An urgent care can see the same number of patients as last year and still be short-staffed. When more visits need lab work, imaging or a transfer, each visit takes longer, and a schedule built on visit counts no longer matches the work.
Operators call this a move toward high-acuity urgent care. What your clinic treats, what it transfers and what a clinician needs to hold to work there are your medical director's decisions. This post covers the operations: how to measure a changing case mix, what it does to the schedule, and how to staff for it.
How a high-acuity case mix changes urgent care staffing
A staffing model built on patients per provider hour assumes a visit length. If a clinician spends 15 minutes on each visit, one clinician covers four visits an hour. At 20 minutes the same clinician covers three.
Your visit count can stay flat while the hours of work behind it rise. The schedule looks correct, and the shift runs behind anyway. Waits get longer through the day and the last patients are seen after closing.
A longer visit also uses more of everyone's time. A visit with a blood draw, an X-ray and a call to a receiving facility takes medical assistant, RN, radiology tech and front desk time that a short visit doesn't. The shortfall may be in those roles and not in the provider role.
Measure the change in your urgent care case mix
Check your EMR data before you change the schedule. Pull the last 12 months and compare them with the 12 months before. Look at five measures, by shift:
- Visit length. The time from check-in to discharge, and the provider's time per visit if your EMR records it.
- Visits with on-site testing or imaging. The share of visits that included a lab test or an X-ray.
- Transfers out. How many patients you sent to a higher level of care, and how long each transfer kept the clinician busy.
- Billing-level mix. A move toward higher visit levels points the same way as longer visits.
- Shift overruns. How often the last patient left after closing, and by how long.
If the measures move together across most shifts, your case mix has changed. If they move only on certain days or hours, the change may come from one source, such as an employer contract or a nearby clinic's closing time. That calls for a change to those shifts only.
A clinic can also grow in volume, services and hours at the same time. Our post on urgent care scope creep covers the full audit for that.
Rework the staffing ratio for a high-acuity case mix
Recalculate capacity with the provider time per visit you measured. If your EMR doesn't record it, time a sample of visits on a few shifts. Divide 60 by the average provider minutes per visit on a shift. The result is the number of visits one clinician can cover in an hour on that shift.
Compare that number with the arrivals per hour on the same shift. The hours where arrivals are higher than capacity are the hours where you need more coverage. Calculating urgent care staffing ratios has the full method.
Add coverage where the numbers show the gap:
- An overlap shift. A second clinician for the busiest four or five hours costs less than a second full shift.
- More support hours. If clinicians are doing their own rooming and blood draws, an added MA or RN gives them that time back.
- An earlier cutoff for walk-ins. If the last hour's patients are routinely seen after closing, stop taking walk-ins earlier or pay for the extra time.
Decide who can cover a high-acuity urgent care shift
Your medical director decides what a clinician needs to work your shifts as the case mix changes: which roles, which certifications and what experience. For NPs and PAs, your state's supervision and collaboration rules are part of that decision. Ask your counsel what those rules require.
Staffing has to carry out what the medical director decides. Do three things:
- Get the requirements in writing, by role. A scheduler can't apply a standard that only the medical director knows.
- Record on the roster what each clinician is cleared for. The scheduler can then fill a shift without asking each time.
- Match the physician's schedule to the supervision arrangement. If your arrangement requires a physician to be on site or reachable during certain shifts, the physician's hours have to cover those shifts.
Each added requirement leaves fewer clinicians who can cover a shift. Shifts take longer to fill and call-outs are harder to replace. Post these shifts earlier, and credential the clinicians who meet the requirements before you have a gap.
Describe the high-acuity case mix in the shift listing
A locum clinician picks shifts from the listing. If the listing describes a routine urgent care day and the shift isn't one, they find out during the shift and are unlikely to take another.
State what the shift is like in plain terms:
- Expected visits, and the share that need lab work or imaging
- Whether the clinician is the only provider on site
- Which support staff are on the shift
- Who the backup or supervising physician is and how to reach them
- How a transfer works: who calls, where patients go and who handles the paperwork
- Whether time after closing is paid
Clinicians who are comfortable with that kind of shift will apply, and others will pass before you've spent time credentialing them. The on-site testing and imaging details belong in the listing too. Matching locum clinicians to your X-ray and lab setup covers how to write them down.
Use locum coverage to test the new staffing model
A change in case mix may not last. A competitor reopens, a contract ends, or a seasonal pattern passes. Hiring a permanent clinician for a change that reverses leaves you overstaffed.
Locum coverage lets you test the change first. Fill the overlap shift or the added support hours with locum clinicians for a few months, and keep tracking the five measures. If visit length and overruns improve and the case mix holds, you have the evidence for a permanent hire. If the mix moves back, you stop posting the shifts.
Use the same few locum clinicians where you can. A clinician who has worked your shifts knows your transfer process and your staff, and needs less from you on the next shift.
Decide whether you want the high-acuity case mix
Staffing up is one response to a changing case mix. The other is to decide the clinic shouldn't take on the heavier visits and to send more of them elsewhere. Your medical director and owners make that choice.
Either answer works for staffing if it's written down. Without a decision, the case mix keeps changing and the people already on the schedule take on the extra work.
Rediworks is a self-service marketplace for urgent care shifts. You post the shift with the clinician type, dates and shift details, and clinicians see the listing before they apply. Sign up to post shifts.