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Expectations exceeded in productivity gains.

The ED at the University of Michigan Health Center in Ann Arbor exceeded expectations when their system adopted a "rolling approach" to budgeting.The department boosted productivity by more than 7%, compared with a target of 2% and a systemwide average of 4.7%. Data on arrivals, occupancy, nursing ratios, and other areas were studied to determine precise staffing requirements. Nursing interns were trained early so they would be available to fill staffing needs. Planning involved "cohorts" that included other units with which the ED regularly interacts.