1. Clerical Staffing and Workload in AES/CES Final Report
Team 11: Alexander Copp, Joelle Grider, Kaya Yarman and Noa Jeremias
Clients: Jennifer Holmes, Director of ED Operations
Deidre Todd, Clerical Manager
Coordinators: Olivia DeTroyer, Industrial Engineer
Mustafa Mushtaq, Improvement Engineering Fellow
Dr. Mark Van Oyen, Professor
2018|Winter|11

2. Introduction

3. Clerical Staff Roles Unit Host Clerk Unit Clerks Check-in Clerk AES:
Main
South
East
West
EC3
CES:
CES
Resource Clerk
Lead/Charge Clerk

4. Goals and Objectives Balance staffing model and workload
Reevaluate each shift
Address over and under utilization
Increase patient and employee satisfaction
Balance staffing model and workload

5. Perceived delay during peak hours
Key Issues
Perceived delay during peak hours
Discontinuity in workflow
Unbalanced workload

6. Project Scope
AES
Employees
Hospital
Clerks
AES
CES

7. Methods: Observations

8. Methods: Time Studies

9. Methods: Interviews

10. Methods: Benchmarks Contacted four large research hospitals
Topics: Clerical tasks, visitors, breaks
Focused on findings from St. Joseph’s Mercy Hospital

11. Methods: Historical Data
Patient Arrival
(Check-in)
Resus bay arrivals
(EC3 Unit Clerk)
Visitor counts
(Unit Host)
Aspect phone data
(Unit Clerks except Main)
Ready bed page data
(South, CES Unit Clerk)
Outside record data
(West, CES Unit Clerk)
Break coverage data
(Resource, Lead/Charge)
**6 months

12. Figure 1. Template of Clerical times sheet for CES unit clerk
Methods: Time Sheets
Figure 1. Template of Clerical times sheet for CES unit clerk
48 hours

13. Findings: Check-In Clerk
Average utilization
AES: 20%
CES: 20%
Table 1. Average check-ins by shift
Shift
AES
CES
11 pm 20 10
3 am 12 4
7 am 31
11 am 52 18
3 pm 49
7 pm 37 21
Table 2. Average patient check-in time
(source: observations, sample size: (AES) n = 23 (CES) n = 17, date: 1/20 - 3/15/17)
AES
1 min. 10 s.
CES
2 min. 36 s.
Figure 1. Workload analysis of AES and CES check-in clerks
(source: check-in data, sample size: n = 183 days, date: 7/ /31/2017)
(source: check-in data, sample size: n = 183 days, date: 7/1 - 12/31/17)
State average utilization at end of each slide

14. Findings: Unit Host Clerk
Average utilization
AES 1: 23%
AES 2: 37%
CES: 22%
Table 3. Daily average visitor counts
(source: Monthly visitor count data, sample size: n = 183 days, date: 7/1 - 12/31/17)
AES
239
CES
131
Table 4. Average visitor escort time
(source: observations, sample size: (AES) n = 6 (CES) n = 13, date: 1/20 - 3/15/17)
AES
2 min. 31 s.
CES
2 min s.
Figure 2. Workload analysis of AES and CES unit host clerks
(source: timesheets, sample size: n = 34 shifts, date: 3/29 - 3/30/2018)
(source: Monthly visitor count data, sample size: n = 183 days, date: 7/1 - 12/31/17)
(source: observations, sample size: (AES) n = 6 (CES) n = 13, date: 1/20 - 3/15/17)

15. Findings: CES Unit Clerk
Ready bed pages
Patient call light
Referrals
Average utilization
Desk 1: 28%
Desk 2: 14%
Total count other tasks (not specified):
Desk 1: 27
Desk 2: 86
No CES Desk 2 clerk 3 am - 7 am 1 of 2 days
Figure 8. Workload analysis of CES desk 1 and desk 2 clerks
(source: timesheets, sample size: n = 23 clerks, date: 3/29 - 3/30/2018, used for task distributions for desk 1 and desk 2 clerks)
(source: Aspect reports, sample size: n = 183 days, date: 7/1 - 12/31/2017, used for average call time and average calls per day for desk 1 clerk)
(source: Monthly record counts, sample size n = 183 days, date: 7/1 - 12/31/2017, used for daily average outside records per day)
(source: CES outside records screenshot, sample size n = 39 hours, date: 3/14 - 3/15/17, used for outside record shift dist.)
(source: Ready bed page data, sample size n = 183 days, date 7/1 - 12/31/2017, used for ready bed page shift dist.)

