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Orlando C. Kirton, MD; Marilyn A. Folcik, RN, MPH; Michael E. Ivy, MD; Rebecca Calabrese, MBA, RTT; Eric Dobkin, MD; Judith Pepe, MD; John Mah, MD; Kevin Keating, MD; Marc Palter, MD

Arch Surg. 2007;142:336-341.

Objective  To quantify midlevel practitioner (MLP) staffing requirements based on the volume and complexity of patient care and the duty-hour constraints of the Accreditation Council for Graduate Medical Education 80-hour workweek.

Design  Data extracted from Eclipsys Sunrise Decision Support Manager, the hospital financial budget, and census reports; and MLP, resident, and subspecialty fellow clinical, operative, and on-call schedules, and educational curriculum. Fiscal year 2005 patient census and hours of required care were defined by attending physician service and/or patient care location. Volume of patient care activity for MLPs, residents, and subspecialty fellows were established by verified self-reporting methodology.

Setting  Urban teaching hospital with 867 beds, of which 116 are surgical beds (which include 36 intensive care unit beds and 12 step-down beds).

Participants  Attending physicians, MLPs, residents, and subspecialty fellows.

Main Outcome Measures  Coverage index (available staffing hours [residents, subspecialty fellows, and MLPs] divided by the clinical coverage schedule), and the workload staffing efficiency index (number of clinical hours of patient care activities divided by the hours of available staff for a specific clinical service).

Results  The workload staffing efficiency index and the coverage index identified 4 services that benefited from the addition of new MLPs.

Conclusion  We developed a quantitative MLP staffing methodology based on patient volume and the type and complexity of direct and indirect patient care activities, encompassing the roles and availability of residents, subspecialty fellows, and MLPs.

Author Affiliations: Department of Surgery, Hartford Hospital, Hartford, Conn.

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