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Planning, Evaluation & Research

RRM Category: AMBULATORY CLINIC

RRM Module: Emergency Department

Overview:
The Emergency Department RRM module estimates the number of primary care providers, nurses, medical assistants and medical clerks for hospital emergency services.

To qualify for an Emergency Department a facility must anticipate a minimum of 25,000 Primary Care Provider Visits (PCPV) and usually be located more than 60 minutes driving time from an alternative facility. Emergency Departments will be considered only if there are inpatient beds in the facility. Emergency department staff will be determined based on the Emergency Department Visit (EDV). EDV are not part of the PCPV and are determined separately.

The RRM is based on two staffing plans:

  • Small Location Emergency Department (SLED), for emergency departments of less than 10,000 annual EDV
  • Large Location Emergency Department (LLED), for emergency departments in locations that have greater than 10,000 annual EDV.

In the SLED, the ED RRM module will provide for additional primary care providers beyond that provided for in the Ambulatory Physicians RRM module. ED providers will be part the pool of primary care providers assigned to the Ambulatory Clinic which will provide medical staff coverage in the ED. ED provider coverage in the SLED is typically single provider.

In the LLED a separate Emergency Department may be organized with a unique staff separate from the Ambulatory Clinic staff. Provider coverage at LLED locations is generally double coverage based on the greater projected workload.

One provider should be designated the Medical Director of the ED to work in cooperation with the Emergency Department RN Supervisor.

Staff for the laboratory, diagnostic imaging and other departments that support the emergency department will be provided in their respective RRM modules.

It is expected that staffing will be adequate to meet the requirements of EMTALA and other regulatory standards.

Services Description:
The Emergency Department staff provides clinical care services including evaluation, stabilization, treatment and disposition of patients presenting in the emergency department. Patients may present as ambulatory self referrals or be delivered as non-ambulatory by ambulance or private vehicles as emergencies. Patients will be triaged and appropriate care determined. Care options include emergency care, urgent care, and referral to other treatment options. After appropriate triage, non-emergency patients may be referred for care in an ambulatory care walk-in clinic or to a same day appointment during established clinic hours. After hours care generally will be provided in the emergency department

Staffing Criteria:
Fixed Emergency Department RN Supervisor staff of 1.0 FTE for each facility with an emergency room.

Fixed Emergency Department Medical Clerk staff of 2.0 FTE, plus 0.44 FTE for every 1000 EDV above 9,000 EDV up to a maximum of 7.0 FTE.

Fixed Emergency Department RN staff of 8.0 FTE, plus 1.0 FTE Emergency Department RN for every 1,000 EDV over 9000 EDV.

Fixed Emergency Department Medical Assistant staff of 2.0 FTE, plus 0.22 FTE Medical Assistant for every 1000 EDV above 9,000 EDV.

Fixed Primary Care Provider staff of 3.0 FTE, plus 1.0 Primary Care Provider staff for every 2,100 EDV above 6,300 EDV.

Emergency Department Medical Director starting at 0.10 FTE at 3,000 EDV plus 0.10 FTE Medical Director for every 2,500 EDV up to maximum of 1.0 FTE.

Nurse Trauma Coordinator staff starting at 0.10 FTE at 9,000 EDV plus 0.10 FTE Nurse Trauma Coordinator for every 1,500 EDV up to a maximum of 0.5 FTE.*

*In facilities that are Level II Trauma Centers, a deviation to 1.0 FTE for the Nurse Trauma Coordinator is required and will be approved as a deviation to the RRM plan for that project.

STAFFING FORMULAE

Personnel Categories:
Primary Care Providers
RN Supervisory
RN
Clerk
Medical Assistant
Medical Director
Nurse Trauma Coordinator

Driving Variables:
Emergency Department
EDV

MINIMUM STAFFING LEVELS (fixed):

Personal Category FTEs per Driving Variables Min. Max.
Registered Nurse Supervisor 1.0 Facility Approved Emergency Dept. n/a  
Registered Nurse 8.0 Facility Approved Emergency Dept. n/a  
Medical Assistant 2.0 Facility Approved Emergency Dept. n/a  
Medical Clerk 2.0 Facility Approved Emergency Dept. n/a  
Providers 3.0 Facility Approved Emergency Dept. n/a  
Medical Director 0.1 Facility Approved Emergency Dept. n/a  

Plus, VARIABLE STAFFING LEVELS:

Personal Category FTEs per Driving Variables Min. Max.
Providers 2.100 EDV in excess of 6,300 3,000 n/a  
Registered Nurse 1.0 1,000 EDV in excess of 9,000 3,000 n/a
Clerks 0.44 1,000 EDV in excess of 9,000 3,000 8.0 FTE
Medical Assistants 0.22 1,000 EDV in excess of 9,000 3,000 n/a
Medical Director 0.10 2,500 EDV in excess of 3,000 3,000 1.0 FTE
Nurse Trauma Coordinator 0.1 1,500 EDV in excess of 9,000 9,000 0.5 FTE


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