Generalizable items and modular structure for computerised physician staffing calculation on intensive care units

Table 1 Basic patient-oriented tasks of physicians on the intensive care unit

		In-house	Standard	In-house time		Standard time		Physicians/handing over
		Time (min)	Time (min)	Physician/patient	Time/patient	Physician/patient	Time/patient
Admission (time per patient, including daily routine on day of admission)
	Patient takeover	5	5
	Clinical evaluation	5	5
	Writing of admission documents	20	20
	Writing of physician's instructions	10	10
	Reimbursement documentation (DRGs)	10	10
	Basic examination and controls	5	5
	Handing over round	5	5
	Senior physician round	5	5
	Sum	65	65
Daily routine (time per patient)
	Transit time	5	5
	Physical examination and status	5	5
	Writing of physician's instructions	5	5
	Documentation	2	2
	Radiology round	2	2
	Microbiology round	2	2
	Physiotherapy round	10	10
	Talking with relatives	5	5
	Rounds with consultants	5	5
	Sum	41	41
Omission/demission (time per patient)
	Final examination	3	3
	Final documentation	15	15
	Physician's letter	5	5
	Handing over	2	2
	Sum	25	25
Handing over medical rounds (time per patient)
Shift 1	Handing over 1 Mo - Fr			25	5	25	5	5
Shift 2	Handing over 2 Mo - Fr			25	5	25	5	5
Shift 3	Handing over 3 Mo - Fr			15	5	15	5	3
	Senior physician round Mo - Fr			10	10	5	5	1
	Sum Mo - Fr			75		70
Shift 1	Handing over 1 Sa, Su, public holiday			15	5	15	5	3
Shift 2	Handing over 2 Sa, Su, public holiday			0	5	0	5	0
Shift 3	Handing over 3 Sa, Su, public holiday			15	5	15	5	3
	Senior physician round Sa, Su, public holiday			5	5	5	5	1
	Sum Sa, Su, public holidays			35		35

Table 2 Additional patient-oriented tasks of physicians on the intensive care unit

		Inhouse time (min)	Standard time (min)	Numbers per yr	Total time
Examinations
	Angiography (diagnostic/interventional)	120	120	45	5400
	CT scan	60	45	379	22740
	Examination	20	20
	Preparation time for transit	20	20
	Transit time	20	20
	Magentic resonance tomography MRT	65	65	80	5200
	Examination	20	20
	Preparation time for transit	30	30
	Transit time	15	15
	Diagnostic bronchoscopy	40	40	298	11920
	Twelve-lead ECG	10	10	0	0
	Haemodynamics (PAC/PiCCO)	15	15	114	1710
	Limon	30	30	0	0
	CVVHF (Heparin)/setup, change	30	30	2	60
	CVVHF (Citrate)/setup, change	40	40	398	15920
	MARS	120	120	0	0
	Thrombelastography (TEG)	20	20	0	0
	Setting up	5	5
	Control	5	5
	Finalization	10	10
Tasks/procedures
	Ascites puncture	20	20	0	0
	Installation of arterial line	10	10	254	2540
	ARDS - 135° position	20	20	280	5600
	Transfusion blood/coagulation products (per unit)	5	5	2732	13660
	Cardioversion	15	15	4	60
	Insertion of central lines (CVC, Sheldon, PiCCO)	40	40	374	14960
	Intracranial pressure measurement	15	15	16	240
	Intubation	15	15	100	1500
	Support of consultants	10	10	49	490
	Transportation to operating theatre (in/out)	20	20	2600	52000
	Installation of PAC/PiCCO	10	10	1	10
	Isolation of patients (f.e. MRSA)/d	15	15	45	675
	Installation of peridural catheters	30	30	6	180
	Percutaneous puncture of bladder	30	30	0	0
	Puncture of pleura (one-time)	20	20	0	0
	Transesophageal echocardiography	45	45	31	1395
	Chest tube	30	30	113	3390
	Tracheotomy (dilation/plastically)	60	60	93	5580
	Transvenous pacemaker	10	10	0	0
	Ultrasonography of bladder	10	10	238	2380
	Ultrasonography of pleura	10	10	200	2000
	Transfer of patient to external institutions	30	30	0	0
	Major wound care	15	15	50	750
Additional efforts (onetime/patient/stay)
	Physician's letter (extensive, multi-page)	30	30	708	21240
	Final documentation in decease	30	30	113	3390
	Inquires by health insurance	15	15	35	525
	Preparation for rehabilitation	45	45	107	4815
Sum additional tasks
	In min				200330
	In h				3339

CT: Computed tomography; MRI: Magnetic resonance imaging.

