Clerical Staffing and Workload in AES/CES Final Report - PowerPoint Presentation

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Clerical Staffing and Workload in AES/CES Final Report

Team 11: Alexander Copp, Joelle Grider, Kaya Yarman and Noa Jeremias

Clients: Jennifer Holmes, Director of ED Operations

Deidre Todd, Clerical Manager

Coordinators: Olivia DeTroyer, Industrial Engineer

Mustafa Mushtaq, Improvement Engineering Fellow

Dr. Mark Van Oyen, Professor

2018|Winter|11

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Introduction

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Clerical Staff Roles

Check-in Clerk

Unit Host Clerk

Unit Clerks

AES:

Main

South

East

WestEC3

Resource Clerk

Lead/Charge Clerk

CES:

CES

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Goals and Objectives

Reevaluate each shift

Address over and under utilization

Increase patient and employee satisfaction

Balance staffing model and workload

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Key Issues

Perceived delay during peak hours

Unbalanced workload

Discontinuity in workflow

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Project Scope

Hospital

AES

CES

Employees

Clerks

A

ES

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Methods: Observations

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Methods: Time Studies

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Methods: Interviews

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Methods: Benchmarks

Contacted four large research hospitals

Focused on findings from St. Joseph’s Mercy Hospital

Topics: Clerical tasks, visitors, breaks

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Methods: Historical Data

Patient Arrival(Check-in)

Visitor counts(Unit Host)

Aspect phone data(Unit Clerks except Main)

Outside record data(West, CES Unit Clerk)

Ready bed page data(South, CES Unit Clerk)

Resus bay arrivals(EC3 Unit Clerk)

Break coverage data(Resource, Lead/Charge)

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Methods: Time Sheets

Figure 1. Template of Clerical times sheet for CES unit clerk

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Findings: Check-In Clerk

Figure 1. Workload analysis of AES and CES check-in clerks(source: check-in data, sample size: n = 183 days, date: 7/21 - 12/31/2017)

ShiftAESCES11 pm20103 am1247 am311011 am52183 pm49207 pm3721

Table 1. Average check-ins by shift

(source: check-in data, sample size: n = 183 days, date: 7/1 - 12/31/17)

Table 2. Average patient check-in time(source: observations, sample size: (AES) n = 23 (CES) n = 17, date: 1/20 - 3/15/17)

AES1 min. 10 s.CES2 min. 36 s.

Average utilizationAES: 20%CES: 20%

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Findings: Unit Host Clerk

Table 3. Daily average visitor counts(source: Monthly visitor count data, sample size: n = 183 days, date: 7/1 - 12/31/17)

AES239CES131

Table 4. Average visitor escort time(source: observations, sample size: (AES) n = 6 (CES) n = 13, date: 1/20 - 3/15/17)

AES2 min. 31 s.CES2 min. 27.5 s.

Figure 2. Workload analysis of AES and CES unit host clerks(source: timesheets, sample size: n = 34 shifts, date: 3/29 - 3/30/2018)(source: Monthly visitor count data, sample size: n = 183 days, date: 7/1 - 12/31/17)(source: observations, sample size: (AES) n = 6 (CES) n = 13, date: 1/20 - 3/15/17)

Average utilization

AES 1: 23%

AES 2: 37%

CES: 22%

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Findings: CES Unit Clerk

Figure 8. Workload analysis of CES desk 1 and desk 2 clerks

(source: timesheets, sample size: n = 23 clerks, date: 3/29 - 3/30/2018, used for task distributions for desk 1 and desk 2 clerks)(source: Aspect reports, sample size: n = 183 days, date: 7/1 - 12/31/2017, used for average call time and average calls per day for desk 1 clerk)(source: Monthly record counts, sample size n = 183 days, date: 7/1 - 12/31/2017, used for daily average outside records per day)(source: CES outside records screenshot, sample size n = 39 hours, date: 3/14 - 3/15/17, used for outside record shift dist.)(source: Ready bed page data, sample size n = 183 days, date 7/1 - 12/31/2017, used for ready bed page shift dist.)

