03 November 2008

How fast is fast?

Our ED is a pretty high-acuity, intense place to work. We staff it to a level of about 2 patients per physician per hour, which is more or less in line with the ACEP practice management recommendations. In the lower-acuity areas ("Fast Track"), there are PAs who see somewhat more: 2.5-3 pph.

I'm one of the faster physicians in our group. I can see 2.5-3 pph without too much trouble, though that certainly requires a high-energy day for me. I average more like 2.25-2.5 over the longer run. The fastest doc we have ever employed averaged about 2.7 pph, and frankly, I worried that he was a little too fast for my comfort.

So I was at ACEP recently and talked to some docs from other areas of the country. They tossed around numbers like 3-4 pph as if it were no big deal. Due to the setting, I was not able to closely question them on how they achieved those numbers, which quite frankly stretch credulity. But it got me thinking. With our ED, and our acuity, and our doctors, numbers like that actually seem impossible.

How about you, O My Readers? What sort of volumes do you or your docs generally see per hour? If it's a higher number, 3+, what factors allow you to achieve such efficiency? Do you work in a high-volume shop which sacrifices safety for speed? I'm curious to know.

So what's your experience?


  1. Our stats seem to mirror your experience.

    70K visits, Community/level II trama/ STEMI recievig ED.

    Avg pt/hr = 2.1/hr. Range 1.7-2.5 PA's seeing 2.1-2.9 in fastrack.

    We seem to be catering on chaos all the time. Any faster and it would be very dangerous. Frankly, I am skeptical about others who claim these high numbers. I know the stats on our group which is a large national group and we are above average in these numbers so I just don't think it is true. We do all dictation. Maybe with scribes and a good EMR people are going faster.

    The way the ebb and flow of shifts go it is not unusual to see 8 or so in your first hour but it averages out to your numbers.


  2. Greetings ... as a call in radio listener would remark "long time listener, first time caller."

    Similar numbers, but I always find it hard to compare apples to apples in terms of hours "worked". By choice, I work our 8 hour night shift (10 pm - 6 am). I've logged my actual hours worked for the last 3 years for every shift. I am also working overtime by choice (~ 1.3 FTE), so my shift numbers are on the high side.

    Fiscal 07-08:
    218 shifts worked
    1740 hours of "scheduled" work
    5151 patients seen
    2270 actual hours worked

    By the scheduled hours, I saw 3 pph
    By actual hours, I saw 2.26 pph

    Groups seem to define the "shift" in various ways ... "hard scheduled hours" vs padding the shifts with some time to dictate and finish patients.

    With 26 years of experience, blessed with good health and a continued high level of energy, I can handle volume and intensity better than most and I would be hard pressed to see much more than this.

    Enjoy your blog ...

    GJB Fargo, ND

  3. Working with residents (lots of them) seems to allow for higher numbers, though I still have to see each and every patient for at least a bit, just to be sure.

    I work exclusively nights, and at an exclusively children's hospital, so that may skew the numbers even further.

    Summer months? Sometimes 1 patient on a whole shift (though that is rare). But winter months? I've already had a couple of nights where I've seen 37-38 patients in 7 1/2 hours. Luckily, those nights had no traumas and no resuscitation room cases, but nights like that happen, too.

    On an average night, I usually maintain 3.5-4 pph. Most of my group can do the same sort of throughput, so I figure it's got to be a combination of residents and seeing only the kids.

  4. I'm fast, and I'm a PA in a fast track, and I've been doing this for 30 plus years. But when I see more than 3.5 patients an hour over a long shift, I can pretty much predict that I will make a probably non-important yet stupid looking omission or a mistake, or I will be so rushed that patients will perceive, which might not be true, that they did not get adequate treatment

  5. My shop is a community ED/Level II trauma center that has 37k visits.

    Currently we average 2.5 pt/hr as a department. My average is 2.9 pt/hr. The somewhat higher average is achieved largely because we have approximately 36 beds in our ED. We almost always have a bed available for our patients when they arrive. We also have great ancillary services who are efficient, x-ray and CT in the center of the ED. We are also compensated on pure production which incents us to work hard. The combination of the above allow us to see a somewhat higher pt/hr than most. Interestingly, when we were salaried employees we claimed we couldn't possibly see more than 2 pt/hr. Now if we see 2 pt/hr it feels like we are not even working.


  6. I think the goal of 2-2.5 pph is reasonable. Some days, more--if you get nothing but snotty noses, simple sprains/fractures, and the occasional belly pain. Some days, less--complicated MI, septic shock, and a bad trauma. Overall, it should average out. More than that means one of two things--you're missing things or you have an unusually low-acuity ED.

  7. Stumbled onto your blog, very interesting topics. Excellent blog. I'm glad I'm within the average range of everyone else. I've also always wondered how those who claim they see >3pph do it.

    My stats:

    93k level 1 trauma center in metropolitan area with residents.

    20-30pts/12hr in the main on avge
    25-35pts/12hr in peds on avge
    30-40pts/12hr in fast track on avge

    When all is said and done, I average about 2.5pph. Couple things I notice:

    1-2 complicated traumas or codes can ruin that day's stats (ie spending 1-2hrs in the trauma room with 1 critical pt).

    I work faster alone, when the residents are at conference. I don't have to double check their work or read their charts or spend time teaching (although that's what I enjoy about working at an academic center).

    I only hit those really high numbers (35-40pts/shift) less than a dozen times per year.

    Ancillary staff is vital to hitting those high numbers.

  8. David Lee Smith, M.D. in AL1/28/2009 7:02 PM

    I'm pulling 29 day shifts this month. Average 24 per mo. About 25k annual visits. Single coverage, no mid-level. Level II.

    Just about completely worn out.


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