TOPS whitepaper - IMX
- 1. © 2014 Intermedix Corporation | www.intermedix.com | Page 1© 2014 Intermedix Corporation || www.intermedix.com || Page 1 Optimizing ED Provider Coverage Published: May 2014. A Whitepaper by:
- 2. © 2014 Intermedix Corporation | www.intermedix.com | Page 1 EXECUTIVE OVERVIEW Emergency departments are unique compared to other patient-care settings in that ED medical directors must plan schedules and resources without definitively knowing how many patients they might see over the course of a shift, or what kind of care those patients are going to need. With sudden fluctuations and changing patterns in patient arrivals by hour, day, week, and season, it is an ongoing challenge for medical directors to make sure that the ED has the right staff at the right time for the right patient. Effectively dealing with this unique challenge can improve the quality of patient care as well as the financial operation and viability of the emergency department. This paper gives a short overview of the difficulties of trying to schedule coverage and resources in the constantly-changing and uncertain setting of an emergency room. Additionally, the paper offers an examination of how Intermedix can help you leverage data more effectively to optimize coverage and take much of the guesswork out of planning and scheduling. SHORTFALLS OF TRADITIONAL PLANNING AND SCHEDULING The data and methods traditionally used by medical directors for planning and scheduling tend to be inadequate for an ED and can result in mismanagement of resources, lower quality of patient care, and financial loss. In an ED, patient arrivals can vary from hour to hour, with different types of patients arriving during different times of day, vastly different patterns by day of week, and even seasonal changes associated with flu, school calendars, and local demographics. Traditionally, medical directors have tried to address these fluctuations by creating coverage schedules using patient-volume data averaged over large periods of time, or often simply by gut hunch. Neither approach adequately engages the actual hour-to-hour variability in patient volume, or the changing patterns in patient acuity by day or season. Adding to this difficulty is the fact that a provider’s performance is not uniform throughout a shift. Providers tend to see more patients at the beginning of a shift and their capacity for treating patients drops off steeply in the final hours. This trend is rarely taken into consideration, and can result in a misrepresentation of the ED’s actual capacity for managing patient arrivals at a given moment.
- 3. © 2014 Intermedix Corporation | www.intermedix.com | Page 2 These issues lead to imperfect calculations of coverage needs. At times, miscalculations result in over-coverage during some hours of the day, which can lead to substantial financial loss. At other times, they result in under-coverage, which can lead to long wait times, high walk-out rates, and risks to patients. A NEW APPROACH TO PLANNING AND SCHEDULING Traditional approaches to coverage planning rely too heavily on average or aggregated data, which often prevents medical directors from adequately addressing the inherent variability they face. Intermedix has a long tradition of applying statistical analysis, simulations, and predictive models to resolve practice management problems. As a data-driven company, Intermedix has had the opportunity to study key data over years of work with billing, scheduling, hospital registration, and patient tracking systems to analyze fluctuations in patient volumes and acuities, as well as trends in provider productivity over the course of a shift. As a result, Intermedix has been able to leverage granular data as a foundation for a new approach for coverage scheduling. The analysis of granular data allows us to recognize historical trends that can help schedule coverage more appropriately. By focusing on granular data, we can see that patient acuity levels, patient age, and types of visits vary in semi-predictable ways by hour of the day, day of the week, and week of the year. Further, we have been able to create robust pictures of provider productivity for every hour of the year based on analysis of schedules and hours worked by providers. Using this data, we can match patient type to provider, and even patient type to certain hours of a particular provider’s shift, to make sure that the right provider is available for the right patient at the right time. For example, by predicting that patient arrivals during a particular time of day will tend to be lower acuity, medical directors can schedule more APPs than physicians during that stretch to manage patient volume economically. Additionally, APPs can be scheduled during times that maximize their shift productivity. The real power of leveraging granular data, however, is the flexibility and analytical capabilities it can provide for medical directors. To optimize schedule definitions, medical directors must be able to weigh different scenarios and possibilities. Using our approach to granular data, medical directors are able to determine the possible outcomes of different scenarios and their effect on capacity, patient flow, and financial viability. For example, directors could weigh the benefits or costs of the following scenarios: ■ How does capacity change if we schedule a certain shift an hour earlier? ■ What are the outcomes if patient volume increases by 5% at a given time? ■ What are the benefits of scheduling a mid-day MLP shift on Mondays? ■ How much could the department save by cutting a double coverage shift?
