SHM Converge Scientific Abstract ePoster Gallery-Implementing a Census-Aligned Standby Staffing Model to Reduce Unnecessary Premium Shifts in Hospital Medicine

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This hospital medicine project addressed rising, unpredictable census levels that often exceeded 350 patients and led to frequent use of pre-scheduled backup rounders (16th and 17th providers). Previously, decisions to activate these premium-paid shifts were based on subjective judgment, which caused inconsistent staffing, unnecessary call-ins, and avoidable expense.<br /><br />The team implemented a standardized, transparent, census-based staffing model that activates additional providers only when objective thresholds are met, while maintaining a target workload of 18 patients per provider. The approach was supported by a strong moonlighting pool, clear communication of activation triggers, and respect for provider autonomy through voluntary standby rather than forced coverage.<br /><br />Results showed meaningful improvement after implementation. From January to March 2025, there were 138 extra shifts costing $345,000, including 38 avoidable shifts that cost $95,000 and did not meet objective need. After the intervention, from April to June 2025, extra shifts dropped to 77, total cost fell to $192,500, and avoidable shifts were eliminated entirely. This produced net savings of $152,500 in one quarter, along with a 44% reduction in extra shift utilization.<br /><br />The project concluded that a census-aligned standby model can reduce unnecessary premium spending while maintaining safe provider workloads. Eliminating subjective activation decisions improved both financial and operational performance within a single quarter. The authors also noted that ongoing adjustments will be needed to account for seasonal census changes and other operational shifts.

Asset Subtitle

Anvesh Narimiti

Meta Tag

Author List Anvesh Narimiti, Gabriella M. Boccia, Kirk Philpot

Category Innovations

Concept Hospitalist Census

Concept Staffing Model

Concept Staffing Costs

Concept Census Threshold

Concept Extra Shift

Distinguished Non-Finalist

Presenter Organization ECU Health

Presenting Author Anvesh Narimiti

Track Other

Keywords

hospital medicine

census-based staffing

backup rounders

provider workload

premium-paid shifts

standby model

operational efficiency

cost savings

staffing thresholds

moonlighting pool

Hospitalist Census

Staffing Model

Staffing Costs

Census Threshold

Extra Shift