nursing vices, ENA, Des Plaines, Ill. J Emerg Nurs 2000;26:5. Copyright 0 2000 by the dmergency Nurses Association. 0099-1767/2000 $12.00 t,d 18/81/103736
Ser-
RN, DNS, CHE, Des Plaines, .
111
aides/technicians, and licensed vocational nursesare given, with step-by-step instructions. In addition, the guidelines explain how to compare your results with those of other similar emergency departments. The benchmark data and staffing guideline included in this book are just a start. They do not, .of course, answer the question, “Is this enough staff?” This question can only be answered by a study involving several emergency departments nationwide that would look at numbers of staff members and staff mix. Through a research project, an objective, scientific approach could be applied to the question of appropriate staffing. We know that each department is different, each locale is different, and each population served is different, but we could set parameters to determine appropriate staffing for various environments. Such a project would not be a short or simple study. In the meantime, ENA has compiled a valid database that can offer some help in guiding determination of ED staffing numbers. The National Emergency Department Benchmark Database and StaIiFing Guide and the National Emergency Department Database Report (the latter is the entire unabridged survey results) are available from ENA. Summarizing the entire database and the staffing guide in an editorial is difficult, but in my role as the Deputy Executive Director of Nursing at ENA, I am always available to discuss our data, the formulas used, or the methodology with any ED nurse manager, vice president for nursing, or chief financial officer. I can be reached at the national office ([800]900-9659) or through E-mail at gvelianoffQena.org. I would like to finish by quoting one finding from the survey: “Waiting time to treatment increases as the number of RNs decreases. Even when ancillary, unlicensed personnel numbers increase, wait times are still longer than those with higher RN numbers.” Is anyone interested in patient satisfaction with wait times?
February 2000 5