Scheduling of advanced practice providers at Level 1 trauma centers

Advanced practice providers (APPs) are essential to the provision of trauma care services, particularly in the wake of residency hour restrictions. Demand for these APPs fluctuates with cyclic patient arrivals; however, most trauma teams continue to staff APPs in a linear fashion. Failure to plan for variable arrivals may contribute to excessive patient wait times and emergency department overcrowding. This study used both qualitative and quantitative approaches to evaluate the impact of APP scheduling on patient wait time and to find schedules minimizing delays in reaching the needed care at the right time.

A retrospective observation of the availability of APPs and the flow of 2,249 trauma patients at a Level 1 trauma center, using both visual overlays and computer modeling, allowed us to evaluate the baseline condition, two what-if schedules, and two model-generated schedules minimizing patient time without any additional APP hours.

A visual overlay of APP staffing on 2010 patient arrivals indicated substantial times of mismatch. Trauma managers considered adding an APP during weekday evenings that would have resulted in a 14.8% increase in APP hours and yielded a 27% reduction in patient wait times according to our model. An alternate schedule was developed and implemented in 2012 with a 10.5% increase in APP hours and yielding a 73% reduction in wait times. We also delineated two schedule options with 57% and 78% reductions in wait time and no increase in APP work hours.

Evaluating alternate shift times and assignments using visual overlays and computer modeling can provide APP staffing solutions with up to 78% reduction in trauma patient wait time without additional APP labor. Knowing that care at the right time is crucial to arriving patients, making sure APP staffing is synchronized with arriving patients is something trauma center managers cannot ignore.

Care management study, level IV.