No CES Desk 2 clerk 3 am - 7 am 1 of 2 days

Ready bed pages

Patient call lightReferrals

Average utilization

Desk 1: 28% Desk 2: 14%

Total count other tasks (not specified):Desk 1: 27Desk 2: 86

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Findings: Main Unit Clerk

No data for either role between 3 pm - 5 pm

Only one clerk on duty 3 am - 7 am

Average utilizationMaize: 21% Blue: 24%

Figure 3. Workload analysis of maize and blue clerks(source: timesheets, sample size: n = 11 clerks, date: 3/30/2018)

Total count other tasks (not specified):Maize: 63Blue: 20

Uploading CD’s

Patient call lights

Resus activation

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Findings: East Unit Clerk

Figure 4. Workload analysis of East unit clerks (source: Timesheets, sample size: n = 12 clerks, date: 3/29 - 3/30/2018, used for workload dist.) (source: Aspect reports, sample size: n = 183 days, date: 7/1 - 12/31/2017, used for average call time)

Average utilizationEast: 8%

Total count other tasks (not specified):East: 268

Patient call lights

Work orders

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Findings: South Unit Clerk

Average utilization

South: 19%

Total count other tasks (not specified):South: 39

Figure 6. Workload analysis of West unit clerks (source: Timesheets, sample size: n = 6 clerks, date: 3/29/2018, used for workload dist.) (source: Aspect reports, sample size: n = 183 days, date: 7/1 - 12/31/2017, used for average call time)(source: Bed ready page data, sample size n = 183 days, date 7/1 - 12/31/2017, used for Bed ready page shift dist.)

Patient call lightsUploading CD’sTransports

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Findings: West Unit Clerk

Average utilizationWest: 12%

Figure 6. Workload analysis of West unit clerks (source: Timesheets, sample size: n = 4 clerks, date: 3/30/2018, used for workload dist.) (source: Aspect reports, sample size: n = 183 days, date: 7/1 - 12/31/2017, used for average call time)(source: Monthly record counts, sample size n = 183 days, date: 7/1 - 12/31/2017, used for number of records per day)(source: AES outside records screenshot, sample size n = 39 hours, date: 3/14 - 3/15/17, used for outside record shift dist.)

No time sheet data between 11 am - 7 pm

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Findings: EC3 Unit Clerk

Average utilization

EC3: 9%

Frequent outside record tallys between11 am - 7 pm

Figure 6. Workload analysis of EC3 unit clerks (source: Timesheets, sample size: n = 6 clerks, date: 3/30/2018, used for workload dist.) (source: Aspect reports, sample size: n = 183 days, date: 7/1 - 12/31/2017, used for average call time)** add in resus registration

Patient call lightsStickers/ Forms/ PagesMeal orders

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Findings: Resource, Lead, Charge Clerks

Figure 7. Workload analysis of Resource, Lead and Charge Clerks

(source: Clerical resource coverage data, sample size: n = 7 days, date: 3/26 - 4/5/2018, used for shift coverage data)

Average utilizationResource: 67%Lead/Charge: 62%

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Findings: Benchmarks for St. Joes

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Findings: Interviews

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Conclusions: Average Utilizations Per Role

Figure 7. Workload analysis all clerical roles

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Recommendations: Additional Tasks

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Recommendations: Reinforced Tasks

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Balanced Workload

Improved Satisfaction

Increased Efficiency

Expected Impact

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Opportunities for Additional Analysis

Completed analysis:

Future analysis:

Major tasks performed in each role

Provider feedback on current state and task re-distribution opportunities

Gathering of historical data on tasks where available

Assess feasibility of additional training opportunities (ex: paging)

Focus on underutilized roles

Utilize time sheets for a more representative workload distribution

Comparison of clerical operations in other emergency departments