The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

IMPLEMENTATION OF A VOLUME-DRIVEN STAFFING MATRIX FOR RESPIRATORY CARE IMPROVES STAFFING WITHOUT UNFAVORABLE IMPACT TO BUDGET

Nabil Migali, MBA, RRT, RPSGT, Elizabeth Wiseman-Chase, BA, RRT, RPFT, Brian Smith, BA, RRT, Larry Goldberg, William Peruzzi, MD, Northwestern Memorial Hospital, Chicago, IL

Background: Increases in demand for respiratory care services present staffing challenges to hospital departments. Volume increases often surpass resources. Managers are faced with the challenge of flexing staff to accommodate these demands, often relying on overtime and agency staffing. Historically, the use of agency staffing in the Department of Respiratory Care (DRC) at Northwestern Memorial Hospital (NMH) had resulted in unfavorable labor variances associated with lower productivity and premium labor rates. Additionally, agencies are not consistent options during periods of peak volume when multiple institutions are requesting agency staffing support. During fiscal year (FY) '99, the DRC experienced an unprecedented increase in requests for services. Relative Value Units (RVUs) performed during peak months were 419,505 and 423,808. Historic peak volumes for FY 97 and FY 98 ranged between 213,932 and 332,017 RVUs (mean = 291,224). A staffing alternative was implemented that was not dependent upon agency staffing and that would assure safe patient care without an unfavorable impact upon the departmental operating budget.

Methods:
Evaluation of workload demands for the peak months of FY '99 revealed that had each respiratory therapist worked one additional 12-hour shift per pay period (84-hours), the department would have met the requested demand for patient care services. Through solicitation of feedback from the clinical staff, it was determined that "on-call" would be an acceptable solution to the workload problem. Management then developed a Critical Volume Indicator Matrix (CVIM) for the automatic authorization of overtime, on-call, and agency staffing use based on volume indicators (RVUs) and patient acuity (number of ventilator patients).

Results:
During FY '00 the CVIM was implemented and the following results were obtained. The department was able to meet its service demands for work volumes accomplished during periods of peak volume (473,330 and 475,180 RVUs). Efficiency increased by using fewer agency staff work hours (40 vs. 4051), when compared to the prior FY. RVUs per FTE increased from 54,973 (FY '99) to 62,540 (FY '00). The departmental operating budget remained in compliance for labor expenses.

Conclusions:
We conclude that the CVIM is an effective management tool for flexing staff to volume, maximizing productivity and maintaining compliance with the departmental operating budget for salary expenses.

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