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World J Crit Care Med. Aug 4, 2017; 6(3): 153-163
Published online Aug 4, 2017. doi: 10.5492/wjccm.v6.i3.153
Generalizable items and modular structure for computerised physician staffing calculation on intensive care units
Manfred Weiss, Gernot Marx, Thomas Iber
Manfred Weiss, Department of Anesthesiology, University Hospital Ulm, D-89081 Ulm, Germany
Gernot Marx, Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, D-52074 Aachen, Germany
Thomas Iber, Department of Anesthesia and Intensive Care, Klinikum Mittelbaden Baden-Baden/Bühl, D-76532 Baden-Baden, Germany
Author contributions: Weiss M, Marx G and Iber T wrote the paper on behalf of the “Forum quality management and economics” of the German Association of Anaesthesiologists (BDA) and the German Society of Anaesthesiology and Intensive Care Medicine (DGAI); Weiss M, Marx G and Iber T were leading in the previous versions and the update and publications in German language of the calculation base for the personnel requirement of physicians on ICUs including an Excel calculation sheet by the “Forum quality management and economics” focusing on quantitative and qualitative cornerstones for personnel requirement of physicians on ICUs.
Supported by the German Association of Anaesthesiologists (BDA) and the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), in that BDA and DGAI sponsored meetings of the working group “personnel management” to create the physician staffing tools 2008 and 2012. Weiss M, Marx G and Iber T are members of the working group “personnel management of BDA and DGAI”.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manfred Weiss, MD, PhD, MBA, Professor of Anesthesiology, Department of Anesthesiology, University Hospital Ulm, Albert-Einstein-Allee 23, D-89081 Ulm, Germany. manfred.weiss@uni-ulm.de
Telephone: +49-731-50060226 Fax: +49-731-50060008
Received: November 13, 2016
Peer-review started: November 15, 2016
First decision: February 15, 2017
Revised: February 23, 2017
Accepted: April 24, 2017
Article in press: April 24, 2017
Published online: August 4, 2017
Processing time: 260 Days and 5.8 Hours
Abstract

Intensive care medicine remains one of the most cost-driving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician’s workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks (performed in every patient) and additional tasks (necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society of Anesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.

Keywords: Budgets; Critical care; Economics; Humans; Intensive care units; Personnel hospital; Personnel staffing and scheduling; Physicians; Workload; Quality of health care

Core tip: After 8 years of experience with the first calculation tool for physician staffing on intensive care units, generalizable key aspects are presented to help physicians all around the world to justify realistic personnel needs. A workload-oriented modular, flexible Excel-based calculation tool is presented, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. Staffing calculations reflect basic tasks (every patient), additional tasks (specific diagnostic and therapeutic requirements), non patient-oriented tasks, and, auxilliary calculations, such as minimal personnel staffing, distribution of personnel demand regarding type of employee due to working hours per year, shift work or standby duty.