Sustaining Affordability in Emergency Medicine

As COVID-19 has tested us to our core, it begs the question: Is sustaining operational affordability in emergency medicine (EM) possible?

The pandemic morphed and shifted. We experienced the initial impact and fear and worked to normalize operations. Even with vaccines and social distancing, we saw cases surge, and emergency departments (EDs) across the country were tested. Now we’re dealing with additional surges and variants with ongoing effects on the public, healthcare workers, and the healthcare systems. As the sight of an endemic phase peeks on the horizon, secondary influences have crept onto the scene: healthcare wellness, compassion fatigue, clinical shortages, looming payor reductions, and the evidence of financial impacts across healthcare systems. So, what are the tactics to achieve sustained affordability in this setting?

Foundationally it begins with vigilant attention to establishing thriving and transformative environments. It starts with investment in developing physicians who understand and lead change for proven clinical performance, affordability, and accountability for outcomes. In collaboration with hospital partners, clinical leaders must focus on the health care experience of all stakeholders. When the right environment is present, it lays a foundation for enduring and evolving sustainability.

Every ED is complex, and EM practices must embrace the complexity of their hospital partners’ EDs. Clinical and operational leadership should listen first to understand, then develop practice models that drive quality, throughput, and cost efficiencies. Start by reframing the historically separate processes for operational flow, traditionally developed by hospitals, and staffing to volume, usually crafted by the EM practice group. These should be interdependent processes.

The reframing step into interdependence challenges both staffing influences on departmental flow efficiencies and departmental flow on the staffing models. The omission of either view ultimately generates financial consequences. Sound leverages internal tools to expand insights and innovate strategies based on patient hourly patterns and acuity site-specific characteristics. Modeling is then crafted to:

• Ensuring capacity for physicians and APPs to manage surges
• Incorporate overall length of stay of patients into calculations
• Minimize queuing potential of patients
• Maximize efficiency in operational patient flow
• Maximize the visibility of information and identified opportunities, including nurse staff alignment through ED Nursing Leadership collaboration
• Support financial stewardship of hospital resource dollars to drive affordability

The next step is the creation of staffing models to incorporate shift flexibility, another reframing must.

Traditionally EM core staffing models are built on busier days versus less busy days and seasonality. Once developed, the plans are reviewed ‘as needed.’ However, ED volumes continue to be unpredictable in the current setting, with volatility often requiring new approaches to address the situation. Nimble and responsive flexibility is the key.

Weekly reviews of volumes spanning 14 and 30 days offer the ability to determine trends, adjust staffing to better match demand, and maintain a margin of compliance to productivity. When developing core staffing models to include shifts to flex up and down offers a reliable approach to managing ongoing shifts in volumes, communicating the plan, and understanding triggers for use is key to agile deployment.

No one has a magic ball for the future. We know right now that EM professionals can challenge traditional thoughts, reimagine tactics to meet and manage the demands of volatility volume swings, and innovate ways to improve sustainable affordability.

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