- 4. © 2014 Intermedix Corporation | www.intermedix.com | Page 3 INTERMEDIX TOPS Using granular data as a foundation, Intermedix has designed a software tool called TOPS (Tool for Optimizing Provider Schedules), which is tailored to the planning needs of ED medical directors. TOPS is organized as a series of control panels, tables, and graphs that medical directors can use to review historical data and current schedule definitions. They can also use it to configure parameters such as hourly rates and anticipated volume changes, study calculated values such as provider productivity, and manage the addition, change, or removal of shifts. TOPS provides medical directors with key data and planning features, including: ■ Frequency histograms of percent over capacity events to address variability ■ Information about arrivals broken down by type of provider that can see the patient, such as Physician Only ■ Shift capacity information modeled in various formats, including blocked productivity assumptions or sculpted capacity graphs that take intra-shift provider productivity variations into account ■ Controls for modeling the impact of increases or decreases in arrival percentages to plan future expectations ■ Saving and sharing of schedules ■ Associated costs of each schedule for quick comparison Figure 1: TOPS provides key data in graphs and tables.
- 5. © 2014 Intermedix Corporation | www.intermedix.com | Page 4 As medical directors make changes to data, parameters, or schedules, the changes are immediately reflected in the various tables and graphs. These tools give medical directors immediate insight into proposed changes, including impact by hour of the day, day of the week, and week of the year. Using TOPS, practices can also rapidly adjust their schedules as conditions change, eliminating the guesswork that was previously required. Additionally, TOPS gives medical directors objective, quantifiable information to share with the hospital so they can align nurse and tech staffing with patient load. Figure 2: Medical directors can use TOPS to compare, edit, and save schedules, as well as review changes to data as they make edits. TOPS is now being used by dozens of EDs across the country, and has realized savings of up to $300,000 per year per site. Physicians at these sites have also noted how fine-tuning their schedules has improved both workload as well as quality of care by having the right staff at the right time for the right patient. THE FUTURE OF TOPS As EDs and practice management change, so will TOPS. Intermedix continues to refine TOPS to provide better information and more effective tools for planning and scheduling. Currently, Intermedix is working on the following features: ■ Real-time predictive models that forecast ED afternoon and evening arrival volumes based on morning arrival patterns ■ Seasonal predictive models for rapid spike volume drivers such as the flu ■ Scheduling and planning for other hospital-based physician specialties in addition to the ED We see this kind of data-driven, software-integrated approach to practice management as an essential strategy for physicians in the quickly changing world of healthcare. Figure 2: Medical directors can use TOPS to compare, edit, and save schedules, as well as review
- 6. © 2014 Intermedix Corporation | www.intermedix.com | Page 5 ABOUT INTERMEDIX TOPS is one of the many dynamic components of the Business Intelligence and Information Technology services provided by Intermedix. Intermedix delivers technology-enabled professional services to health care providers, government agencies and corporations. The company supports approximately 15,000 health care providers with practice management and revenue cycle management services. The Intermedix suite of physician solutions promotes superior patient care by allowing providers to focus on their clinical practice. Providers can take advantage of a complete set of business services that includes HR, scheduling, legal and strategic planning. Revenue cycle management services are tailored specifically to each provider specialty. Advanced technology solutions such as benchmarking and patient satisfaction surveys facilitate a focus on quality care. Please contact us at info@intermedix.com to learn more about these state-of-the-art practice management tools and resources, or to schedule a webinar.