Scheduling for Emergency
Department Personnel
Jim Holliman, M.D., F.A.C.E.P.
Professor of Military and Emergency Medicine
Uniformed Services University of the Health Sciences
Clinical Professor of Emergency Medicine
George Washington University
Bethesda, Maryland, U.S.A.
E.D. Personnel Types Requiring
Separate Scheduling
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E. M. residents
Rotating residents from other services
E. M. faculty
Nurses
Other patient care personnel
–E.M.T.'s
–Nursing assistants
ƒ Medical students
E. M. Residency Review Committee (RRC)
Scheduling Requirements for E.M. Residents
ƒ No more than 12 hours clinical duty at one
time
ƒ At least 12 hours off between shifts
ƒ At least one day off in every seven days
ƒ No more than 72 work hours per week
ƒ Must attend at least 70 % of scheduled
conferences, so must have other coverage
arranged for conference time
ƒ "Moonlighting" time must be monitored by
the Program Director
Advantages of 12 Hour Shifts
ƒ Much simpler scheduling for the
scheduler
ƒ More full days off in a week
ƒ Fewer "transition pickups" for staff
coming on-duty
ƒ Less time spent in commuting to work
ƒ All assigned personnel can attend a
conference at shift "overlap" time
Disadvantages of 12 Hour Shifts
ƒ Do not divide evenly into 40 hours (the
standard American workweek)
ƒ More tiring if E.D. is busy
ƒ Cannot do other work duties on the
same day
ƒ Technically violates the RRC rule of at
least 12 hours off between shifts if any
other academic duties or conferences
required between shifts
Two Shift Workday with Different
Shift Lengths
ƒ Approach taken by some E.M.S.
organizations (especially where the
day shift is usually very busy and the
night shift usually quiet) :
–8 to 10 hour day shift
–14 to 16 hour night shift
–Should be considered only if night shift
personnel are likely to be able to sleep for
part of their shift
Different Scheduling Patterns to
Consider for 12 Hour Shifts
ƒ 5 days (0700 to 1900) work followed by 4
days off, followed by 5 nights (1900 to
0700) work, followed by 6 days off
–This results in average of 180 work hours per
month or 45 hours per week
ƒ Other common pattern is to do 3 day
shifts followed by 3 night shifts and then
have 3 days off
–This results in average work week of 60 hours
Effects of E.D. Census on
Personnel Scheduling
ƒ In the U.S.A., majority of E.D. patients
present in the afternoon and evening
ƒ Many U.S. E.D.'s have much greater census
on weekends and holidays (when other
offices and clinics are closed)
ƒ So to match personnel numbers to E.D.
patient loads, non-even scheduling of E.D.
personnel is usually required
Options for Different Overlapping
Work Shifts for E.D. Personnel
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1 person 0700 to 1700 or 1900
1 person 1000 to 2200
1 person 1700 or 1900 to 0100 or 0300
1 person 1900 or 2200 to 0700
May need to "double up" additional
available personnel on the second or third
shifts to provide the most "overlap"
during the higher census times
1990 A.C.E.P. Recommendations
for Physician Coverage for E.D.'s
Visits Per Year
< 8000
Shift Length
(hours)
24
Coverage
Single
8000 to 12000
12
Single
12000 to
20000
20000 to
30000
> 30000
12
Double at
peaks
Double at
peaks
Double and
triple
8 to 10
8 to 10
Recommended
Number M.D.'s
3 fulltime plus
moonlighters
4 fulltime plus
moonlighters
4 fulltime plus
moonlighters
5 fulltime plus
moonlighters
5 FT + 1 FT per
5000 visits
Other Options for "Overlap"
E.D. Coverage
ƒ Have personnel assigned to less than a 40
hour work week but they are also
assigned to have beeper or phone
availability for 12 to 36 hours per week to
be called in to the E.D. if it gets busy
ƒ Most hospitals using this system pay a
small amount per hour on-call and then
pay the person's usual hourly salary for
the time they are actually called in
General Scheduling Rules to
Remember to Keep Personnel Happy
ƒ Advance from day shift to evening shift to
overnight shift to days off duty
ƒ Balance assignment to weekends and holidays
ƒ Allow at least one full day off when
transitioning from overnight shift to day shift
ƒ A month of all night shifts is often better
tolerated than frequent switching between day
and night shifts
Other Options for Night Shift
Scheduling
ƒ Consider paying extra per hour for night or
evening shifts
ƒ May have permanent designated night shift
staff
–Consider not expecting these staff to meet the
same academic or conference attendance
expectations as for the other staff
–Will still need other staff to cover vacation times
for the permanent night shift staff
Options for Prescheduling
E.M. Faculty and Residents
ƒ Simplest system is to predesignate a shift
pattern (e.g., 3 days on & 3 days off) for
the entire year and then require each
person to make shift trades if they need to
alter this schedule
ƒ This rigidity usually does not work well for
academic E.M. physicians because of their
need to schedule attendance at other
events (conferences, etc.)
Options for Scheduling E.M.
Faculty and Residents (cont.)
ƒ Can require time-off requests a certain
period in advance (one to three
months)
–Should also require each person to
volunteer for a specified "even" number of
holidays and weekends
ƒ Scheduler then matches requests to
give each person the maximum
number of requests possible
Options for Scheduling E.M.
Faculty and Residents (cont.)
ƒ Can use a "lottery" system :
–Staff get together and sign up for shifts in
"rounds"
–Start each selection "round" with staff
with higher seniority
–Continue "rounds" until all shifts have
been filled
–Each person may not "skip" a round in
order to maintain fairness
Scheduling Limitations for "OffService" Residents in the E.D.
ƒ Internal Medicine and Family Practice
RRC's require their residents to do
"continuity clinics" each week
ƒ May need to schedule off for
department Grand Rounds
ƒ Probably best if "even" conference
time trades with the E.M. residents
Scheduling Options to Cover
Personnel Illness
ƒ Can require each person to arrange
their own coverage if ill
ƒ Or can have a predesignated "at risk"
person to be called to fill in
ƒ Other consideration is if the ill person
will have to "pay back" the shift to the
covering person
Different Resident Scheduling
Options Tried at Hershey
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3 day - 3 night - 3 off
4 day - 2 off - 4 night - 2 off
4 day - 2 off - 4 eve - 2 off - 4 night - 2 off
"Overlap" resident from 1000 or 1100 to 2200 or
2300 5 days a week with coverage of same time
slot on weekends with moonlighters
ƒ "Irregular" overlapping shifts (0700 to 1700, 1000
to 2200, 1700 to 0100, 2200 to 0700, with "extra"
assigned residents doubled up on day or eve
shifts
E.D. Personnel Scheduling
Summary
ƒ Scheduling should be matched to E.D. census
ƒ General pattern of "day to night to off" should
be followed
ƒ Scheduler should strive for even distribution
of nights, weekends, and holidays
ƒ Schedule should be arranged well in advance,
but should have mechanism for covering for
illness