Should ER Groups Use Locums? Passing the Baton in Connecticut

One of the first issues an emergency medicine group must address when they take over a new Emergency Department is whether to employ temporary locums providers to staff the department. The pressure is on to staff up, and many groups use locums as a stop-gap until they have hired full-time emergency physicians. Other groups may not use locums, but rush to hire the first emergency physicians that come through the door.

My company recently had an official hand-off to 10 new, exceptional providers it has hired to staff the Emergency Department at Bristol Hospital in Connecticut, our newest hospital partner. It was a time to reflect on the last nine months of starting up a new location so far away from our original hospitals (which are all in the Maryland area).

We made many choices along the way – but one of the key choices was no locums.

So on January 1st, the day we took over, the most senior physicians, including most of our senior partners, began traveling to Bristol Connecticut to staff the emergency department. Some of those in the business world would say that this was an inefficient use of resources. But to me it was keeping a promise. It’s the same promise we have made with all our hospital partners over the last 15 years.

Over the last nine months, many of us have spent many nights away from our own families delivering care to patients in a place far away from where we started. That choice reflects our core values as well as a commitment we made to not only Bristol Hospital but all the hospitals where we provides service.

We could have chosen many ways to start providing service in this location. We could have hired the first physicians we interviewed or contracted with locums companies to provide start-up staffing. Instead, we sent our most senior physicians to do the job, chalking up quite a few frequent flyer miles between Maryland and Connecticut (thank you Southwest Airlines!).

What do we have to show for those last nine months? The left without being seen rate has dropped from over 2% down to 0.3%. At one point in the last month of service, only five patients out of 3,300 left the emergency department prior to treatment.

Door to provider times have fallen from over 45 minutes to under 30 minutes. There have been numerous comments from private patients stating how pleased they are and how quickly they are being seen. We’ve also seen patient satisfaction scores improve significantly, as measured by Press Ganey.

We are defined by both the large and small decisions we make over the course of a company or over the course of our lives. While it is very easy to talk the talk, it is much more impactful to walk the walk. As we turn over the reins in Bristol to an exceptional group of emergency physicians, physician assistants and nurse practitioners we have stayed true to the promise we made the day before we set foot in the door. It is a commitment that defines who we are as an organization and I, for one, would not want it any other way.