Table 3 Non patient-oriented tasks of physicians on the intensive care unit

		Time in h per year	FE net
Working groups				Name working groups ... Projects
	Airway management	84	0.04
	Haemostaseology	84	0.04
	Regional anaesthesia	84	0.04
	Working group A	84	0.04	Ultrasound
	Working group B	84	0.04	Quality management, SOPs
	Working group C	42	0.02	Hygiene standards
Administrative tasks
	Waste management/recycling	42	0.02
	Department homepage	42	0.02
	Controlling	84	0.04
	Duty rota/duty pay off	218	0.10
	Inhouse continued education	42	0.02
	Executive board meetings	104	0.05
	Anual report	84	0.04
	Documentation of effort	84	0.04
	Computers and interconnection	84	0.04
	Rotation	21	0.01
	Emergency room management	21	0.01
	Rota plan	42	0,02
	Holiday plan	42	0.02
	Certificates	42	0.02
	Administrative task A	84	0.04	Strategy planning
	Administrative task B		0.00
	Administrative task C		0.00
Work in committees
	Antibiotics	42	0.02
	Drugs	42	0.02
	Urban planning	84	0.04
	Equipment	84	0.04
	Materials management and control	42	0.02
	Transfusions	42	0.02
	Committee A	84	0.04	Patients's feedback
	Committee B		0.00
	Committee C		0.00
Students in practical year (PY)
	Number of PY students per year			8
	Time demand of physicians for PY students (h)	2192	1.30	1 gross physician/8 PY-students
Work in projects
	Project A	218	0.10	Antibiotic stewardship
	Project B		0.00
	Project C		0.00
	Project D		0.00
	Project E		0.00
Teaching
	Nurses	500	0.23
	Other matters		0.00
Regulatory decrees/representatives			0.00
	Worker protection	52	0.02
	Data security	52	0.02
	Diagnosis related groups	52	0.02
	Hygiene	52	0.02
	Devices	52	0.02
	Hazardous material	52	0.02
	Ordinance on medical devices	52	0.02
	Quality management	52	0.02
	Protection against X-rays	52	0.02
	Transplantation	52	0.02
Sum hours net per year (h)		5348.4	3.16

Table 4 Total calculation of physician staffing on the intensive care unit

		Time demand per patient (min)
Patient days per year	5868
Caes per year	705
Public holidays/yr	11
Total amount
Numbers of "admissions"	705	Admission	65
Numbers of "daily routine"	5163	Daily routine	41
Numbers of "discharges/transferrals"	705	Discharge/transferral	25
Numbers of "handing over rounds monday - friday"	4019	Handing over round monday - friday	75
Numbers of "handing over rounds Sat, Sun, public hol."	1849	Handing over rounds Sat, Sun, public holidays	35
Total times
Time "takeover"	45825 min
Time "daily routine"	211683 min
Time "discharges/transferrals"	17625 min
Time "handing over rounds monday - friday"	301438 min
Numbers "handing over rounds Sat, Sun, public hol."	64709 min
Total time BT	641280 min
	10688 h
Total time AT	3339 h
Time demand (BT + AT)	14027 h
Time for non patient-oriented tasks	5348 h
Holidays for shift workers	205 h
Total time expenditure	19580 h
Rest allowance in %	19.5%
Total time expenditure plus rest allowance	23398 h
Working hours without break per day (h)	8.4
Standard weekly hours of FE in h	42
Annual net time per FE (h)	1691	Gross time per FE	2192 h
Number of FE	11.6	(net 1)
Number of beds	16
LS role	0.4	(0.15 FE/6 beds/net)
Leadership role h/yr	676	(hours for 0.15 FE/6 beds/net)
Number of physicians < 3 mo of ICU experience/yr	7
PT	2.1	(0.3 FE/physician < 3 mo ICU experience/year/net)
Postgraduate training hours per year	3550	(hours for 0.3 FE/physician < 3 mo ICU experience/yr/net)
Total time + leader ship, PT	23806	h
Number FE without continuing medical education	14.1	(net 2)
CME/SA (h)	704	50	(h/yr/FE)
Continuing medical education/staff appraisal in FE	0.4
Total time + LS, PT, CME, SA (net total)	24511	h
Number FE (net total)	14.5

BT: Basic tasks; AT: Additional tasks; FE: Full-time employee; LS: Leader ship role; PT: Postgraduate training; CME: Continuing medical education; SA: Staff appraisal.

