What is the best way to schedule an Emergency Room (ER) with 3 overlapping shifts?

From the Guidelines

The best way to schedule an Emergency Room with 3 overlapping shifts is to implement a structure with morning (7am-3pm), afternoon (3pm-11pm), and overnight (11pm-7am) shifts, with 30-60 minute overlaps between each transition, as this approach prevents provider fatigue and accommodates the natural flow of ER traffic, ultimately improving patient care and outcomes. When scheduling an Emergency Room with 3 overlapping shifts, it is crucial to consider the limitations of human beings, particularly fatigue, as it can negatively affect cognitive and psychomotor skills, leading to medical errors 1.

Key Considerations

• The length of shifts should be carefully considered, with evidence suggesting that 8-hour shifts are preferable to 12-hour shifts to minimize fatigue and safety concerns 1.
• Shift sequence and rotation should take into account circadian rhythms, with single overnight shifts being recommended for larger ED groups to prevent sleep deprivation 1.
• Strategic napping can be an effective fatigue countermeasure, with physicians encouraged to nap in a call room before driving home after an overnight shift 1.
• Staffing models that utilize nurse practitioners or physician assistants can have positive effects on patient flow and satisfaction, particularly during peak hours 1.
• Physician-led team triage models have been associated with improved throughput and quality of care, and can be an effective way to manage patient volume and reduce wait times 1.

Implementation

• Staff each shift according to patient volume patterns, with more providers during peak afternoon and evening hours, and fewer overnight.
• Ensure adequate physician coverage with at least one attending physician per shift, supplemented by appropriate numbers of residents, nurse practitioners, or physician assistants based on patient load.
• Nursing staff should follow similar patterns with charge nurses present during each shift.
• Regular evaluation of patient wait times and staff satisfaction can help refine the schedule over time.

From the Research

Scheduling an Emergency Room with 3 Overlapping Shifts

To determine the best way to schedule an Emergency Room (ER) with 3 overlapping shifts, several factors must be considered, including patient demand, physician productivity, and resident wellness.

• Patient Demand: A study published in the Canadian Journal of Emergency Medicine 2 found that patient arrival rates vary by weekday, weekend, or holiday weekend, and that a mathematical programming model can be used to produce an optimal ER shift schedule that aligns physician productivity with patient arrivals.
• Physician Productivity: The same study 2 found that the planning model reduced unmet patient demand by 19%, 39%, and 69% for three different scheduling scenarios, demonstrating the importance of aligning physician productivity with patient arrivals.
• Resident Wellness: A study published in AEM Education and Training 3 found that emergency medicine resident scheduling preferences are not universally consistent with shift work guidelines, and that residents identify schedule design as a significant factor in their overall wellness.

Optimal Scheduling Strategies

Based on the available evidence, optimal scheduling strategies for an ER with 3 overlapping shifts may include:

• Circadian Scheduling: Scheduling shifts to align with the natural circadian rhythm, as recommended by the American College of Emergency Physicians 3.
• Flexible Scheduling: Allowing residents to request days off and have full weekends off, as preferred by 84% and 78% of residents, respectively 3.
• Optimized Shift Lengths: Using a mathematical programming model to determine the optimal shift length and scheduling strategy to align physician productivity with patient arrivals 2.

Note that the other studies 4, 5, 6 do not provide relevant evidence for scheduling an ER with 3 overlapping shifts.