Comparing Models of Staffing in the Emergency Department on Patient Wait Times and Left Without Being Seen Rates


The emergency department (ED) is a vital component of the health care system, providing care to patients with urgent and emergent needs. However, the ED also faces many challenges, such as increasing patient demand, limited resources, variability in patient flow, and high staff turnover. These challenges can affect the quality and efficiency of care, as well as the satisfaction and well-being of patients and staff. One of the key factors that influences the performance of the ED is the staffing model, which determines how physicians and other clinicians are allocated and deployed within the ED. Different staffing models may have different impacts on patient outcomes, such as wait times and left without being seen (LWBS) rates.

Wait times and LWBS rates are important indicators of ED access and throughput. Wait times measure the duration between a patient’s arrival and various milestones in the ED process, such as triage, registration, bed assignment, physician evaluation, and disposition. LWBS rates measure the proportion of patients who leave the ED before being seen by a physician or completing their treatment. Both wait times and LWBS rates reflect the balance between demand and supply in the ED, as well as the efficiency and effectiveness of ED operations. Long wait times and high LWBS rates can have negative consequences for patients, such as delayed diagnosis, increased morbidity and mortality, lower satisfaction, and higher costs. Therefore, reducing wait times and LWBS rates is a common goal for ED improvement.

The purpose of this blog post is to compare different models of staffing in the ED and their effects on patient wait times and LWBS rates. The post will review the literature on various staffing models, such as team-based, zone-based, pod-based, split-flow, fast-track, and flexible models. The post will also discuss the advantages and disadvantages of each model, as well as the factors that influence their implementation and effectiveness. The post will conclude with some recommendations for ED leaders and managers who are considering changing or optimizing their staffing model.

Team-Based Model

A team-based model is a staffing model that assigns a group of clinicians (e.g., physicians, nurses, technicians, scribes) to work together as a team to care for a subset of patients in the ED. The team members share information, coordinate tasks, and collaborate on decision making. The team-based model aims to improve communication, continuity, accountability, and efficiency within the team, as well as to enhance patient satisfaction and quality of care.

The team-based model can have different variations depending on the size, composition, location, and function of the teams. For example, some EDs may have small teams (e.g., one physician and one nurse) that work in a designated area (e.g., a pod or a zone) within the ED. Other EDs may have larger teams (e.g., two physicians and four nurses) that work across multiple areas (e.g., triage, fast-track, main ED) depending on patient acuity and volume. Some EDs may have specialized teams (e.g., trauma team, stroke team) that focus on specific types of patients or conditions.

The literature on the team-based model suggests that it can have positive effects on patient wait times and LWBS rates. For instance, a study by Jensen et al. (2011) compared a team-based model with a traditional model in two urban academic EDs. The team-based model consisted of four teams of one physician and one nurse each that worked in four pods within the ED. The traditional model consisted of individual physicians that worked across the entire ED without assigned nurses or pods. The study found that the team-based model reduced median door-to-doctor time by 18 minutes (from 54 to 36 minutes), median length of stay by 26 minutes (from 240 to 214 minutes), and LWBS rate by 1.6% (from 4.5% to 2.9%) compared to the traditional model.

Another study by Fairbanks et al. (2014) compared a team-based model with a zone-based model in an urban academic ED. The team-based model consisted of three teams of one physician

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