16. Findings: Main Unit Clerk
Uploading CD’s
Patient call lights
Resus activation
Average utilization
Maize: 21%
Blue: 24%
Total count other tasks (not specified):
Maize: 63
Blue: 20
No data for either role between 3 pm - 5 pm
Figure 3. Workload analysis of maize and blue clerks
(source: timesheets, sample size: n = 11 clerks, date: 3/30/2018)
Only one clerk on duty 3 am - 7 am

17. Findings: East Unit Clerk
Patient call lights
Work orders
Average utilization
East: 8%
Total count other tasks (not specified):
East: 268
Figure 4. Workload analysis of East unit clerks
(source: Timesheets, sample size: n = 12 clerks, date: 3/29 - 3/30/2018, used for workload dist.)
(source: Aspect reports, sample size: n = 183 days, date: 7/1 - 12/31/2017, used for average call time)

18. Findings: South Unit Clerk
Patient call lights
Uploading CD’s
Transports
Average utilization
South: 19%
Total count other tasks (not specified):
South: 39
Figure 6. Workload analysis of West unit clerks
(source: Timesheets, sample size: n = 6 clerks, date: 3/29/2018, used for workload dist.)
(source: Aspect reports, sample size: n = 183 days, date: 7/1 - 12/31/2017, used for average call time)
(source: Bed ready page data, sample size n = 183 days, date 7/1 - 12/31/2017, used for Bed ready page shift dist.)

19. Findings: West Unit Clerk
Average utilization
West: 12%
No time sheet data between
11 am - 7 pm
Figure 6. Workload analysis of West unit clerks
(source: Timesheets, sample size: n = 4 clerks, date: 3/30/2018, used for workload dist.)
(source: Aspect reports, sample size: n = 183 days, date: 7/1 - 12/31/2017, used for average call time)
(source: Monthly record counts, sample size n = 183 days, date: 7/1 - 12/31/2017, used for number of records per day)
(source: AES outside records screenshot, sample size n = 39 hours, date: 3/14 - 3/15/17, used for outside record shift dist.)

20. Findings: EC3 Unit Clerk
Patient call lights
Stickers/ Forms/ Pages
Meal orders
Average utilization
EC3: 9%
Figure 6. Workload analysis of EC3 unit clerks
(source: Timesheets, sample size: n = 6 clerks, date: 3/30/2018, used for workload dist.)
(source: Aspect reports, sample size: n = 183 days, date: 7/1 - 12/31/2017, used for average call time)
** add in resus registration
Frequent outside record tallys between
11 am - 7 pm
** add in resus registration

21. Findings: Resource, Lead, Charge Clerks
Figure 7. Workload analysis of Resource, Lead and Charge Clerks
(source: Clerical resource coverage data, sample size: n = 7 days, date: 3/26 - 4/5/2018, used for shift coverage data)
Average utilization
Resource: 67%
Lead/Charge: 62%

22. Findings: Benchmarks for St. Joes

23. Findings: Interviews

24. Conclusions: Average Utilizations Per Role
As you can see all roles are underutilized. For this project, we are focusing on roles that are the most underutilized!
Figure 7. Workload analysis all clerical roles

25. Recommendations: Additional Tasks
On a side note, the clerks would require training to successfully take on additional tasks.

26. Recommendations: Reinforced Tasks

27. Improved Satisfaction
Expected Impact
Increased Efficiency
Balanced Workload
Improved Satisfaction

28. Opportunities for Additional Analysis
Completed analysis:
Future analysis:
Major tasks performed in each role
Focus on underutilized roles
Provider feedback on current state and task re-distribution opportunities
Assess feasibility of additional training opportunities (ex: paging)
Comparison of clerical operations in other emergency departments
Utilize time sheets for a more representative workload distribution
Gathering of historical data on tasks where available