Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units(ICUs) and provide focused, high quality care ...Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units(ICUs) and provide focused, high quality care to critically ill patients. However, these ICUs were traditionally managed by primary physicians who used to admit patients in ICUs under their own care. The presence of specially trained intensivists in these ICUs has started a "turf" war. In spite of the availability of overwhelming evidence that intensivists-based ICUs can provide better patient care leading to improved outcome, there is hesitancy among hospital administrators and other policy makers towards adopting such a model. Major critical care societies and workgroups have recommended intensivists-based ICU models to care for critically ill patients, but even in developed countries, on-site intensivist coverage is lacking in a great majority of hospitals. Lack of funds and unavailability of skilled intensivists are commonly cited as the main reasons for not implementing intensivist-led ICU care in most of the ICUs. To provide optimal, comprehensive and skilled care to this severely ill patient population, it is imperative that a multi-disciplinary team approach must be adopted with intensivists as in-charge. Even though ICU organization and staffingmay be determined by hospital policies and other local factors, all efforts must be made to attain the goal of having round-the-clock onsite intensivist coverage to ensure continuity of specialized care for all critically ill patients.展开更多
Based on probing into the literature on multinational enterprise (MNE) staffing, we set up a concept model for MNEs’ subsidiary staffing by two groups of influencing factors: the national differences bwteen the paren...Based on probing into the literature on multinational enterprise (MNE) staffing, we set up a concept model for MNEs’ subsidiary staffing by two groups of influencing factors: the national differences bwteen the parent country and the host country, and the strategies employed by MNEs. We also tested the model and proposed propositions by a sample evaluation method, specifically with 1 000 copies of questionnaires given out to managers or directors of MNEs’ subsidiaries in China Mainland and resulting in 151 sets of valid answers. The empirical study supports that national differences between the parent country and the host country and the strategies employed by MNEs do have impact on the subsidiary staffing, and MNE headquarters should make different staffing plans according to the difference of nations and strategies. We welcome testing our model by peer researchers in other country.展开更多
Background: Academic anesthesia departments are under increasing financial pressure. Many struggle to integrate the priorities of their academic and clinical missions. Previous studies have documented increasing need ...Background: Academic anesthesia departments are under increasing financial pressure. Many struggle to integrate the priorities of their academic and clinical missions. Previous studies have documented increasing need for monetary institutional support of academic anesthesia departments. In view of current economic and legislative circumstances, it is arguable that the need for support will grow. This survey demonstrates that staffing issues, which are most likely engendered by financial circumstances, have impacted academic anesthesia departments in the United States to the point of having deleterious effects upon clinical safety and resident education.Methods: After IRB approval, we electronically solicited the anonymous response to a 23 question survey from all 133 chairpersons of academic anesthesia departments in the United States. Results: Sixty-two responded electronically, for an overall response rate of 46.6%. Conclusion: The results of this survey suggest that academic anesthesia departments are being financially stressed to the point that education and patient care are affected.展开更多
The nursing shortage is a global issue that because there is a growing consensus that identifying flaws and opportunities for improving the working environment in hospital is vital to maintain positive patient outcome...The nursing shortage is a global issue that because there is a growing consensus that identifying flaws and opportunities for improving the working environment in hospital is vital to maintain positive patient outcomes, adequate staffing, high-quality care, nurses’ job satisfaction and hence their retention. The aim of this study was to explore the staffing and resource adequacy in NPE and the association with POs (adverse events). A descriptive correlational study was conducted and participated 395 staff nurses (94.3%) from three university hospitals in Malaysia over two months, from January to February 2011. In this paper, the results showed that 344 (87.1%) staff nurses rated that was unfavorable (展开更多
