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PubMed1990

Workload contribution of a physician assistant in an ambulatory care setting.

To evaluate the workload contribution of a Physician Assistant (PA) in an Ambulatory Care-Walk-in setting the number of patients registered, seen by the PA, and by the Supervising Physician (SP) was used. The simple average was drawn for comparison purposes. Quality of care assessment done by record review of patients seen. The workload contribution of the PA was 10.8%, that of the SP was 11.6%, with a joint contribution of 22.5%. The non supervising physician average was 11.2%. The quality of care assessment showed 100% compliance with the first four, and 93% compliance with the last three criteria. A PA makes an efficient workload contribution in this setting, not endangering the workload contribution of the supervising physician, who is able to maintain a similar workload contribution to that of a non supervising physician.

Ambulatory Care↗

PubMed1989

Estimates of general practitioner workload: a review.

This paper reviews four studies sponsored by the Department of Health which have attempted to measure workload in general practice and compares these with data from the general household survey. Despite the considerable differences in the objectives and methods employed by the four studies, they were found to contain remarkably consistent measurements of general practitioner workload. In a 'normal working week' general practitioners spend 38 hours on general medical service duties (including 24 hours of patient contact and five hours of travel to home visits), they see 150 patients or their representatives in surgery, and make 26 home visits. In an 'annual average week', taking into account holidays and sick leave, general practitioners undertake 90% of this workload. The studies show consistently large variations in the workload of general practitioners measured in this way, but fail to identify the key determinants of such variations. The reasons underlying the variation in general practitioner workload will remain unclear until we can distinguish between the expected, measurable variation and the residual, unexplained variation which may be due to the personal preferences of general practitioners.

Appointments and Schedules↗

PubMed1989

The effect of sustained acceleration and noise on workload in human operators.

Biodynamic stressors such as acceleration, vibration, heat, and cold can affect pilot performance. The objective of this research was to determine the individual effect of two of these stressors, sustained acceleration or high intensity pink noise, on workload in human operators. Combined stressors were not investigated. A total of 13 workload measures, including 1 subjective, 4 performance, and 8 physiological, were recorded on subjects (N = 9) performing a dual psychomotor task in the human centrifuge. Increasing noise stress (max 100 dB-A weighted) had a significant effect on the Subjective Workload Assessment Technique or SWAT scores (p = 0.0001) and reaction times (p = 0.0189); acceleration stress (average peak, 3.75 Gz) had a significant effect on SWAT (p = 0.0001), heart rate (p = 0.0001), total eye blinks (p = 0.0184), blink duration (p = 0.0017), and the standard deviation of the EMG on the tracking forearm (p = 0.0452). Although many of the workload measures were affected by the noise or acceleration, subjects were able to maintain their performance on the primary tracking task. It is concluded that biodynamic stressors, such as noise and acceleration can adversely affect subjective operator workload without affecting objective task performance.

Acceleration↗

PubMed1989

PharmaTrend as a management tool: capturing workload data.

Several methods of collecting workload data for use in PharmaTrend, a computerized pharmacy management information system, are described. Although the number of indicators produced by PharmaTrend is limited by the input of the user, the integrity of the indicators that are produced is not compromised; this allows the user to implement PharmaTrend on a limited scale, such as for workload only. Workload data that can be used in PharmaTrend are collected routinely by most pharmacies. Many activities are already recorded in logs and other noncomputerized sources. The aid of members of the pharmacy department and other departments may be enlisted in collecting these data. Self-reporting through time sheets and cards can also be used to obtain data on the distribution of work hours. Recording is simplified if employees are told to record only exceptions to their usual job responsibilities. The PharmaTrend manual contains detailed definitions of the workload categories, but simpler and more practical definitions may have to be used. A computer spreadsheet program should probably be used for compiling data if they are collected from several sources; this will facilitate entry into PharmaTrend. Simple methods are available for capturing workload data for input into the PharmaTrend program.

