Pediatric Emergency Department Staffing

Shift Coverage Visualization

24-Hour View | Pediatric Emergency Department

Key Findings
3× census swing: 11 pts at 7am → 31 pts at 7pm peak
Coverage gap: Only 2 providers 10pm–7am while clearing 20 patients
Peak coverage: 4 providers overlap 3pm–6pm during plateau (26-31 pts)
Night drain: Census drops -2.6/hr at midnight (steepest decline)
Resident (13 pts)
AP (16 pts)
Flex Attending (16 pts)
ATTENDING SHIFTS
Check-ins/hr

Three-Phase Model: Providers see more patients early when fresh, taper in middle hours, and wind down at end (no new patients in final hour).

First 6 hours: 1.5× base rate
Middle hours: 0.5× base rate
Final hour(s): 0 patients

Note: Flex Attending has 1.5h wind-down; all others have 1h.

6
Total Shifts
3
EM Resident
2
AP
1
Attending
87
Total Patients/Day
3
Peds Shifts
15
Peds Patients
2
EM Intern Shifts
14
EM Intern Patients
Patient Flow Insights FY24/25 Peds ED Data Winter (Oct–Mar)
96
Arrivals/Day
84
Discharges
12
Admits (12%)
3
LWBS (3%)
7 AM Handoff
11 patients
8 in rooms 3 waiting
Lowest census. Day builds: +0.9 to +2.7/hr
7 PM Handoff
31 patients
20 in rooms 11 waiting
Peak census. Night clears: -0.9 to -2.6/hr
Peak Plateau
1 PM – 9 PM
Census 26-31, net flow near zero. Holding pattern.
Night Drain
9 PM – 7 AM
Census drops 31 to 11. Steepest at midnight (-2.6/hr).
ED Census (hover for net flow)
7A 12P 7P 12A 6A
Arrivals vs Dispositions (hover for detail)
7A 12P 7P 12A 6A
Low
Moderate
High
Night clears; Day builds
Daily Variability: How Census Ranges Across Different Days (hover for details)
50 40 30 20 10 0
7A 12P 7P 12A 6A
Surge (top 5%)
Busy (top 25%)
Typical (median)
Quiet (bottom 25%)
Provider Coverage vs Census (hover for patients-per-provider ratio)
4 3 2 1 0
7A 12P 7P 12A 6A
2 providers (gap)
3 providers
4 providers (peak)
WR Census & LWBS Risk Threshold
14 10 6 2 0
WR=8 threshold
7A 12P 7P 12A 6A
When WR > 8 patients, LWBS events begin. Peak WR of 22 (P95) at 7pm.
15.5
Peak Load
pts/provider @ 7pm
6.5
Best Coverage
pts/provider @ 4pm
10h
Night Gap
only 2 providers
7.4
Avg Load
pts/provider (24h)
24-Hour Timeline: Shifts + Census + Load Hover for details
7A89101112P 123456 7P89101112A 123456
Census
Patients in ED
Providers
Resident
AP
Attending
Load (pts/provider)
<8 Good
8-12
>12 High
10PM - 7AM
2 providers clear 20 to 11 patients overnight
3PM - 6PM
4 providers handle plateau (26-31 pts)
7PM Handoff
Night inherits 31 patients at peak
Deep Dive: Peds ED Patterns FY24/25 Data Analysis
Winter vs Summer Census
Winter runs 15-20% higher volume
Winter (Oct-Mar)
Summer (Apr-Sep)
APP Coverage Calendar
Weekly hours: High (25+) Medium (18-24) Low (<18)
Waiting Room Census Throughout Day
Peaks mid-afternoon, clears overnight
7A101P47P101A46
1-2
Boarding Patients
Average overnight (12A-6A)
3%
LWBS Rate
~3 patients/day leave
12%
Admission Rate
~12 admits/day
12P-10P
Fast Track Hours
10 hours coverage
Daily Encounter Variability by Provider Type
Some days are much busier than others
MD
24 38 122
APP
11 23 38
Resident
18 30 69
10th percentile Median 90th percentile
Surge Days
MD volume can spike to 122/day (3x median). Plan for high-census protocols.
Thursday Dip
APP coverage drops to 18 hours on Thursdays vs 29 hours Wednesday.
WR Clears by 2AM
Waiting room drops to 1-2 patients after 2AM. Night team focuses on rooms.
Seasonal Staffing Proportionality
Does staffing scale with demand?
Winter (Oct–Mar)
5 shifts
42.5 h/day
Peak Census: 31
Summer (Apr–Sep)
4 shifts
34 h/day
Peak Census: 28
Proportional? Census drops ~10% (31 → 28) but staffing drops 20% (5 → 4 shifts). Is the Mid-Day shift cut justified?
APP Coverage Optimization
Target: 2.5 patients/provider/hour
Friday (9h) and Saturday (11.25h) fall below the 12.4h target needed for 2.5 PPH during peak census. These are the highest-risk days for APP understaffing.
Demand vs Capacity Where patient demand exceeds staffing capacity
31
Peak Demand Gap
pts vs 7.5 capacity @ 7pm
2
Night Understaffing
providers for 20 patients
4pm
Best Coverage
6.5 pts/provider ratio
22
WR Overflow
Peak WR P95 @ 7pm
Census vs Provider Capacity (24h, 7am start) Bars = census mean | Step line = providers on duty
35261780
7A12P7P12A6A
Census (mean) Adequate coverage Demand exceeds capacity
Hourly Net Flow (Arrivals − Discharges − Admits) Green = clearing | Red = building
+40-4
7A12P7P12A6A
Waiting Room Census (Leading Indicator) Threshold at WR=8 — above this, LWBS risk zone
14840
7A12P7P12A6A
When WR > 8 patients, LWBS events begin. Peak WR of 22 (P95) at 7pm.
7PM – 10PM
Peak demand gap: 31 patients, only 7.5 effective capacity
10PM – 7AM
Night gap: 2 providers clearing 20 patients (10:1 ratio)
3PM – 6PM
Best window: 4 providers, census 27–30, ratio 6.5–7.5
Attending Staffing Analysis Hourly attending coverage and patient capacity (PPH = 2.5)
Attending Coverage by Hour
Stacked bars show which attending shifts are active. Number = patient capacity at PPH 2.5
Day (7:30a–4p) Eve (11:30a–8p / Flex in Winter) Swing (5p–1:30a / 3:30p–12a) Night (11:30p–8a)
Shift Summary
Capacity vs Census (75th percentile)
Green = capacity exceeds census   Red = census exceeds capacity
PEM Staffing Survey Help us understand your preferences on resident staffing
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Poll Results Summary Written analysis of staff survey responses
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