An assessment of staffing and training needs for effective delivery of extension services in mainstreaming sustainable land management (SLM) practices in Kilimanjaro Region was conducted in June/July 2013. Data collec...An assessment of staffing and training needs for effective delivery of extension services in mainstreaming sustainable land management (SLM) practices in Kilimanjaro Region was conducted in June/July 2013. Data collection methods included discussions with key informants at the regional and district levels, consultations with village level stakeholders and potential collaborators, review of human resources data both at regional, district and ward levels and collection of individual staff bio-data including capacity deficiencies. The staffing situation at the regional and district levels was considered to be adequate for effective mainstreaming of SLM interventions in the region. Staffing at ward and village levels was very poor and largely inadequate for sustainable execution of extension services. It is optimistically estimated that on average the staffing at ward level needs to be increased by at least 50%. In some districts the deficiency of extension staff at ward level was as high as 80%. Training needs exist at all levels from the region down to community level. At the regional and district levels both long and short term training programs were required. At the community level required training is more practical and purely focused in mainstreaming SLM interventions at individual households and community lands. Potential collaborators with local government were identified in four main categories namely, NGOs/CBOs, private sector, government departments and faith-based organizations. The study recommends a capacity building program on specific knowledge gaps identified at regional, district, ward and village levels. The study further recommends that immediate measures need to be taken by the district authorities to address the staffing problem at ward level including recruitment of volunteers and developing collaboration framework with identified potential partners.展开更多
Intensive care medicine remains one of the most costdriving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel st...Intensive care medicine remains one of the most costdriving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks(performed in every patient) and additional tasks(necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society ofAnesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.展开更多
Background:Nigeria faces health workforce challenges and poor population health indices resulting from disparities in health worker densities by geographical locations and levels of health care delivery.Nigeria is con...Background:Nigeria faces health workforce challenges and poor population health indices resulting from disparities in health worker densities by geographical locations and levels of health care delivery.Nigeria is constantly reforming its health system with the primary aim of having the right number of health workers in the right place at the right time to meet the population’s health needs.The majority of primary health facilities in the country are staffed using perceived needs.The Workload Indicators of Staffing Need(WISN)tool developed by the World Health Organization is used to determine staffing requirements for facilities.Methods:The WISN tool was used in assessing the staffing requirements for nurses/midwives and community health practitioners in 26 primary health facilities in Port Harcourt City Local Government Area(PHALGA)and Obio Akpor Local Government Area(OBALGA).Documents were reviewed to obtain information on working conditions and staffing,and interviews conducted with key informants in 12 randomly selected facilities.We supported an expert working group that comprised of nurses/midwives and community health practitioners to identify workload components and activity standards and validate both.We also retrieved workload data from January 1-December 31,2015 from the national district health information system.Results:Findings showed varying degrees of shortages and inequitable distribution of health workers.Health facilities in PHALGA had a WISN ratio of 0.63 and a shortage of 31 nurses/midwives.There was also a shortage of 12 community health practitioners with a WISN ratio of 0.85.OBALGA had a shortage of 50 nurses/midwives and 24 community health practitioners;and WISN ratios of 0.60 and 0.79 for nurses/midwives and community health practitioners respectively.Conclusion:Our findings provide evidence for policies that will help Nigeria improve the population’s access to quality health services and reduce inequities in distribution of the health workforce.Evidence-based health workforce planning and redistribution using WISN should be institutionalized.Review of scopes of practice of health workforce should be conducted periodically to ensure that the scope of practice matches the training received by the specific cadres and those skills are used to deliver quality services.展开更多