Database Management Systems↗

PubMed1996

Individual profiles of dyspnoea and fatigue in chronic bronchitic patients, defined by intensity and duration of submaximal workloads performed.

The subjective perception of fatigue and dyspnoea during submaximal exercise was studied in 10 chronic bronchitic patients using Borg's CR10 scale, with the aim of developing a model for the assessment of sustainable workloads (through the definition of individual perceptual profiles). Each subject performed five trials, consisting of steptests at constant submaximal workloads. Fatigue (CRf) and dyspnoea (CRd) perceptions, heart rate (HR) and duration times were measured. Maximal duration was set at 30 min. The trial was stopped if a fatigue/dyspnoea score of 7 ("very strong") or 85% of the maximum HR was reached. The growth of fatigue and dyspnoea perceptions (R) as functions of time (S) were expressed by the formula: R = a + c (S-b)n. Parameters a, b, c and n calculated for each subject and trial were (mean and SD): a = 0.49 (0.31); b = 2 (0); c = 1.3 (0.61); and n = 0.55 (0.2) for dyspnoea; a = 0.51 (0.27); b = 2 (0); c = 1.4 (0.75); and n = 0.55 (0.2) for fatigue. Individual CR3 "iso-perception" curves (W = k t alpha) for fatigue and dyspnoea in a workload/duration reference system were computed from the experimental data obtained during the five trials. Mean values of the exponent alpha were (.0.5) +/- (-0.23) for dyspnoea, and (-0.41) +/- (-0.22) for fatigue. The CR3 "iso-perception" curves represented the subjectively acceptable level of exertion (defined for load and duration). By doubling the duration and workload, CRd score increments of 1.55 (SD 0.46) and 4.9 (SD 0.42), respectively, were computed. Subjective perceptions are correlated to the intensity and duration of submaximal workload performed, and can be used in conjunction with physiological parameters to predict acceptable workloads in chronic bronchitic patients.

Bronchitis↗

PubMed2026

Evaluation of Physical and Mental Workload and Transfusion Time in Trauma Resuscitation.

BACKGROUND: Trauma resuscitation is time sensitive and complex. Whole blood (WB) and blood components are standard treatments for trauma related hemorrhage, yet their nursing workload and transfusion time have not been well evaluated. PURPOSE: To assess feasibility of a simulation-based crossover trial and obtain preliminary estimates comparing nursing workload and transfusion completion time between WB and blood component administration. METHODS: A randomized crossover pilot study using in situ simulation was conducted with experienced trauma nurses. Time-motion analysis measured transfusion completion time, and the National Aeronautical and Space Administration Task Load Index assessed workload domains. RESULTS: Strong feasibility was demonstrated across recruitment, retention, adherence, and completion. WB was associated with significantly shorter transfusion time, lower overall workload and mental demand, less effort, and better perceived performance. CONCLUSIONS: These findings support the feasibility and justify a fully powered trial. WB may improve resuscitation efficiency and reduce cognitive burden, with potential implications for patient outcomes and nursing workflow.

Humans↗

PubMed1992

List size, composition of practice and general practitioners' workload in The Netherlands.

Workload of general practitioners plays an important role in discussions about list size and remuneration in health care systems with fixed patient lists and capitation payments, such as in the Netherlands and in the United Kingdom. Against the background of the fairness of differences in income level between GPs the question is posed to what extent differences in list size reflect differences in workload and to what extent differences in patient characteristics influence workload. Both list size and practice composition relate to the demand led character of general practice. Data collected in the National Study of Morbidity and Interventions in General Practice are used. Central to this study is a three month recording of all contacts of 161 general practitioners (and their locums, assistant GPs and trainees) in the Netherlands. For each practice a patient register has been made to relate contacts to the practice population. The participating GPs kept a detailed diary covering 24 hr a day during one week. As indicators of workload several contact rates, hours worked in practice per week (in direct patient care and in other activities) and average length of office consultations are used. Demand related characteristics have the strongest relation to the number of hours worked by GPs, particularly the number of hours spent in patient-related activities. Rates of contacts, with the exception of the office contact rate, are not related to list size, but mainly to practice composition. The average length of consultations is negatively related to list size and some characteristics of the practice population.

