The Detailed Staffing Exercise (DSE) Approach
Initial Efforts

The first meeting of the rehabilitation medicine panel was conducted in the spring of 1990. The primary purpose was to examine whether the expert judgment panel process, as the study committee first envisioned it, could be applied to rehabilitation medicine.

The focus of this analysis was the initial draft of a physician staffing instrument, which required the expert to assess the time (and hence FTEE) required by physiatrists to render patient care, work with residents, and perform other tasks at the VA medical center. To test this approach, staffing instruments were constructed for three actual VAMCs. Each facility was portrayed as consisting of a set of patient care areas (PCAs), where direct patient care and resident training occur. For each PCA, data were presented on the volume of patient workload expected, the number of residents available, and the overall availability of nursing and support staff. The critical question with respect to each PCA was, how much physiatrist time is required, in total, to meet these VA mission-related demands in the course of a typical workday? Each PCA was analyzed in turn, and total physiatrist FTEE for the facility was computed. Additional questions at the end of the instrument elicited FTEE requirements for weekend coverage, special procedures, and non-VA physician consultants.

In the course of this first meeting the panel reached several initial conclusions about the assumptions that would undergird the development of subsequent physician staffing instruments:

  • The education of staff and residents is carried out mostly in the clinical setting and occurs as part of daily rounds. However, education time is not always documented properly in the VA's cost distribution report (CDR) for RMS. It is often allocated under the cost center for medicine.

  • Insufficient numbers of rehab professionals (including nurses) reduce the efficiency of the physiatrist and may also compromise the quality of care, but probably will not alter physician FTEE requirements.

  • Full-time physiatrists in the VA typically work substantially more than 40 hours a week. However, the 40-hour work week will be be used in estimating requirements in order to be consistent across panels.

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