A queueing model of the Markov-modulated Poisson process (MMPP) with thresholds was investigated. The customer arrival with various arrival rates in the model was viewed as the MMPP. In contrast to the Poisson, s arri...A queueing model of the Markov-modulated Poisson process (MMPP) with thresholds was investigated. The customer arrival with various arrival rates in the model was viewed as the MMPP. In contrast to the Poisson, s arrival process, the MMPP can better describe the situation that the arrival rate changes with changing conditions;therefore, the model fits better with reality. The threshold conversion was added to the model based on the general MMPP/M/C model. When the number of customers in the system exceeds a threshold, all servers work to serve;when the number of customers in the system is less than another threshold, some servers are shut down. This is the congestion-based staffing policy with two thresholds. Specifically, the problems in the slab stocking stage of slab production at the Iron and Steel Complex in China were analysed. In the slab production process, because the rate of the upstream steelmaking is not constant, the rate of slab reaching the slab yard is uncertain. The crane service is used to store slabs in a warehouse. Because the slab arrival rate varies, different numbers of cranes in service need to be optimized for cost control. Thus, MMPP was used to describe slab arrival with varied arrival rates. Therefore, an MMPP/M/C queue with thresholds was used to analyse and solve the practical problems, and the optimal number of service cranes was obtained to minimize the cost of slab stocking.展开更多
从铅的生产、铅制品的加工制造、铅制品的使用和废杂铅的处理等阶段详细地阐述了铅循环的'STAF(stocks and flows)'物质流分析模型.运用此模型分析了2006年我国铅的社会存量变化及其流动状况,并且计算出2000—2006年几项重要指...从铅的生产、铅制品的加工制造、铅制品的使用和废杂铅的处理等阶段详细地阐述了铅循环的'STAF(stocks and flows)'物质流分析模型.运用此模型分析了2006年我国铅的社会存量变化及其流动状况,并且计算出2000—2006年几项重要指标的平均值分别为:生产阶段的原料自给率PZ=79.28%;生产阶段使用废杂铅的比例PS=19.08%;加工制造阶段的原料自给率MZ=148.91%;加工制造阶段使用废杂铅的比例MS=30.25%;矿石指数R=0.834 9;废铅指数S=0.194 9.在此基础上总结了我国在铅资源循环利用方面的不足,并对铅工业的发展和资源的循环利用提出建议.展开更多
目的评价STAF评分(score for the targeting of atrial fibrillation,STAF)筛查缺血性卒中患者心房颤动(atrial fibrillation,AF)的诊断价值。方法为单中心、回顾性研究,连续收集年龄≥18岁、发病7 d内、经头颅MR/CT证实的缺血性卒中患...目的评价STAF评分(score for the targeting of atrial fibrillation,STAF)筛查缺血性卒中患者心房颤动(atrial fibrillation,AF)的诊断价值。方法为单中心、回顾性研究,连续收集年龄≥18岁、发病7 d内、经头颅MR/CT证实的缺血性卒中患者,收集其基本临床特征、入院首次美国国立卒中卫生院卒中评分量表(the Na tional Institute of Health stroke scale,NIHSS)评分、心脏彩超结果、经典TOAST(Trial of Org 10172 in Acute Stroke Treatment)分型、既往史、12导联心电图(electrocardiogram,ECG)、24小时动态心电图(24h-Holter)、心电监护结果并进行STAF评分。绘制受试者工作特征(receiver operator characteristic,ROC)曲线确定STAF诊断房颤的界值,分析其诊断价值。结果共收集患者219例,STAF评分诊断房颠的ROC曲线下面积(area under the curve,AUC)为0.901。以STAF≥5分作为界值,STAF评分的灵敏度为97.37%,特异度为70.72%。结论初步发现STAF评分对缺血性卒中患者具有较好的诊断价值,仍需进一步研究验证。展开更多
BACKGROUND:Patients backlogged in the emergency department(ED) waiting for an inpatient bed(boarders) continue to require the attention of ED physicians,exacerbating crowding in the ED.To address this problem,we added...BACKGROUND:Patients backlogged in the emergency department(ED) waiting for an inpatient bed(boarders) continue to require the attention of ED physicians,exacerbating crowding in the ED.To address this problem,we added a "float shift" to our winter schedule solely to care for boarders.We sought to quantify the effect of this float shift,hypothesizing greater physician productivity.METHODS:We performed a retrospective observational study in our community hospital ED,measuring the number of new patients seen in each 10-hour shift in the presence or absence of a float shift physician.We calculated the number of new patients seen per shift for each of the 7 daily shifts,during February(float shift scheduled) and May(float shift unscheduled) of 2008.We then compared the mean number of patients seen per shift in February with May.RESULTS:Total monthly patient volume was 6 656 for February and 6 775 for May,with the mean daily census being 230 and 219 patients,respectively.The number of new patients seen during each shift was greater in February than in May,with a mean increase of 1.1 patients per shift(with the float shift).Surveying participants about intervention effectiveness showed 92%of residents,but only 65%of attending physicians,in favor of maintaining the float shift.CONCLUSION:The presence of a "float shift" physician caring only for boarding patients allows other physicians to maintain and even increase their productivity in our ED,despite the presence of longer throughput times and increased time on diversion.展开更多
文摘Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units(ICUs) and provide focused, high quality care to critically ill patients. However, these ICUs were traditionally managed by primary physicians who used to admit patients in ICUs under their own care. The presence of specially trained intensivists in these ICUs has started a "turf" war. In spite of the availability of overwhelming evidence that intensivists-based ICUs can provide better patient care leading to improved outcome, there is hesitancy among hospital administrators and other policy makers towards adopting such a model. Major critical care societies and workgroups have recommended intensivists-based ICU models to care for critically ill patients, but even in developed countries, on-site intensivist coverage is lacking in a great majority of hospitals. Lack of funds and unavailability of skilled intensivists are commonly cited as the main reasons for not implementing intensivist-led ICU care in most of the ICUs. To provide optimal, comprehensive and skilled care to this severely ill patient population, it is imperative that a multi-disciplinary team approach must be adopted with intensivists as in-charge. Even though ICU organization and staffingmay be determined by hospital policies and other local factors, all efforts must be made to attain the goal of having round-the-clock onsite intensivist coverage to ensure continuity of specialized care for all critically ill patients.