Capitation Fee↗

PubMed1996

Physiological indices of workload in a simulated flight task.

The sensitivity of physiological measures to evaluate workload was investigated in a simulated flight task. Heart rate, blood pressure (from beat to beat), respiration and eye blinks were recorded in 14 subjects while they performed a complex task in a flight simulator. Workload was manipulated by introducing an additional task and by varying the task difficulty of segments of the flight scenarios. Heart rate and blood pressure were both affected by the different levels of task difficulty. Heart-rate variability was found to be confounded by respiration. Slow respiratory activity contributed considerably to heart rate variability, especially after periods of high workload (for example, after landing). The gain between blood-pressure and heart-rate variability (modulus) was sensitive to mental effort and was not influences by respiration. Eye blinks, in particular the duration, were specifically affected by the visual demands of the task and not by the workload in general. When subjects had to process visual information, the number and duration of blinks decreased.

Adult↗

PubMed1996

Psychophysiological responses to changes in workload during simulated air traffic control.

In this investigation, eight Air Force air traffic controllers (ATCs) performed three scenarios on TRACON (Terminal Radar Approach Control), a computer-based air traffic control (ATC) simulation. Two scenarios were used each with three levels of difficulty. One scenario varied traffic volume by manipulating the number of aircraft to be handled and the second scenario varied traffic complexity by manipulating arriving to departing flight ratios, pilot skill and mixture of aircraft types. A third scenario, overload, required subjects to handle a larger number of aircraft in a limited amount of time. The effects of the manipulations on controller workload were assessed using performance, subjective (TLX), and physiological (EEG, eye blink, heart rate, respiration, saccade) measures. Significant main effects of difficulty level were found for TRACON performance, TLX, eye blink, respiration and EEG measures. Only the EEG was associated with main effects for the type of traffic. The results provide support for the differential sensitivity of a variety of workload measures in complex tasks, underscore the importance of traffic complexity in ATC workload, and support the utility of TRACON as a tool for studies of ATC workload.

Adult↗

PubMed2006

Workload of primary-care midwives.

OBJECTIVE: to assess the actual workload of primary-care midwives in the Netherlands. BACKGROUND: In 2000, a strike and large demonstration before parliament convinced everyone of the shortage of midwives and their excessive workload. The government reacted by increasing the capacity of the midwifery schools and lowering the 'standard caseload' for a full-time working midwife. To assess whether this would lead to sufficient improvement of the situation, more insight was needed of the actual workload of midwives in primary care. METHOD: a 4-year prospective survey of the work of primary-care midwives, during 3 weeks each year, including all midwives working in a representative sample of midwifery practices. On average, 224 midwives participated each year. During 3 weeks in the summer and autumn, midwives kept a diary of their work, with an accurate timetable, covering 24 hours a day. They also filled out questionnaires about practice organisation, work schedules and experiences of workload. FINDINGS: primary-care midwives worked an average of 29 hours a week, and about 74% of their time (22 hours a week) was spent on client-related activities. On average, a midwife was on call during 53 hours a week, and 17 of the 29 hours of work took place during on-call-hours. This meant that an average midwife was involved in her work 65 hours a week. The time spent on direct client care increased by nearly 20%. In particular, the average time spent with a woman during labour and birth increased by almost one-third. CONCLUSION: primary-care midwives spend an average of 29 hours per week working, and this has remained constant between 2001 and 2004. In client-related care, there has been a shift towards fewer clients per midwife but more time per client.

Adult↗

PubMed1993

Tracing the missing link between nursing workload and case mix groups: a validation study.

