Urgent Care provider stats....

[lumbeendn25]

Hello All

 

I am a PAC working in a hospital owned Urgent Care located on a hospital campus. We are separate from the ED (across the parking lot) so the ED has its own fast track.

 

I generally avg. 35 pts/day during my 12h shift. I work 3 - 12h shifts/wk. I have been hearing/reading of providers averaging 45-50/60 pts/day in UC.

 

I have seen upwards of 65pts/shift, however this has been primarily during flu season with mainly low acuity pts. and also my shift ends at 8pm however when seeing 60+ pts I don't get out until 1h or so after my shift has ended. I get one 30 min. lunch break and rarely take over 15min. and always take lunch during slow period of day. If no slow period eat on the go.

 

I get patients routinely with SOB, CP, have seen a few PE's CVA, Hypertensive Urgencies and emergencies....chronic uncontrolled DM/HTN with no PCP, all need at least an evaluation and prompt referral to ED or work up if deemed not in imminent danger...which will pretty much kill pt flow if you get 4 or 5 of these pts during different hours of your shift.

 

So my question is are providers actually AVERAGING 45-50/60+ pts/12h shift or is it more of I have a busy shift 60+ pts a few days a month and decreased pt load the remainder of shifts in the month. And are those pts seen within the shift hours ie 800 am - 800 pm not getting out of work at 900 or 1000 pm. Which would mean pts are seen over 13-14h vs 12h?

 

In my opinion I feel providers who are seeing 50/60+ pts/12 h shift in an Urgent Care setting must be routinely seeing run of the mill illnesses 95% of the time, URI, pharyngitis, uncomplicated UTI, acute gastroenteritis....anything much outside of the run of the mill requires further workup or a firm punt to the ED.

 

I don't know about many providers but if I had to see 50+ pts every 12h shift I worked burn out would be my middle name.

 

Please Chime in...

[EMEDPA]

3-4hr is reasonable for ft or urgent care even including a few really sick folks. If everyone has a cold 5-6/hr is doable, but as you said painful.

[DizzyJ]

I average about 30 patients during a 12hour shift 9-9p...mostly FT type stuff, but often get workups/admissions scattered throughout the day. On a busy day I could see over 40 patients...I leave one cranky and exhausted guy when I have to see 40 patients. I couldn't even imagine how I would feel after 60! I generally always get out on time unless it's busy and I feel bad for handing off a patient that i could finish up in a reasonable amount of time.

[ventana]

30 per 12 in a fast track connected to the ER - if slow pick up some main side patients (1-2)

[hrjames]

We work 6 hour shifts (7a-1p or 1p-7p) with fairly high volume. I routinely see 25-30 in an average 6 hour shift. Generally low acuity, but we do get the appy, MI, PE, CVA, new onset DM, new onset afib/CHF, tension pneumo, etc. Usually 1-2 of these per 6 hour shift. If I work a weekend, I'm alone and generally see 7 pts per hour, but that is almost always very low acuity, and very doable.

I think the key to this is staffing and enough exam rooms. I have one RN, two MAs plus lab and xray techs, same as the MDs, which is nice. Sometimes we get a bonus MA if we're really busy. We do have a "backup second provider" who helps lighten the load during busiest hours. We also have a fairly efficient EMR system, which helps with documentation, which is the worst part of my job. It's one thing to see so many patients. It's another to have an extra 1-2 hours of dictation to complete AFTER you've gotten the patients out the door.

[lumbeendn25]

We work 6 hour shifts (7a-1p or 1p-7p) with fairly high volume. I routinely see 25-30 in an average 6 hour shift. Generally low acuity, but we do get the appy, MI, PE, CVA, new onset DM, new onset afib/CHF, tension pneumo, etc. Usually 1-2 of these per 6 hour shift. If I work a weekend, I'm alone and generally see 7 pts per hour, but that is almost always very low acuity, and very doable.

I think the key to this is staffing and enough exam rooms. I have one RN, two MAs plus lab and xray techs, same as the MDs, which is nice. Sometimes we get a bonus MA if we're really busy. We do have a "backup second provider" who helps lighten the load during busiest hours. We also have a fairly efficient EMR system, which helps with documentation, which is the worst part of my job. It's one thing to see so many patients. It's another to have an extra 1-2 hours of dictation to complete AFTER you've gotten the patients out the door.

 

After reading your last sentence, I must add that we use old fashioned paper charting....everything is hand written and the note is finished before the patient leaves the room for discharge. Maybe that's why everyone else seems able to see 5-6/7 pt/hr, they have EMR and or they dictate after pts are gone for 1-2hrs. (Interesting)

[EMEDPA]

emr slows you down. you will never be faster than you are on paper.

when we went to emr we had to double the # of providers to see the same # of pts/hr in the dept.