文摘Based on probing into the literature on multinational enterprise (MNE) staffing, we set up a concept model for MNEs’ subsidiary staffing by two groups of influencing factors: the national differences bwteen the parent country and the host country, and the strategies employed by MNEs. We also tested the model and proposed propositions by a sample evaluation method, specifically with 1 000 copies of questionnaires given out to managers or directors of MNEs’ subsidiaries in China Mainland and resulting in 151 sets of valid answers. The empirical study supports that national differences between the parent country and the host country and the strategies employed by MNEs do have impact on the subsidiary staffing, and MNE headquarters should make different staffing plans according to the difference of nations and strategies. We welcome testing our model by peer researchers in other country.
文摘Background: Academic anesthesia departments are under increasing financial pressure. Many struggle to integrate the priorities of their academic and clinical missions. Previous studies have documented increasing need for monetary institutional support of academic anesthesia departments. In view of current economic and legislative circumstances, it is arguable that the need for support will grow. This survey demonstrates that staffing issues, which are most likely engendered by financial circumstances, have impacted academic anesthesia departments in the United States to the point of having deleterious effects upon clinical safety and resident education.Methods: After IRB approval, we electronically solicited the anonymous response to a 23 question survey from all 133 chairpersons of academic anesthesia departments in the United States. Results: Sixty-two responded electronically, for an overall response rate of 46.6%. Conclusion: The results of this survey suggest that academic anesthesia departments are being financially stressed to the point that education and patient care are affected.
文摘The nursing shortage is a global issue that because there is a growing consensus that identifying flaws and opportunities for improving the working environment in hospital is vital to maintain positive patient outcomes, adequate staffing, high-quality care, nurses’ job satisfaction and hence their retention. The aim of this study was to explore the staffing and resource adequacy in NPE and the association with POs (adverse events). A descriptive correlational study was conducted and participated 395 staff nurses (94.3%) from three university hospitals in Malaysia over two months, from January to February 2011. In this paper, the results showed that 344 (87.1%) staff nurses rated that was unfavorable (
文摘An assessment of staffing and training needs for effective delivery of extension services in mainstreaming sustainable land management (SLM) practices in Kilimanjaro Region was conducted in June/July 2013. Data collection methods included discussions with key informants at the regional and district levels, consultations with village level stakeholders and potential collaborators, review of human resources data both at regional, district and ward levels and collection of individual staff bio-data including capacity deficiencies. The staffing situation at the regional and district levels was considered to be adequate for effective mainstreaming of SLM interventions in the region. Staffing at ward and village levels was very poor and largely inadequate for sustainable execution of extension services. It is optimistically estimated that on average the staffing at ward level needs to be increased by at least 50%. In some districts the deficiency of extension staff at ward level was as high as 80%. Training needs exist at all levels from the region down to community level. At the regional and district levels both long and short term training programs were required. At the community level required training is more practical and purely focused in mainstreaming SLM interventions at individual households and community lands. Potential collaborators with local government were identified in four main categories namely, NGOs/CBOs, private sector, government departments and faith-based organizations. The study recommends a capacity building program on specific knowledge gaps identified at regional, district, ward and village levels. The study further recommends that immediate measures need to be taken by the district authorities to address the staffing problem at ward level including recruitment of volunteers and developing collaboration framework with identified potential partners.
