New ER Provider and Patients Per Hour

[Dabba]

So I'm only 2 months into my first job out of school and I just wanted to ask what the general milestones were for speed in the ER without sacrificing safety and patient care. I currently have a 3 month orientation where I'm the extra provider on shift and at this point I'm basically seeing the same amount of patients as my mentor (Basically splitting the load one person would have) at 1.3/hour. My director expects me to be seeing 2.5 patients by the end of my orientation, so basically in one month.

For the record we have an approximately 35 beds with 6 of those being dedicated to a fast track. During the day we have 2 docs and one midlevel. I'm expected to see the fast track stuff plus some of the "vertical" 3s but a lot of the patients I see are not fast track and most require a workup, so its not be any means purely fast track patients.

What is good milestones for patients per hour, especially reaching 2.0 and 2.5/hour? I'm not sure what is normal and if I am just progressing slowly or they expect a lot of me quickly. I don't have any frames of reference. I've done a lot of reading on efficiency and I'm doing my best to improve while maintaining safe care of the patients.

My other concern is that this ER recently lost its entire mid-level team for reasons which I'm unsure but this combined with what I'm not sure is high expectations for new providers has me a little worried.

[LT_Oneal_PAC]

As on reddit, 2-2.5 an hour is reasonable seeing level 3 or less only. Some days you’ll see less, some days you’ll see more. It should all average out. Seeing 1.3/hr when you’re an extra person is understandable because it there isn’t always enough volume to go around. I can only speculate why you’re group had a mass exodus, but I’m sure it had something to do with them being tired of being pretty much fast track and getting burned out.

[Dabba]

Thanks for the reply. I guess the true test will come in Jan when I have them all to myself instead of splitting. The hospital has some issues which I've already seen but nothing that I can see a mass exodus over. PAs here arent only fast track which is great for me as I enjoy seeing the sicker patients as well, but it can definitely affect my PPH.

[ohiovolffemtp]

I believe the learning curve for a new grad in EM is at least 3 years long.  If the expectation is that you'll be hitting 2-2.5 PPH within 3 months of starting that will need to be almost exclusively 4's & 5's with very simple 3's.  Once you have your flow down and are proficient with the EMR and your standard workups for the straightforward level 3's, then you can work on increasing your speed.

[SB23]

As a new grad at 5 months I was seeing 1 pph most level 2 and 3 with some patients needing multiple consults and admission. 7 months in and I’m seeing 1.7 pph with level 3s and 4s. I think I’m slower than most ED PAs but oh well. I’m still constantly using references at work which definitely slows me down.  

[TWR]

I am tired of bean counters dictating how many patients you are to treat in an hour.  These are people just like us and they come in with the full gamut of complaints and should be treated with respect and attention to the reason they are there.  Not sew 'em up and get 'em out!  Next customer!!!!  Patients are not like chocolates on Lucy's factory job!!

At the end of the day you don't want to go home wondering if you did the right thing because you have to see x amount of patients per hour.  On any given day one of us or even the bean counters could be an ER patient.  You can bet your a** the bean counter will expect total attention.

[sas5814]

There really is no "reasonable" number per hour. Complexity is everything and each patient takes as much time as they take.What matters is providing good care while being as efficient as you reasonably can.