Table 5 Calculation with work-fellows with different annual working times

Carryover of table total calculation, total time + rest allowance, leadership, postgraduate training							24511
CME, staff appraisal: AWT desired net value (h)
	Standardweekly hours (h)	Publicholidays	GrossAWT (h)	Rest allowance plusLS, PT, CME, SA (%)	NetAWT (h)	Number ofphysicians	NetAWT real (h)
Employee type 1	42.00	11	2192	19.5	1691	4.0	6762
Employee type 2	21.00	11	1096	19.5	808	2.0	1616
Employee type 3	48.00	11	2506	19.5	1943	1.0	1943
Employee type 4	54.00	11	2819	19.5	2195	3.0	6584
Employee type 5	10.50	11	548	19.5	367	1.0	367
Employee type 6	40.00	11	2088	19.5	1606	3.0	4819
Employee type 7	20.00	11	1044	19.5	766	3.0	2298
Employee type 8		11	0	19.5	-74		0
Employee type 9		11	0	19.5	-74		0
Employee type 10		11	0	19.5	-74		0
				Sum employees		17.0
				Sum annual working time net (h)			24389
				Hours net demand (if negative values) (h)			-121

Gross AWT = [Standard weekly hours : 5 (d)] × (261 workdays - public holidays), underlying (365 running days - 102 saturdays; sundays = 261 workdays). Net AWT = gross AWT - [gross AWT × (Rest allowance plus LS, PT, CMA, SA)]. AWT: Annual working time; CME: Continuing medical education; LS: Leadership; PT: Postgraduate training; SA: Staff appraisal.

Table 6 Calculation of minimal physician staffing per year to run an intensive care unit

Time handing over round (min)	45
Shift model hours		Number of handing overs day	Sum handing over (min) per day	Sum handing over (h) per day
8 h		3	135	2.25
12 h		2	90	1.50
x h			0	0.00
Standard weekly hours FE in h		42		Gross	Net
				per year	per year
Working hours per day in h		8.4		2192	1691
Rest allowance in %		19.5
Minimal demand of physicians
Minimal occupancy: 1 physician, 24 h/d, 7 d/wk, 365 d/yr
Number of physicians		Shift	Net hours	Net hours	Gross hours	FE net
per shift			per day	per year	per year	42
			plus handing over	plus handing over	plus handing over	h/wk
1		8 h	26.25	9581	11450	6.8
1		12 h	25.50	9308	11122	6.6
1		x h	24.00	8760	10468	6.2

Not considered: times for CME, LS, PT, SA. Take care for legal working regulations: e.g., at maximum 48 h/wk in shift work, as well as 54 h/wk with opt-out in standby duty! Take care for legal regulations: e.g., at maximum 12 h shift + 45 min handing over! AWT: Annual working time; CME: Continuing medical education; FE: Full-time employee; LS: Leadership; PT: Postgraduate training; SA: Staff appraisal.