This paper reports on the creation of a nursing workload data base of over 40,000 inpatient records by the Hospital Medical Records Institute (HMRI). During the 1989-90 fiscal year, five Ontario hospitals (four teaching, one community) reported total hours of nursing on the HMRI abstract along with standard clinical and demographic information. The accuracy of nursing workload data varied across hospitals and seemed to reflect differences in how data collection was implemented. When the data base was grouped by Case Mix Groups (CMGs), analysis demonstrated that patterns of resource utilization in nursing workload and length of stay were similar across CMGs. Results of this analysis indicate that the nursing workload component of the Resource Intensity Weight may be useful for estimating a hospital's nursing costs by CMG.

Analysis of Variance↗

PubMed1997

Basic Treatment Equivalent (BTE): a new measure of linear accelerator workload.

The measurement of linear accelerator workload in radiation oncology departments is usually based on the number of fields treated per unit time. However, this approach ignores variations in treatment complexity. This prospective study, was designed to measure treatment workload directly, taking into account the variations in complexity of different treatment techniques. From this, a model was to be developed, which would be simple to apply and reproducible, both within and between radiation oncology departments in Australasia. It would provide a realistic basis for assessing treatment costs and enable the comparison of patient throughput between departments. This paper describes the derivation of the model. Over a 4-week period in the Radiation Oncology Department of Westmead Hospital, all fractions of radiotherapy were timed. The data collected included: tumour site; treatment intent; number of fields; number of wedges, compensators and shielding blocks; fraction number; patient age; performance status; and need for general anaesthesia. Multivariate modelling was performed to identify factors that significantly affected fraction duration, so that these could be used to develop a model of resource utilization. The durations of 2371 fractions were measured in 219 patients. Seventy-five per cent of fractions were given with radical intent. The factors found to influence fraction duration on multivariate modelling were: number of fields; number of shielding blocks; first treatment fraction; need for anaesthesia; and performance status. The number of wedges and compensators were also found to be significant but were not included in the model in order to maintain simplicity. This was felt to be necessary if the model is to be applied to the widest possible variety of machines. A model of resources utilization called 'Basic Treatment Equivalent' (BTE) was derived, which incorporated these factors. When tested at Westmead Hospital, this model accurately reflected the predicted BTE value over a further 1-week study period. This model of linear accelerator use, which incorporates complexity has been derived and evaluated in one radiation oncology department. This requires further prospective testing before its widespread use. The model appears to reflect linear accelerator workload better than previous measures. An Australasian study to validate the model further will be undertaken. If adopted, this model has implications for comparative workload reports, diagnostic-related groups, waiting list calculations, and patient scheduling.

Efficiency↗

PubMed2003

Trends in on-call workload in an academic medical center radiology department 1998-20021.

RATIONALE AND OBJECTIVES: The workload in radiology departments is increasing rapidly. This study was designed to determine whether and to what extent the workload is being generated outside of traditional working hours (defined as 0800-1700 Monday thru Friday, excluding holidays). MATERIALS AND METHODS: Exam statistics were derived from the radiology department's automated examination scheduling and reporting system for four successive fiscal years. The distribution of the number of studies completed throughout the 24-hour day and the 7-day week was charted. RESULTS: A large proportion of studies are being completed outside of traditional working hours. Moreover, as the overall workload of the department increased, the proportion of studies being completed during nontraditional working hours was increasing at an even faster pace, particularly in the cross-sectional imaging modalities. Computed tomography, magnetic resonance imaging, and ultrasound have increased by 59%, 51%, and 30%, respectively, over 4 years. The on-call proportions have increased from 34% to 40% and 13% to 18% for computed tomography and ultrasound, respectively, over 4 years and from 44% to 50% for magnetic resonance imaging over 3 years. CONCLUSION: These trends have implications for radiologist and radiology technologist staffing. The department has already modified the scheduling of technologist staffing to provide in-house extended-hours coverage in most modalities. As the number of studies conducted outside of traditional working hours continues to expand and the demand for contemporaneous readings increases, radiologist staffing may need to be adjusted as well. Traditional on-call coverage may be insufficient to competently handle the growing workload. This may have particular implications for radiology residency programs.