[hrjames]

After reading your last sentence, I must add that we use old fashioned paper charting....everything is hand written and the note is finished before the patient leaves the room for discharge. Maybe that's why everyone else seems able to see 5-6/7 pt/hr, they have EMR and or they dictate after pts are gone for 1-2hrs. (Interesting)

 

Other than when I was a student, I have never used paper charts in clinic. We used to dictate EVERYTHING (could do URIs in my sleep, though I'd question the accuracy). We got an expanded EMR which allows for "point and click" notes for common complaints such as URI and UTI. With these, little to no typing is required so we can actually finish the note in about 30 seconds after the patient leaves the room. I enter the history as I take it and can quickly add the exam and plan right after they leave. I can type fairly well, so I do put in a few specific details in the encounter, mostly so I can remember which patient it was later when the mother calls later to insist that their dear little one really needs abx for their cold. Is it perfect? No, but it's definitely an improvement over dictation. I'm sorry if I wasn't clear in my prior post, but now I actually have less to do at the end of the day than I did before. I used to routinely spend 45-90 minutes after clinic dictating. Now I rarely spend more than 30 minutes completing my documentation. But I still dislike that part of my job.

 

emr slows you down. you will never be faster than you are on paper.

when we went to emr we had to double the # of providers to see the same # of pts/hr in the dept.

 

I agree that EMR limits speed, but not necessarily efficiency. As part of a health system, it has big advantages in that I can read the notes from the last ER/card/psych/primary visit and get a more accurate hx in a very quick fashion. The notes are also legible, which is often not the case with paper records, which are usually in another building anyway. I can definitely take better care of a complicated patient when I have access to their record and know what their docs have been doing and are trying to accomplish with them. This is especially helpful with our many elderly patients who are often quite poor historians with complex medical problems.

 

 

Wow, look at me posting 3 times in 1 week! I should probably check on my kiddos and get some sleep.

[marilynpac]

I have to agree with emed. Not only do I like paper, but I prefer a checklist with a side area for added notes if I need them...goes soooo fast!

[tlahut]

Personal maximum productivity was 50 patients in a 12 hour shift. That maximum productivity covers a 20 year career. Average in UC / FT environments is 20-25 / 12hr shift. Unfortunately this is an institutional limitation of this hospital, as it seems to require an optimal alignment of the sun-moon-&-stars to perform well. I’ve done better in other EDs.

 

Major requirement is ‘good triage’, meaning acuity that is less than the acuity appropriate for hospital admission. Hospital admissions are daily occurrence in my UC / FT, with ICU admissions from fast track not-uncommon. Other major requirement is good staffing. For us, good staffing means a minimum of one RN, one tech and one secretary – usually we get any two of those three.

 

Documentation is hybrid. Aspirations for EMR have been expressed, but only incremental changes toward that goal have occurred, so the documentation is a mix. Full EMR implementation has been "postponed" Q3 months for the past three years.

 

Institutional weirdness is unfortunately prevalent among our administrators. They want maximum productivity but don’t want to spend to provide appropriate resources.

 

-Tom

 

 

 

 

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[v_chicky]

Oh you all give me hope. I'm a at a walk in clinic attached to a family practice clinic. When really busy, I see 26-30 pts in 8 hours, that's normally URI/AGE/UTI/AOM/etc, with pressure from the admin to see more. Normal volume before we became oversaturated with providers was 20-22 in 8 hours, which is comfortable for me. Mostly easy stuff, but with the occasional acute on chronic renal failure, real SOB, new onset DM, RSV baby satting at 80%, CP, weak and dizzy for 3 years, face went numb yesterday but won't go to the ER, etc thrown in, normally 1-2 of those per day. Those definitely throw me for a loop and s l o w things down. Now with so many providers, we average 14 per day which gets excruciatingly boring. No EMR yet, paper charts with no check off sheet, just a blank piece of paper to write a SOAP note, so charting takes forever. Not enough MAs so it takes forever to get patients in, track down labs, consult notes, give shots, get EKGs, etc.

 

PA friend's hubby who is also a PA works in a local UC, normally sees 30-40 in 12 hours. He saw 56 a few weeks ago as the sole provider and was fried after his shift. Thankfully, that's doesn't seem to be the norm.

[rcdavis]

V_chicky,

 

I still covet your avatar.

 

Just so you know.

[cbrsmurf]

^steal it!

[bwd72]

I do the same sort of urgent care that the folks above generally talk about. Mostly non-sick, simple stuff, but the occasional more involved workup. 35 is a good day for me in 12 hour shift, and I generally get out on time. 45 is getting pretty rough and all but guaranteed to be out an hour after close. 50+ and I am running silly. BUT I will say that much of the time, I spend equal amount of time documenting in the EMR as actually doing work for the pt. That's sad!