Baseline Emergency Staffing Tool (BEST)

Important notice: this tool is under evaluation

This tool is currently available for use, however formal evaluation is ongoing and will be completed in November 2013. If you take part in the evaluation of this tool please feed back to help us refine the final version.

About BEST

This tool has been developed by the RCN Emergency Care Association (ECA) and Faculty of Emergency Nursing (FEN).

BEST is a workforce planning tool for use at local level in your Emergency Department (ED) to allow any disparity between nursing workload and staffing to be highlighted. The tool allows you to:

analyse the volume and pattern of nursing workload in your ED
track this against your rostered staffing level
calculate the whole time equivalent workforce and skill mix which would be required to provide the nursing care needed in the department during the audit period.

The tool does not produce recommended staffing levels but will allow EDs to work locally to reduce any disparity between workload and staffing. This can be achieved for example by improving patients pathways, departmental and hospital processes, roster designs and actual staffing.

What's required

The BEST calculation requires data to be collected and input for a seven-day period on an hour-by-hour basis. A user guide is provided below, together with the various data collection appendices to explain how to gather your data, how to enter it and what the results portray.

It is important to pay particular attention to the definitions and instructions relating to:

how to measure patients dependency in adults and children
which staff to include and which to exclude.

Every ED is different and it is important that your results are used by the people who know most about your ED, you. BEST is not designed to define a minimum staffing number or to compare organisations to each other.

How it works

The calculations work by using nurse-to-patient ratios in the various dependency categories. It is primarily these ratios which will be refined during the evaluation period April 2013 – November 2013.

The ratios used by BEST are:

total dependency - two nurses to one patient
high dependency - one nurse to one patient
moderate dependency - one nurse to two patients
low dependency - one nurse to 3.5 patients.

The hourly data sets used by BEST are:

patient dependency volume in the department using the Jones Dependency Tool
the total number of staff rostered to be clinical on shift in the department.

A calculation will also provide an indication of what skill mix breakdown is required in the whole time equivalent workforce in your ED using the FEN competency levels and supporting definitions which can be found at www.fen.uk.com

For help and advice or to offer feedback please email us at eca@rcn.org.uk