Hospitals, University↗

PubMed2001

The nurse's workload in care situations.

AIM: The aim of this study was to describe the nurse's workload in care situations and on different work shifts on surgical and medical wards. Changes in heart rate, shoulder-neck muscle tension and perceived exertion were measured in these care situations. DESIGN: Nurses' physical fitness was tested using a clinical exercise test. RESULTS: Transportation of a patient to the operating theatre was the most strenuous care situation on morning and evening shifts. Primary care, and situations related to practical nursing procedures were the second most strenuous situations regardless of the shift. Workload in primary care situations and in transporting the patient can be classified as medium heavy based on heart rate and relative workload, whereas in other situations it can be classified on average as moderate or light. The nurse's good physical fitness was reflected in relative workload in care situations so that in primary care and practical nursing procedures there was a statistically significant difference between those who scored high on a fitness test and those who scored low. Transferring tasks and practical nursing procedures involved more shoulder-neck muscle tension than other care situations.

Adaptation, Psychological↗

PubMed2003

Measuring nursing workload in intensive care: an observational study using closed circuit video cameras.

BACKGROUND: There is an increasing demand for intensive care provision in the United Kingdom (UK), partly because of a national shortage of intensive care beds. The problem is compounded by the current method for calculating the nurse: patient ratio using a Nurse Workload Patient Category scoring system or similar adaptations used in many intensive care units. This ratio is calculated by using patient category or dependency scales, which operate on the assumption that the more critically ill the patient, the more nurse time is needed to care for the patient. However, many mechanically ventilated critically ill patients (allocated a high category of care) may need less nursing care than patients who are self-ventilating and allocated a lower level of dependence. PURPOSE: In this study, a video recorder was used to document nurse activity for 48 continuous shifts in two intensive care units to determine the accuracy of the Nursing Workload Patient Category scoring system in measuring nurse workload. METHODS: The video data were correlated later with the Patient Category allocated to the patient by the nurse at the time. RESULTS: The results of this observational study demonstrated that, despite complex care needs, a high percentage of nursing activities observed in each unit consisted of low skill activity. Furthermore, nurses spent less time with patients categorized as in need of intensive care than those in need of high dependency care in both units. CONCLUSION: The findings suggest that existing nurse:patient ratio classifications may be inappropriate, since nurses spent less time with critically ill patients. Radical reconsideration of nursing levels and skill mix might make it possible to increase intensive care provision because fewer nurses would be needed to staff each bed. The findings support alternative and more flexible systems for assessing workload and the use of different nurse:patient ratios.

Adult↗

PubMed2003

Is midwife workload associated with quality of process of care (continuous electronic fetal monitoring [CEFM]) and neonatal outcome indicators? A prospective study in consultant-led labour wards in Scotland.

Evidence for staffing recommendations in labour wards is scant. This study aimed to test association between midwife workload with adjusted process of continuous electronic fetal monitoring (CEFM) and neonatal outcome indicators. This was a prospective workload study in 23 consultant-led labour wards in Scotland. There were 3489 livebirths during September 2000, and 1561 consecutively delivered women with CEFM case review during the mid-two weeks. Process measures were: adjusted rates of CEFM, appropriate CEFM, and time to medical response for a serious fetal heart trace abnormality. Neonatal outcome indicators were: Apgar score < 7 at 5 minutes, admission to neonatal unit (NNU) > 48 hours, and neonatal resuscitation. Complete information was available for 99% (2553/2576) of workload time points, 99% (1559) of CEFM process, and 3083 eligible neonates. There were no associations between occupancy or staffing ratios and adjusted CEFM process, Apgar < 7 at 5 minutes (0.98 [0.83, 1.15]) or admission to NNU for > 48 hours (0.97 [0.95, 1.00]). However, there was association between increasing staffing ratios and lower odds of adjusted neonatal resuscitation (excluding bag and mask only) (0.97 [0.94, 0.99]). The direction of effect of increasing workload suggests detriment to outcome indicators, although the size of effect may be small.

