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PubMed2003

Speech-language caseloads in the schools: a workload analysis approach to setting caseload standards.

This article highlights key concepts of the recently revised policy documents of the American Speech-Language-Hearing Association on workload and caseload size for speech-language pathologists (SLPs) in schools. A major premise is that the total workload activities required and performed by school-based SLPs must be taken into account to set appropriate and reasonable caseload standards. Current policies and practices used to define caseloads appear to be inadequate to ensure caseloads that allow enough time for the provision of quality services. In this article we describe school-based SLPs' workload, including the expanded roles and responsibilities that are mandated by the Individuals with Disabilities Education Act (IDEA) and other legislation. We consider the available research on the effects of large caseloads on the service options chosen by SLPs, treatment outcomes for students, and SLP attrition and burnout. Finally, we present an approach for analyzing a SLP's total workload activities, along with a discussion of how that analysis can be used to help determine caseload standards consistent with meeting the intent of IDEA and the needs of students with disabilities.

Humans↗

PubMed2000

Behavioural implications of alarm mistrust as a function of task workload.

The research was conducted to investigate the effect of increasing primary task and alarm workload on alarm mistrust as reflected by alarm and primary task performances. A total of 126 undergraduate students performed a complex psychomotor task battery three times, with the number of concurrent tasks increasing each time. During their performance, the students were required to react to an alarm system (including visual and auditory components) of questionable reliability. Depending on the group to which participants were assigned, the alarm presentation rate constituted a low-, medium- or high-workload condition. Alarm response data (times, frequencies, accuracies) and primary task data (tracking error) were analyzed to assess performance differences as a function of primary and secondary task workload levels. Results generally supported the hypotheses: increasing primary task and alarm task workload degraded alarm response performance. Also, response frequencies supported earlier research suggesting that participants 'probability match' their response rates to alarm system reliability. The results are discussed with regard to the cry-wolf effect, attention theory and alarm system design.

Analysis of Variance↗

PubMed1993

Heart rate as a psychophysiological measure for in-flight workload assessment.

The need to assess pilot workload during flight has become of increasing importance over the past decade--both in combat aircraft where workload can be excessive, and in civil transport aircraft where underload may occur. Subjective reporting in some form has been the long and well established method for assessing workload in the 'real world'. but because subjective opinions are vulnerable to bias and to preconceived notions, an additional measure can be of considerable value on occasions. Of the available psychophysiological variables, recording pilots' heart rates appears to be the most useful. This paper discusses the choice of this measure and presents examples from several studies in which workload was assessed in flight.

Aircraft↗

PubMed1994

Physical, mental, emotional, and subjective workload components in train drivers.

This study, using 12 train drivers on a high speed track and 11 drivers on a mountain track, tried to differentiate between the physical, emotional, mental, and subjective workload components imposed on the drivers during work. With the simultaneous recording and on-line analysis of heart rate and physical activity, the emotional component in terms of the so-called additional heart rate was separated from the physical component. Mental workload was calculated by the heart rate variability and by shifts in the T-wave amplitude of the ECG. Speed of the train, mode of driving, and stress of the situation were rated by two observers who accompanied the drivers in the cabin. During speeds up to 100 km/h as compared to standstills no heart rate changes occurred, but with speeds from 100 km/h up to 200 km/h heart rate decreased indicating a monotony effect. However, heart rate variability, and T-wave amplitude indicated higher mental load during driving in most speed categories. Starting the train and coming to a halt showed greater emotional workload as compared to moving. Observer ratings of stress and subjective ratings of stress by the drivers revealed several discrepancies. Discrepancies were also seen between workload as indicated by the physiological parameters, and corresponding stress ratings by the observers or by the drivers.

Heart Rate↗

PubMed1996

An experimental evaluation of instantaneous self-assessment as a measure of workload.

Instantaneous self-assessment (ISA) is a technique that has been developed as a measure of workload to provide immediate subjective ratings of work demands during the performance of primary work tasks such as air traffic control. This paper reports a study that compared the results of ISA with those gathered from other established workload evaluation techniques; subjective ratings collected at the end of the task, mean heart rate and heart rate variability, and error in the primary task of tracking. ISA ratings were found to be correlated significantly with the post-task ratings of workload, heart rate variability, and task performance. Generally each of the techniques was sensitive to variations in task difficulty. However, performance on the primary tracking task was found to be poorer during periods when ISA responses were required, regardless of whether they were spoken or manual responses. This finding suggests that the usefulness of the technique is limited in comparison to less intrusive measures of workload.

