Our facility is quite old. We see over 100,000 patients per year in an ED environment which includes:
- 1 trauma resuscitation bay
- 4 medical resuscitation beds
- 32 "regular" telemetry beds
- 6 fast track beds cannibalized to be regular tele beds
- 4 observation beds also so cannibalized
- 3 "real" fast track beds
And the physical plant is essentially the only rate-limiting factor in our ability to move patients through. The docs are well-staffed (overstaffed, some might say), and the nursing staffing could be better but is adequate, and the hospital is great when it comes to admissions (we never board patients in the ED more than 2-3 hours). There just isn't enough physical space to put any more patients (I have suggested bunk beds, but administration doesn't like the idea). And I get the feeling that the business would be there for us if we could build the capacity.
So we are building a new shop. I just got back from a planning meeting. It is going to be absolutely gargantuan, costing in the range of half a billion dollars, with an ED only slightly small than one in the Death Star. The footprint of the ED will be over a football field on each side, over 100,000 square feet, sporting 90 beds.
That's planned out as 4 "pods" of 20 beds each, and one ten-bed Fast Track. For comparison purposes, the median ED in the US is probably about 20 beds. It boggles the mind and scares the crap out of me.
You see, I have to run this joint. Not alone, of course, and thank god for that. But how on earth am I going to staff that place? I have a couple of years to get ready, fortunately, but consider the imponderables:
- How many patients will there be? Will our volume jump 10% the first year? 15%? 20%?
- How many docs will have to be on shift during peak hours?
- How many during off hours?
- What time of day will I flex up and down?
- How many shifts will I need to schedule?
- How many doctors will I need to employ to fill those shifts?
- Should we get specialized peds ER docs? etc etc etc.
So, exciting, but I get palpitations and chest tightness just thinking about the challenge. Hey, and I'm a little sweaty and my left hand is sort of tingling . . . .