[Physician staffing and shift work schedules : Concepts for emergency and intensive care medicine]

Human resource development is a key factor for a successful management of Intensive Care Units (ICU) and Emergency Departments (ED). It comprises the processes of recruiting and retaining employees. The present article offers strategies how the optimal manning level in ICUs and EDs can be determined and highlights the importance of active management of well being in acute care units. The manning level can be determined by using the work place method which is the common method for ICUs. For the EDs a method based on the specific times which are needed for patient care in relation to the intensity of care is more appropriate. This method needs to integrate the patient number per hour, the time needed per patient, and the defined service level particularly with respect to the time to be seen by a physician. For detailed staff calculation, complex mathematical models are needed (e.g. Erlang formula). The resulting manning level needs then to be distributed on the various shifts. Additional resources are needed for observation units and additional tasks like management tasks etc. Retainment of employees is only possible when the working field remains attractive over many years. While a structured and competence based education is of utmost importance in the beginning of a carrier, attractive rooster plans and the compatibility between work and private life, becomes more important when the specialisation has been achieved.