Table 7 Calculation of physician staffing in shift work

Characteristics of shift work							Demand of physicians
Duty hours (shift)					06:00-14:54
Public holidays/year					11		Carryover of table total calculation, total time
Rest allowance in %					19.5		plus RA, LS, PT, CME, SA =
Working hours without break per day (h)					8.4		Sum net annual working time desired (h)				24511
Standard weekly hours of full-time employee (FE) in h					42		Sum number full-time physicians (net total) desired				14.5
Gross annual time per full-time employee FE (h)					2192
Net annual time per full-time employee FE (h)(without public holidays, holidays, illness)					1691
Shift	Days	Shiftmodel	Start	End	Break h	Working hours without break h	Physician/shift	Demand/week		Physicians	Demand /year
								Workdays/week (n)	Workhours/week	Workdays/ year (n)	Workhours/ year net (h)	Full-time employees/year net
a. m. shift	Weekday	8 h	6:00	14:54	0.5	8.4	5	5	210	250	10500	6.2
p. m. shift	Weekday	8 h	14:00	22:54	0.5	8.4	2	5	84	250	4200	2.5
night shift	Weekday	8 h	22:00	6:54	0.5	8.4	2	5	84	250	4200	2.5
a. m. shift	Weekday	8 h	6:00	14:54	0.5	8.4	2	2	33.6	104	1747.2	1
p. m. shift	Weekday	8 h	14:00	22:54	0.5	8.4	2	2	33.6	104	1747.2	1
night shift	Weekday	8 h	22:00	6:54	0.5	8.4	2	2	33.6	104	1747.2	1
a. m. shift	Public holiday	8 h	6:00	14:54	0.5	8.4	2			11	184.8	0.1
p. m. shift	Public holiday	8 h	14:00	22:54	0.5	8.4	2			11	184.8	0.1
night shift	Public holiday	8 h	22:00	6:54	0.5	8.4	2			11	184.8	0.1
Senior physician	Weekend/public holiday		8:00	10:00	0	2	1	2	4	115	230	0.1
Inhouse special duty			0:00	0:00					0		0	0
								Sum	482.8		24926	14.7
								Net demand			-415.4	-0.2

Take care for legal regulations: e.g., at maximum 12 h shift + 45 min handing over! Take care for legal working regulations: e.g., at maximum 48 h/wk in shift work! CME: Continuing medical education; FE: Full-time employee; LS: Leadership, PT: Postgraduate training; SA: Staff appraisal.

Table 8 Calculation of physician staffing in standby duty

Charcteristics of standby duty								Demand of physicians
Duty hours (shift)					07:15-16:09
Public holidays/year					11			Carryover of table total calculation, total time plus
Rest allowance in %					19.5			RA, LS, PT, CME, SA =
Working hours without break per day (h)					8.4			Sum net annual working time desired (h)				24511
Standard weekly hours of full-time employee (FE) in h					42			Sum number full-time physicians (net total) desired				14.5
Gross annual time per full-time employee FE (h)					2192
Net annual time per full-time employee FE (h) (without public holidays, holidays, illness)					1691
Shift	Days	Type	Start	End	Break h	Working hours without break h	Physician/shift	Demand physicians/wk		Demand physicians/yr
								Workdays/wk (n)	Workhours/wk	Workdays/yr (n)	Workhours/ yr net	Core time full-time employee/ yr net	Standby duty full-time employees/yr net
a. m. shift	Weekday		7:15	16:09	0.5	8.4	3	5	126	250	6300	3.7
p. m. shift	Weekday		13:30	22:24	0.5	8.4	2	5	84	250	4200	2.5
x shift	Weekday		0:00	0:00				5	0	250	0	0
a. m. shift	Weekday		7:15	16:09	0.5	8.4	0	2	0	104	0	0
p. m. shift	Weekday		0:00	0:00				2	0	104	0	0
x shift	Weekday		0:00	0:00				2	0	104	0	0
a. m. shift	Public holiday		7:15	16:09	0.5	8.4	2			11	184.8	0.1
p. m. shift	Public holiday		0:00	0:00			2			11	0	0
x shift	Public holiday		0:00	0:00			2			11	0	0
Standby duty	Weekday	1	0:00	0:00	0			5	0.0	250	0		0
Standby duty	Weekend	1	0:00	0:00	0			2	0.0	104	0		0
Standby duty	Public holiday	1	0:00	0:00	0					11	0		0
Standby duty	Weekday	2	16:09	8:00	0	15.85	2	5	158.5	250	7925		4.7
Standby duty	Weekend	2	7:15	8:00	0	24.75	2	2	99	104	5148		3
Standby duty	Public holiday	2	7:15	8:00	0	24.75	2			11	544.5		0.3
Senior physician	Weekend /public holiday		8:00	10:00	0	2	1	2	4	115	230		0.1
Inhouse special duty			0:00	0:00					0		0		0
Sum									261.5		24532.3	6.3	8.2
Sum core time, standby duty + special duties full-time employees net													14.5
Net demand											-21.7		0

CME: Continuing medical education; FE: Full-time employee; LS: Leadership; PT: Postgraduate training; SA: Staff appraisal.