• Bryan A Stenson, Joshua W Joseph, Peter S Antkowiak, David T Chiu, and Leon D Sanchez.
• Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: bstenson@bidmc.harvard.edu.
• J Emerg Med. 2021 Sep 1; 61 (3): 336-343.

BackgroundStaffing and provider capacity are essential components of emergency department (ED) throughput. Patient flow is dependent on matching patient arrivals with provider capacity. Current models assume a static rate of patients per hour for providers; however, this metric has been shown to decrease throughout a shift in a pattern we describe as a staircase.ObjectiveWe sought to analyze the demand capacity mismatch based on both a static and staircase model of resident productivity. We then suggest a new staggered staffing model that would improve flow in the ED.MethodsThis was a retrospective analysis of patient demand and productivity, analyzing both static and staircase models of provider capacity. An alternative staggered shift model was then suggested, and a 2-sample t test was performed to assess if a new model reduces the amount of demand/capacity mismatch.ResultsSeventeen thousand five hundred twenty data points were analyzed over the 2-year interval, comparing the difference between actual patients placed into a treatment space at each hour and projected resident capacity based on the staircase model, using both the existing schedule and a new staggered schedule. Mean absolute values for the disparity in coverage was 2.69 (95% confidence interval 2.65-2.72) for the staircase scheduling model, and 2.14 (95% confidence interval 2.12-2.17) when staggering provider start times. The mean difference between these data sets was 0.54 (95% confidence interval 0.52-0.57; p < 0.0001).ConclusionsAcademic EDs may find value in using a staircase model to analyze provider capacity because it is more reflective of actual capacity. EDs may benefit from visualizing their capacity curves to identify mismatches and staggering resident shifts to improve throughput and flow.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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