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RRM Category: AMBULATORY CLINIC RRM Module: Emergency Room/Urgent Care Overview: To qualify for an Emergency Room/Urgent Care department the facility must anticipate a minimum of 25,000 PCPVs and be located more than 60 minutes driving time from an alternate facility. It should be noted that 25,000 PCPVs provides a minimally justified service with only 3,000 emergency room visits anticipated. Only 755 of these 3,000 visits are anticipated to be true emergency visits. It is estimated that true emergency visits account for 3% of a facilities total PCPVs and non-emergency visits to the ER account for 12% of a facilities total PCPVs. Therefore to estimate ER workload multiply the total expected PCPVs by 15%. The RRM Emergency Room/After Hours staffing module estimates the requirements for ambulatory clinical care during periods beyond the normal clinical service schedule. The workload parameters that are the key variables in the staffing estimation are After Hours PCPVs, ER patient escourt hours and number of observation beds. This module estimates the need for after hour's emergency room staff including: Primary Care Providers, Clinical Nurses, Patient Escort Staff and Clerical Support. Services Description: After Hours Emergency Room Services provide ambulatory clinical care during periods beyond the normal clinical service schedule. Staffing Criteria: Fixed Emergency Room RN Supervisor staff of 1 FTE for each facility with an emergency Room. Emergency Room Medical Clerk staff of 1 FTE plus 1.0 FTE Emergency Room Medical Clerk staff for every 7,500 emergency room PCPVs over 3000. Registered Emergency Room Nurse staff of 2.70 FTEs, plus 1.0 FTE Registered Emergency Room Nurse staff for every 4,400 emergency room after hours PCPVs for every facility with an emergency room. Patient Escort staff of 1 FTE for every 1,540 patient escort hours from the facility to a higher level facility. Observation Bed RN staff of 4.9 FTE for every five observation beds, plus 0.4 FTE Ambulatory Clinic Observation Bed RN staff for each additional observation bed. (Note: for 4 or less observation beds there are no FTEs.) After Hours Primary Care Provider staff of 0.000859 FTEs for every emergency room PCPV up to 4000 visits, plus 0.0005 After Hours Primary Care Provider for every emergency room visit over 4000. NOTE: There is discussion to changing the ER staffing formulas to increase staff as work load increases (i.e. a 3000 PCPV versus a 45,000 PCPV emergency room. This has not been done to date (5/20/03). STAFFING FORMULAE Personnel Categories: ER RN Supervisor Medical Clerk ER Registered Nurse Patient Escort Observation Bed RN After Hours Primary Care Provider Driving Variables: Approved Emergency Room After Hours PCPVs Emergency Room PCPVs Patient Escort Hours for the ER Number of ER Observation Beds MINIMUM STAFFING LEVELS (fixed): Personal Category FTEs per Driving Variables Min. Max. ER Registered Nurse Supervisor 1.0 Facility Presence of an ER n/a   Emergency Room Registered Nurse 2.7 Facility Presence of an ER n/a   Medical Clerk 1.0 Facility Presence of an ER n/a   Observation Bed Nurse 4.9 Facility Observation Beds 5   Plus, VARIABLE STAFFING LEVELS: Personal Category FTEs per Driving Variables Min. Max. Registered Nurse 1.0 4,400 After Hours PCPVs 0 n/a Medical Clerk 1.0 7,500 Emergency Room PCPVs     Patient Escort 1.0 1,540 Patient ER Escort Hours 0 n/a Observation Bed Nurse 0.40 1.0 Observation Beds 5 n/a ER Physician 0.000859 1.0 After Hours PCPVs 0 4,000 ER Physician 0.0005 1.0 After Hours PCPVs 4000 n/a Back to RRM Module Table of Contents