Apgar Score↗

PubMed2001

Radiation oncology in Australia: workforce, workloads and equipment 1986-1999.

Regular national surveys of all public and private radiation oncology facilities in Australia have been carried out between 1986 and 1999. Workforce data recorded were numbers of radiation oncologists and trainees, radiation therapists, medical physicists and physics technicians, nursing staff, data managers, social workers and clerical staff. Workloads included treatments with megavoltage beams (linear accelerators, cobalt-60), orthovoltage/superficial X-rays, brachytherapy, total body irradiation and stereotactic radiosurgery. Major equipment recorded included numbers of megavoltage and orthovoltage/superficial X-ray machines, planning simulators, computerized dosimetry systems and brachytherapy equipment. The use of radiotherapy beds and the public-private mix of treatments were also documented. Data were assembled for Australia based on each individual state. Within Australia the number of public and private treatment facilities has increased by 44% from 18 in 1986 to 26 in 1999. The population has increased by 16.4%, cancer incidence by 51.8% and megavoltage workloads (fields) by 102%. The number of radiation therapists and physicists and the number of linear accelerators have, in general, increased with the growth in workloads. The number of radiation oncologists has increased by 60% from 4.5 full-time equivalent (FTE) radiation oncologists per million population in 1986 to 7.2 per million in 1999. There is currently a deficit of at least 40 radiation oncologists to be able to treat the 50% of newly diagnosed cancer patients requiring radiotherapy. In addition, a significant deficiency exists in numbers of radiation therapists, nursing staff, data managers, social workers and clerical staff. Clearly the demands for medical physicists has increased but the data are insufficient to comment on deficiencies. Despite the increases in workloads the proportion of patients with cancer receiving radiotherapy remains below 40%. A positive correlation has been shown between the proportion of newly diagnosed cancer patients treated and the number of FTE radiation oncologists, the number of megavoltage machines and number of radiation therapists. This was shown for Australia as a whole, for each state and for the years 1986 to 1999. This was also the case when total megavoltage fields was used as the dependent variable. Multiple regression analysis using the same independent variables confirmed these positive correlations. It is concluded that the low treatment rate with radiation oncology for cancer patients in Australia is due mainly to the lack of resource allocation. The stated commitment of governments and health departments to a 50% treatment rate can only become a reality if there is a concerted effort to increase the numbers of radiation oncologists, radiation therapists, megavoltage machines and support staff. Otherwise at least one in every 10 newly diagnosed cancer patients will continue to be denied adequate and equitable access to radiotherapy - in 1999 that total figure was 9400 persons.

Australia↗

PubMed2003

Development of a comprehensive scoring system to measure multifaceted nursing workloads in ICU.

A new scoring system, the comprehensive nursing intervention score (CNIS), was developed to quantify the overall workload of diverse nursing activities in the intensive care unit (ICU). A total of 88 nursing items were listed. With the cooperation of 20 skilled ICU nurses, a three-round Delphi survey was conducted to assign a four-grade workload score to each item from five aspects: number of nurses required, muscular exertion, mental stress, skill, and intensity. After the survey, 15 unnecessary items were deleted. Appropriateness of the assigned scores was confirmed by surveying 118 nurses in other ICU. Within-individual reproducibility, examined in 44 nurses, was summarized as a mean kappa-coefficient of 0.65. Time required for each job was recorded and added as the sixth aspect of the workload. Thus, final CNIS gave six subscores (0-3) plus one overall score (3-18) to each of the 73 job items. The CNIS was confirmed as truly representing overall nursing workload by applying it to the daily care of 107 patients.

Critical Care↗