Even though Orlando healthcare providers are accustomed to the dramatic increase in older patients visiting Florida hospitals and ERs during the winter months, healthcare administrators remain challenged to meet staffing demands - juggling physicians, stretching hours, bringing in doctors per diem. Setting throughput goals and having core measures in place helps improve efficiency in patient flow and quality of care in Florida ERs, said Catherine Polera, DO, MPH, chief clinical officer for the Division of Emergency Medicine at Sheridan Healthcare.

The Sunrise-based company, established in 1953, is the nation's leading physician staffing provider for emergency medicine, anesthesia, neonatal management and radiology services in hospitals and ambulatory surgery centers."Getting to see a doctor faster really drives patient satisfaction," said Polera. "Our job is to do what's needed to find an optimal way to get us shorter door-to-doctor time."

Covering the Floor

For starters, Sheridan Healthcare creates a productive environment for its staff. For example, physicians' hourly rate is a type of pay-for-performance: good quality, metrics and patient satisfaction are the measures. To provide sufficient ER physician coverage, the company uses the demand capacity staffing model, and makes sure it aligns with the nursing staffing model.

Some overflow days are anticipatory, such as those following major holidays.

"It's typical for the day after Thanksgiving to be the busiest ER day of the year," she said. "Eating sodium-rich and fatty foods prompts trips to the ER. People hold off as best they can not to be in the ER on a holiday."

The ER was busier than usual last February and March. Last fall, ER patient volume increased earlier in the snowbird season, which begins in October.

"It sparked unusually high ER activity," said Polera, a former snowbird who served as chief medical officer at Saint Michael's Medical Center in Newark, NJ, and chief medical officer at MedExcel USA Inc. in New Windsor, NY, before joining Sheridan Healthcare.

"That's a challenge for staffing. Usually, we increase our coverage by day or by hour as trends dictate. Many times, our own doctors will pick up extra shifts, but we also employ part-time doctors, who may also be snowbirds themselves. I've been talking to more of those doctors who are getting really sick of cold weather and looking at ways to change their lifestyle. Some emergency medicine doctors have work that allows them to be almost semi-retired and contract part-time in warmer climates. Also, many more doctors are calling me, saying they wouldn't mind taking shifts in the winter, or downsizing their shifts and coming to Florida. That helps."

The PCP Component

Significant changes sparked by healthcare reform have already affected the way primary care providers (PCPs) practice medicine in ways that alleviate pressure on ERs. Some PCP groups open longer on certain days of the week, or are more accessible using the Patient Centered Medical Home (PCMH) model.

Also, the influx of urgent care clinics is taking some of the ER load. Yet there's much ground to cover for PCPs and ER doctors to work together more effectively, noted Polera.

"Hospitals are under a great deal of pressure to have good patient satisfaction, good relationships in the community, and make sure patients are seen as soon as possible," said Polera, pointing to lack of communication - verbally and via electronic medical record (EMR) systems - as major stumbling blocks to ER physicians providing optimal patient care.

"If I could call their office to get patient records, it would help lower healthcare costs tremendously. Knowing a patient's medical history would make a huge difference in the patient's ER care. We wouldn't repeat a CT scan, for example. Getting medical history is a big challenge, especially in the wintertime." If PCPs decreased their door-to-doctor time, it would ease the burden on ERs, said Polera.

"If patients see they're in for a long wait at the doctor's office, they'll check online to see the fast wait times at ERs, where they can also get labs, x-rays and CT scans," she said. "The McDonald's mentality is impacting the way people choose healthcare. Why wait when everything can be done at once? The overall mindset may be changing from loyalty to a particular doctor to another direction."