Adolescent↗

PubMed2002

Workload pressures in rural general practice: a qualitative investigation.

OBJECTIVE: To examine whether there are workload pressures, as reported by healthcare professionals, which are unique to rural general practice. DESIGN: Semi-structured face-to-face interviews with staff from general practice teams located in different geographical areas. SETTING: The north-east of Scotland (Grampian). PARTICIPANTS: 16 GPs, 14 practice nurses, 9 practice managers and 14 administrative staff from 14 general practice teams. MAIN OUTCOME MEASURES: Recurrent themes were identified by the systematic analysis of interview transcripts. RESULTS: Workload pressures experienced at aDl locations included continual change, increased volumes of administration and dealing with rising patient expectations. Workload pressures particular to rural areas were long periods on-call and difficulties in taking time off from the practice, the "specialist-generalist" role of rural practitioners and feelings of responsibility, including a pastoral role within the community. CONCLUSION: Although some workload pressures exist regardless of location, rural practices appear to have some unique difficulties. Solutions which help practices cope with change and demand will be useful to both rural and urban practices. Staff from rural practices, however, also need location-specific solutions, such as those for reducing stress from being on-call for prolonged periods.

Administrative Personnel↗

PubMed1996

Housestaff experience, workload, and test ordering in a neonatal intensive care unit.

BACKGROUND: Little is known of how the inexperience or the clinical workload of housestaff affects the decisions they make in the neonatal intensive care unit (NICU). The authors hypothesized that less experienced interns would order more tests per infant than more experienced residents, especially under conditions of heavy workload. METHOD: The NICU at the University of Kentucky A. B. Chandler Medical Center has either an intern or a resident on call by himself or herself at night, a natural setting to compare test ordering by interns and residents. The authors counted the numbers of X rays, analyses of arterial blood gases (ABGs), and electrolyte determinations ordered by the house officers on call for 321 infants from July through November 1993. Data for nine interns and seven residents were compared using multivariate linear regression. RESULTS: When workload became heavier (about five NICU patients), the interns increased their ordering of ABGs per infant to a significantly greater degree than did the residents (p = .01), with the difference being even greater on weekends when the housestaff were under less supervision (p = .004). CONCLUSION: As workload becomes greater in the NICU, interns order more ABGs per infant than do more experienced residents, especially when the interns are less supervised.

Academic Medical Centers↗

PubMed1998

The effect at one teaching hospital of interns' workloads on the satisfaction of their patients.

PURPOSE: To explore whether the amount of workload of first-year residents (interns) affects the satisfaction of their patients. METHOD: The authors collected data from January through May 1995 for 145 patients admitted to Lexinton Veterans Affairs Medical Center with the primary diagnosis of chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Workload was measured as the number of other patients for whom the intern had primary responsibility on the day of the studied patient's admission. A questionnaire measured the patients' satisfaction on the day of discharge. The authors analyzed the data using Pearson correlation and multiple linear regression. RESULTS: For the 89 patients with COPD (controlling for patient age, severity of illness, and sex of intern), greater workloads for their interns was a significant predictor of decreased patients' satisfaction (p = .001). No association was found for the 56 patients with CHF. CONCLUSION: Interns' workloads on the day their patients are admitted can influence their patients' subsequent satisfaction.

APACHE↗

PubMed2002

Physical workload and risk of early retirement: prospective population-based study among middle-aged men.

