Okay, I have no financial relationship with commercial support to disclose. So, let's start with a polling question. Did your organization lose staff due to the impact of COVID-19? Well, that's what I figured. It's very difficult to move an RN and LPN during these times. So, striking the balance. Right sizing is a measure of efficiency. How do you decide you have the right people for the right flow? One thing that we learned during COVID is that survival is more important than efficiency. And that's one thing we are going to talk about. The goal, hopefully, is that even now in the midst of COVID, at least we can mitigate the increased cost of providing care that we are really forced to in order to provide a safe environment for both patients and the staff. So, let's define right sizing. So basically you want to match staffing levels to patient throughput to achieve levels of efficiency. Adaptation to providing care in a safe environment during COVID-19 has forced us to increase staffing at a time when case frequency has decreased. What we most understand is that patient throughput drive the staff. Let's understand the concept of an FTE. So before we get into the impact of COVID-19, let's understand the concept of an FTE. Many of us use FTEs as a measure of efficiency, but in fact, it's the measure of a warm body. So let's go back and reflect on having your staff operate at the top of their license. What does that mean and how is that determined? So operating at the top of their license, what does it mean? So you want RNs to do the RN type of things. You want your LPNs to do your LPN type of things. Your techs and MAs to do your MA and tech type of things. So this is applicable to both the office operations and endocenters. So what I've done is I've identified some tasks. So you have things like rooming a patient. There's nothing about rooming a patient that requires an RN license. So most of us use an MA or techs to room the patient. Taking vital signs. What are the requirements for vital signs? This is not necessarily RN work, but mostly in endocenters, you will see that happening. And in office space, it's usually MAs or techs or assistants that take care of that. Having a patient don a gown. Again, that's not necessarily RN work. Room turnover. Room turnover is very important, but again, no licensure is required for this task. Repositioning your stretchers. It's extremely important, especially during the COVID time. But again, does not require a license. So starting IVs. It depends on the state that you're in, in terms of who can do it. Same thing with given injections. Again, it depends on the state. Some states that's RN work, in some states that's LPN work. Record a 12 week EKG. Who can put it on and who can record it? But keep in mind, the physicians will be the ones to read it. Again, this is something that will vary by license, by state. Supervise infusions. Normally in the office space setting, it is an RN or a PA that supervise those infusions. Provide conscious sedation. In most ASC settings, that's done by the RN. But again, this is something that will vary by licensure, by state. So basically, this gives you an idea of the tasks in office settings and ASC settings, and the different types of licensure that might be associated with those tasks. So if you want all your staff operating at the top of their license, what's the next step? You want to separate your tasks into those that do and do not include licensure requirements. So you group your tasks by licensure requirements and create job descriptions. Doing this will give a good idea of what personnel that are required. Keep in mind, you must meet license requirements for those tasks. So it actually might be more efficient if you have people operate below their license level. So job descriptions for an RN and stating what RNs will do. You want to have a job description for an LPN stating what the LPNs will do. Job descriptions for the MA stating what the MAs will do. And of course, every job description always has something that states any other duties assigned, and that pretty much takes care of all the other tasks that need to be completed. So again, if you want your staff operating at the top of their license, the next step is to have the RNs do the RN type of things, the LPNs do the LPN types of things, the techs and MAs to do the techs and MA type of things. So pre-visit, pre-procedure questionnaire screenings of patients. Do you really have to have someone do this? Have you been tested? Do you have any new symptoms? Have you recently traveled to any COVID-19 hotspots in the last 14 days? In the last 14 days, have you had any close contact with anyone perhaps that tested positive for COVID-19? This is typically done by a phone call, perhaps telemedicine visits, and some facilities and offices have phone apps that this can be done through. Again, there is no licensure required for these tasks, but there is a need for this issue to be handed off to an RN. So the exam room or procedure room preparation and cleaning. You've got to have proper use of the appropriate cleaning agents, and you need increased attention to detail and the appropriate use of PPE while this is being done. There is no real licensure associated with this, but it's going to take time, and you know time, as you know, is money. This is nothing necessarily new, but it is the tradeoff between time to complete versus additional staff. Are you going to use your clinical staff or janitorial staff to complete these extra tasks? I know in my facility during this time, a lot of the clinical staff has stepped up and trained in cleaning and disinfecting to help the janitorial and housekeeping staff along. So everyone does try to pitch in to help. So contact tracing. You want to have a plan for contact tracing should a patient, staff, or provider test positive. So if you have a patient that tests positive or has answered yes, you need a plan for how you're going to handle that. So license will vary, but you need to have a plan in place. Who will do your contact tracing? And you need a plan for isolation and impact on staffing provider capacity. What is overstaffed versus loss of capacity? Compliance with proper PE protocols is always something that's very difficult. Now they're requesting no watches, no rings, no earrings, necklaces, any other jewelry, and even artificial nails. If N95 masks are being reprocessed, then you can't wear any facial cosmetics. Require proper donning and doffing of PPE. You need to make sure your staff is well trained and that it's documented. You need to review your traffic pattern requirements for levels of PPE by the area. Again, no license implications, but it will slow down the process. And again, you may need to add staff. This is always the hardest part to get done. Restrooms. Are you going to clean your restrooms after every patient use? What is the recommendation? How frequently does it have to get done? And by whom? Are you going to be adding more janitorial or housekeeping staff? What happens if you get too busy? Again, there is no licensure implications, but it will slow down the process. And again, you may need to add staff to maintain your throughput. The exam room or procedure rooms. The turnover and terminal cleaning. Are your janitorial and housekeeping services properly trained and doing an appropriate job? Can the reception area furniture be properly cleaned? Are the stretches and exam rooms being properly cleaned? If they're cracked or broken, should they be cleaned? And do the staff know to notify someone when they are cracked and broken? If you have not increased your janitorial or housekeeping crew, and your staff are finishing at about the same time, then that means you are not getting the job done. Pre-COVID staff efficiency was often a provider convenience. Increased costs paired with decreased throughput may not be sustainable. Right-sizing based on licensure and tasks still works, but safety precautions will increase expense for the foreseeable future. Familiarity with new protocols may identify efficiency opportunities, and periodic reviews of wait staffing levels may be required and ongoing. Some practice pearls. A weight approach to the concept of an FTE results in a superior measure of efficiency. Having staff perform at the top of their license is the first step in managing the cost of clinical labor. Even organizations that have reached levels of efficiency pre-COVID-19 will struggle with the cost of additional labor, forced by adapting to this new normal post-COVID-19. Thank you.

COVID-19

staffing levels

efficiency

licensure requirements

cost management