title: A cost-efficiency analysis to increase clinician staffing in an academic emergency department.
abstract: OBJECTIVE
  To develop a software-based model to determine which combination of attendings working with/without residents and/or midlevel providers (MLP) was most cost-efficient for incremental staffing in an academic emergency department (ED).
  
  
  METHODS
  A decision tree model using standard decision analysis software was created to compare different staffing configurations for the Rhode Island Hospital ED. The productivity, salary, and working hour data of different staffing configurations were determined using data from the ED, reported productivity data, and assumptions based on the authors' experience. Attending physician productivity alone was assumed to be 2.1 patients per hour, and each additional resident and/or MLP was assumed to add smaller net productivity gains (the first one adds 0.75 patients/hour; the second, 0.5 patients/hour; the third, 0.33 patients/hour). Resident and MLP productivity were assumed to be equivalent in the base case and varied during subsequent analysis. Noneconomic variables were not included in the model.
  
  
  RESULTS
  The lowest base case cost option is to pair one attending with one resident; all other approaches are more expensive. The difference between most options is less than $5/patient. Only at extremes of variables do overall choices differ.
  
  
  CONCLUSIONS
  Incrementally staffing an academic ED with a ratio of one attending per resident achieves the lowest cost, but other models are minimally more expensive. The model allows an ED administrator to determine the costs of different models.
authors.affiliation: Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA. asucov@lifespan.org
authors.forename: Andrew
authors.initials: A
authors.lastname: Sucov
authors.forename: Robert
authors.initials: R
authors.lastname: Sidman
authors.forename: Jonathan
authors.initials: J
authors.lastname: Valente
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000458:organization & administration*; D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency / Q000191:economics; D008505:Medical Staff, Hospital / Q000191:economics*; D009722:Nurse Practitioners / Q000191:economics; D010561:Personnel Staffing and Scheduling / Q000191:economics*; D010823:Physician Assistants / Q000191:economics; D014505:Urban Population; D016526:Workload / Q000191:economics