Early retirement produces a heavy economic burden in many western societies. There is a need to identify single risk factors for early retirement and to find methods for preventing it. To estimate the effect of heavy physical work on early retiring, a cohort of 1755 men aged 42 to 65 years from eastern Finland was followed up from 1984 to 2000. Self-estimated physical workload was assessed at baseline. The inclusive pension records were obtained from national pension institutions. Logistic regression modeling was used to estimate the effect of physical workload and single physical risk factors on the risk of disability pension and nonillness-based pension. Risks were estimated for both disease-specific and all disability pensions. The interaction of physical fitness and physical workload and the resulting effects on risk were also estimated. During the follow-up, 861 (49.1%) men retired on a disability pension and 331 men (18.9%) retired on a nonillness-based early pension. Only 273 (15.6%) men reached the age for getting the normal old-age pension without having had any other early pension After adjustment for age, body mass index, alcohol consumption, smoking, maximal oxygen uptake, education and corresponding illness at baseline, heavy physical work was found to be associated with an increased risk of being retired on a disability pension due to musculoskeletal disorders (odds ratio (OR) 2.21, 95% confidence interval 1.36 to 3.61) but not due to cardiovascular or mental diseases. The association was stronger if cardiorespiratory fitness was poor. Lifting, static muscular loading and uncomfortable work positions increased the risk of early retirement especially due to musculoskeletal disorders. Loading of the upper extremity alone or with the neck and shoulder region seems to be an independent risk factor for early retirement. We concluded that physical workload increases the risk of retirement on a disability pension especially due to musculoskeletal disorders. In heavy physical work, the risk is increased especially among men with musculoskeletal or cardiovascular disease and poor cardiorespiratory fitness.

Confidence Intervals↗

PubMed2004

Multicentre study of validity and interrater reliability of the modified Nursing Care Recording System (NCR11) for assessment of workload in the ICU.

BACKGROUND: Reliable assessment of nursing workload is necessary for the quantitative approach to staffing of intensive care units. The Nursing Care Recording System (NCR11) scores both the nursing contribution to patient care and those related to medical procedures. The purpose of the present work was to compare NCR11 scoring with the Therapeutic Intervention Scoring System (TISS) and Nine Equivalents of Nurse Manpower use Score (NEMS) and to examine the interrater reliability of NCR11 scoring. METHODS: Bias and precision of workload scores (NCR11 vs. TISS or NEMS) were assessed for 6126 consecutive admissions (23910 ICU-days) at three intensive care units. Inter-rater reliability was analyzed by having nurses at nine ICUs score workload using NCR11 for three dummy intensive care patient cases presented over a 3-year period. Variability in scoring was analyzed using the coefficient of variation. RESULTS: Agreement between NCR11 and TISS or NEMS was poor and limits of agreement were wide. Linear relationships between NCR11 and TISS or NEMS scores differed between units. Variability in NCR11 scoring decreased significantly from 10.4% to 5.9% between dummy cases 1 and 2 and remained low for patient case 3. CONCLUSION: The NCR11 does not measure the same elements of workload in the ICU as do TISS and NEMS. Inter-rater reliability with NCR11 is good, showing little variation in scoring between nurses.

Analysis of Variance↗

PubMed2006

Measuring nursing workload in neonatal intensive care.

AIM: To determine if a suitable method of measuring nursing workload could be developed in neonatal intensive care units (NICUs). BACKGROUND: Nursing is a multifunctioning activity and previous methods measuring the demand for nurses do not put enough emphasis on the individual capabilities. The reporting of NICU activity has traditionally been related to bed occupancy and the number of infants requiring ventilator support. A classification system based on activity, hours of care and nursing staff ratios has been used; however, it does not consider the clinical ability of the individual nurses. METHODS: A 5-month prospective study was undertaken in which nurses in two NICUs scored their patients' level of dependency and professional assessment of the level of intensity of care required by the infants in each shift. In addition, serial measures of severity of illness scores for each patient were collected. KEY ISSUES: The study identified methods of measuring workload that consider the individual nurse's ability and contributing organizational factors. We found that the estimates of nursing hours using the two traditional dependency measures did not match the current practice or take into account the skill of the nurses. A method in which the nurses indicated the intensity of nursing care required by their patients was suitable one for capturing their individual capabilities. System factors were also found to contribute to the nursing workload. CONCLUSIONS: It is not sufficient to use patient acuity or severity of illness alone. Other factors such as the nurse's assessment of the intensity of care required and the organizational factors are important components of workload estimates.

Activities of Daily Living↗

PubMed1999

Pulmonary vascular resistance of horses decreases with moderate exercise and remains unchanged as workload is increased to maximal exercise.