基金Supported by the German Association of Anaesthesiologists(BDA)the German Society of Anaesthesiology and Intensive Care Medicine(DGAI),in that BDA and DGAI sponsored meetings of the working group"personnel management"to create the physician staffing tools 2008 and 2012.Weiss M,Marx G and Iber T are members of the working group"personnel management of BDA and DGAI"
文摘Intensive care medicine remains one of the most costdriving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks(performed in every patient) and additional tasks(necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society ofAnesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.
基金funded by the United States Agency for International Development(USAID)(Associate Cooperative Agreement#AID-620-LA−15-00002).
文摘Background:Nigeria faces health workforce challenges and poor population health indices resulting from disparities in health worker densities by geographical locations and levels of health care delivery.Nigeria is constantly reforming its health system with the primary aim of having the right number of health workers in the right place at the right time to meet the population’s health needs.The majority of primary health facilities in the country are staffed using perceived needs.The Workload Indicators of Staffing Need(WISN)tool developed by the World Health Organization is used to determine staffing requirements for facilities.Methods:The WISN tool was used in assessing the staffing requirements for nurses/midwives and community health practitioners in 26 primary health facilities in Port Harcourt City Local Government Area(PHALGA)and Obio Akpor Local Government Area(OBALGA).Documents were reviewed to obtain information on working conditions and staffing,and interviews conducted with key informants in 12 randomly selected facilities.We supported an expert working group that comprised of nurses/midwives and community health practitioners to identify workload components and activity standards and validate both.We also retrieved workload data from January 1-December 31,2015 from the national district health information system.Results:Findings showed varying degrees of shortages and inequitable distribution of health workers.Health facilities in PHALGA had a WISN ratio of 0.63 and a shortage of 31 nurses/midwives.There was also a shortage of 12 community health practitioners with a WISN ratio of 0.85.OBALGA had a shortage of 50 nurses/midwives and 24 community health practitioners;and WISN ratios of 0.60 and 0.79 for nurses/midwives and community health practitioners respectively.Conclusion:Our findings provide evidence for policies that will help Nigeria improve the population’s access to quality health services and reduce inequities in distribution of the health workforce.Evidence-based health workforce planning and redistribution using WISN should be institutionalized.Review of scopes of practice of health workforce should be conducted periodically to ensure that the scope of practice matches the training received by the specific cadres and those skills are used to deliver quality services.
基金We thank the referees and editors, whose comments significantly helped the presentation and analysis in this paperThis work is supported by the National Key Research and Development Program of China (2016YFB0901900)+2 种基金the Fund for Innovative Research Groups of the National Natural Science Foundation of China (71621061)the Major International Joint Research Project of the National Natural Science Foundation of China (71520107004)the Major Program of National Natural Science Foundation of China (71790614) and the 111 Project (Bl6009).