This study was carried out to examine changes in pulmonary vascular resistance (PVR) induced by moderate and strenuous exercise; the objective being to understand why pulmonary artery blood pressure of exercising horses increases progressively as work intensity increases. Pulmonary arterial and wedge pressures (referenced at the point of the left shoulder) were determined simultaneously with cardiac output in 2 groups of healthy, sound, exercise-trained horses. Horses in Group 1 (n = 8) were studied at rest and during exercise performed at 8 and 13 m/s; the latter workload eliciting maximal heart rate (mean +/- s.e. 212 +/- 3 beats/min). Horses in Group 2 (n = 7 Thoroughbreds) were studied at rest and during galloping at 14.5 m/s on 5% uphill grade, a workload which elicited maximal heart rate (217 +/- 3 beats/min) and could not be sustained for > 90 s. Pulmonary vascular resistance was calculated by dividing pulmonary perfusion pressure gradient (i.e. mean pulmonary arterial pressure minus mean pulmonary wedge pressure) with cardiac output. Pulmonary arterial and wedge pressures, pulmonary perfusion pressure gradient and cardiac output increased significantly (P < 0.05) with exercise in both groups. There were no differences in PVR between the 2 groups of horses at rest. In Group 1 horses PVR decreased significantly (P < 0.05) with exercise at 8 m/s, but further pulmonary vasodilation did not occur as workload increased to 13 m/s. During exercise at 14.5 m/s on 5% grade, PVR of Group 2 horses also decreased significantly and was not different from values for 8 or 13 m/s in Group 1 horses. It is concluded that PVR reaches its nadir during moderate exercise, presumably due to upper limit of recruitment and distension having been reached. Therefore, in accordance with Ohm's law (P alpha Q x PVR), in going to higher workloads pulmonary blood flow (Q) remained the sole determinant of the rise in pulmonary arterial blood pressure (P). Our data also indicate that pulmonary artery wedge pressure is another variable that is important in determining the absolute value of pulmonary arterial blood pressure.

Animals↗

PubMed2004

General practitioners' perceptions of sharing workload in group practices: qualitative study.

OBJECTIVE: To explore general practitioners' beliefs and experiences of distribution of workload and teamwork between doctors in general practice. DESIGN: Qualitative semistructured interview study. SETTING: South London. PARTICIPANTS: 18 general practitioners from 11 practices. MAIN OUTCOME MEASURES: Perceptions and experiences of distribution of workload and teamwork between doctors. RESULTS: Equitable distribution of workload was a common concern among general practitioners in group practices. Several ways of addressing the problem were identified, including relying on trust, creating systems of working based on explicit rules such as points' systems, and improving communication. Improvement of communication was hampered by the taboo nature of the problem. CONCLUSION: Resentment about perceived inequalities in workload places a further burden on general practices. The issue of working together warrants further support.

Attitude of Health Personnel↗

PubMed1999

Who calls 999 and why? A survey of the emergency workload of the London Ambulance Service.

BACKGROUND: In 1996-97 there were 623,000 emergency (999) calls made to the London Ambulance Service (LAS) and this represents a 30% increase over the previous five years. The reasons for this increase, which is also observed nationally, remain unknown. It has been suggested that some callers may be using the 999 service "inappropriately" but no data are available from the ambulance service. OBJECTIVE: To describe the workload of the emergency ambulance service in London with specific reference to the nature and characteristics of 999 calls, to determine who dials 999 and why, and to establish the number and types of calls that could most appropriately be dealt with by other agencies. DESIGN: A one week census of all emergency calls responded to by the LAS. SETTING: Sixty eight LAS stations. METHODS: Collation of all routine LAS incident forms (LA4) including the classification of the crews' free text description of the incident. This was supplemented by a detailed workload questionnaire for 25% of calls. RESULTS: There were 10,921 calls responded to from 29 April to 5 May 1996. The census showed that the daily number of calls was highest on Saturday and lowest on Wednesday with about half being made during normal general practitioner (GP) working hours. Half of all calls were for women and one third were for people aged > or = 65. Accidents were the commonest type of incident (24%). The remainder comprised various medical conditions such as respiratory, cardiac, and obstetric problems. In 1.5% of calls there was no illness, injury, or assistance required and 5% were for "general assistance" and mostly concerned people aged > or = 65. The workload survey indicated that two thirds of incidents occurred at home and 70% of callers had not tried to contact a GP before dialing 999. In the professional opinion of the responding crew, 60% of calls required a 999 response, with the remainder thought more appropriately dealt with by other services such as primary care, psychiatric services, and social services. CONCLUSIONS: This study suggests that while the majority of 999 calls were "appropriate", part of the 999 workload could be dealt with by other services. More research is required to clarify why people contact the 999 service for non-emergency incidents and also to establish the views of GPs and other agencies as to the role and function of the IAS.

Emergency Medical Service Communication Systems↗

PubMed1993

A survey of workload measurement systems: the occupational therapy manager's perspective.

Interest in measuring workload for budget specific purposes has increased in recent years as health care managers are being forced to cope with the demands of cost containment and fiscal accountability. This paper reports on a survey of senior occupational therapy managers of Ontario facilities accredited by the Canadian Association of Occupational Therapists (CAOT). Respondents were surveyed on their experiences with, and attitudes toward, occupational therapy workload measurement systems and the ability of these systems to assist in management activities. The survey found that most departments were using the National Hospital Productivity Improvement Program (NHPIP) system. Seventy eight percent of managers indicated they were somewhat or very satisfied with the system, but 60% also indicated that it did not adequately meet all of their management needs. In terms of desirable features of a revised workload system, 87% of managers reported wanting a system based on diagnostic or case mix group recording. Client variables (91%), physical and psychosocial aspects of client care (89%) and therapist variables (85%) were also rated as important factors to address in developing new workload systems.

Attitude of Health Personnel↗

PubMed1994

Responding to workload measurement needs.

Workload measurement is a way of capturing and recording the time and/or activities of personnel in the performance of their health care duties. The traditional focus of workload systems in occupational therapy has been on resource allocation, activity tracking and long range planning. The systems are not organized to link with other institutional, financial and management tools to identify and cost client and programme resource use. The position taken in this paper is that occupational therapy workload measurement systems must be expanded to meet these new managerial responsibilities. Occupational therapists must be able to prospectively predict their workload to accommodate the move towards case costing and programme management. The paper also provides information from a national survey which indicates that there is support from the field for this position.

Canada↗

PubMed2005

Are continuity clinic patients less satisfied when residents have a heavy inpatient workload?

The purpose of this study was to assess the influence of resident non-clinic workload on the satisfaction of continuity clinic patients. Over a 2-month period in 2002, residents and patients were surveyed at the University of Kentucky internal medicine continuity clinic. Residents provided a self-report of their non-clinic workload as light or medium versus heavy or extremely heavy. Patient satisfaction was assessed with a 7-item, 10-point scale with items derived from commonly used patient satisfaction instruments. In 168 patient encounters, patients were significantly less satisfied with their clinic visit if they were seen by a resident who had a heavier workload. In addition, these patients gave significantly lower ratings with regard to the amount of time spent with the patient during the visit, and how well the resident listened and paid attention. Although alternative explanations exist, we propose that heavy hospital workload is associated with decreased patient satisfaction in resident continuity clinic.

Adolescent↗

PubMedDate not supplied

Workload as a determinant of staff injury in intermediate care.

Care aides (CAs) and licensed practical nurses (LPNs) in intermediate care (IC) facilities experience high risks of injury. Workload measures were examined in eight IC facilities to ascertain their relationships with musculoskeletal injury rates, pain, burnout, and self-reported health. Workload was measured using (1) focus groups and telephone interviews to obtain CA/LPN perceptions; (2) systematic observation (numbers of tasks performed in shift); and (3) CA-to-resident staffing ratios. Controlling for resident dependency and facility funding, all workload measures were correlated with staff injury rates and burnout. Facilities with low injury rates had better CA/LPN-to-resident staffing ratios and fewer tasks. The differences in staffing reflected differences in how organizations prioritized and allocated resources. Thus, workload is an important determinant of injuries and increased staffing levels correlate with decreased injuries.

Adult↗