文摘A queueing model of the Markov-modulated Poisson process (MMPP) with thresholds was investigated. The customer arrival with various arrival rates in the model was viewed as the MMPP. In contrast to the Poisson, s arrival process, the MMPP can better describe the situation that the arrival rate changes with changing conditions;therefore, the model fits better with reality. The threshold conversion was added to the model based on the general MMPP/M/C model. When the number of customers in the system exceeds a threshold, all servers work to serve;when the number of customers in the system is less than another threshold, some servers are shut down. This is the congestion-based staffing policy with two thresholds. Specifically, the problems in the slab stocking stage of slab production at the Iron and Steel Complex in China were analysed. In the slab production process, because the rate of the upstream steelmaking is not constant, the rate of slab reaching the slab yard is uncertain. The crane service is used to store slabs in a warehouse. Because the slab arrival rate varies, different numbers of cranes in service need to be optimized for cost control. Thus, MMPP was used to describe slab arrival with varied arrival rates. Therefore, an MMPP/M/C queue with thresholds was used to analyse and solve the practical problems, and the optimal number of service cranes was obtained to minimize the cost of slab stocking.
文摘从铅的生产、铅制品的加工制造、铅制品的使用和废杂铅的处理等阶段详细地阐述了铅循环的'STAF(stocks and flows)'物质流分析模型.运用此模型分析了2006年我国铅的社会存量变化及其流动状况,并且计算出2000—2006年几项重要指标的平均值分别为:生产阶段的原料自给率PZ=79.28%;生产阶段使用废杂铅的比例PS=19.08%;加工制造阶段的原料自给率MZ=148.91%;加工制造阶段使用废杂铅的比例MS=30.25%;矿石指数R=0.834 9;废铅指数S=0.194 9.在此基础上总结了我国在铅资源循环利用方面的不足,并对铅工业的发展和资源的循环利用提出建议.
文摘目的评价STAF评分(score for the targeting of atrial fibrillation,STAF)筛查缺血性卒中患者心房颤动(atrial fibrillation,AF)的诊断价值。方法为单中心、回顾性研究,连续收集年龄≥18岁、发病7 d内、经头颅MR/CT证实的缺血性卒中患者,收集其基本临床特征、入院首次美国国立卒中卫生院卒中评分量表(the Na tional Institute of Health stroke scale,NIHSS)评分、心脏彩超结果、经典TOAST(Trial of Org 10172 in Acute Stroke Treatment)分型、既往史、12导联心电图(electrocardiogram,ECG)、24小时动态心电图(24h-Holter)、心电监护结果并进行STAF评分。绘制受试者工作特征(receiver operator characteristic,ROC)曲线确定STAF诊断房颤的界值,分析其诊断价值。结果共收集患者219例,STAF评分诊断房颠的ROC曲线下面积(area under the curve,AUC)为0.901。以STAF≥5分作为界值,STAF评分的灵敏度为97.37%,特异度为70.72%。结论初步发现STAF评分对缺血性卒中患者具有较好的诊断价值,仍需进一步研究验证。
文摘BACKGROUND:Patients backlogged in the emergency department(ED) waiting for an inpatient bed(boarders) continue to require the attention of ED physicians,exacerbating crowding in the ED.To address this problem,we added a "float shift" to our winter schedule solely to care for boarders.We sought to quantify the effect of this float shift,hypothesizing greater physician productivity.METHODS:We performed a retrospective observational study in our community hospital ED,measuring the number of new patients seen in each 10-hour shift in the presence or absence of a float shift physician.We calculated the number of new patients seen per shift for each of the 7 daily shifts,during February(float shift scheduled) and May(float shift unscheduled) of 2008.We then compared the mean number of patients seen per shift in February with May.RESULTS:Total monthly patient volume was 6 656 for February and 6 775 for May,with the mean daily census being 230 and 219 patients,respectively.The number of new patients seen during each shift was greater in February than in May,with a mean increase of 1.1 patients per shift(with the float shift).Surveying participants about intervention effectiveness showed 92%of residents,but only 65%of attending physicians,in favor of maintaining the float shift.CONCLUSION:The presence of a "float shift" physician caring only for boarding patients allows other physicians to maintain and even increase their productivity in our ED,despite the presence of longer throughput times and increased time on diversion.
