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PubMed1997

Intensive care 1980-1995: change in patient characteristics, nursing workload and outcome.

OBJECTIVE: To assess temporal changes in patient characteristics, nursing workload and outcome of the patients and to compare the actual amount of available nursing staff with the estimated needs in a medical-surgical ICU. DESIGN: Retrospective analysis of prospectively collected data. SETTING: A medical-surgical adult intensive care unit (ICU) in a Swiss university hospital. PATIENTS: Data of all patients staying in the ICU between January 1980 and December 1995 were included. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The estimated number of nurses needed was defined according to the Swiss Society of Intensive Care Medicine (SGI) grading system: category I = one nurse/patient/shift (= 8 h), category II = one nurse/two patients/shift, category III = one nurse/three patients/shift. An intervention score (IS) was obtained, based on a number of specific activities in the ICU. There was a total of 35,327 patients (32% medical and 68% postoperative/trauma patients). Over time, the number of patients per year increased (1980/1995: 1,825/2,305, p < 0.001) and the length of ICU stay (LOS) decreased (4.1/3.8 days, p < 0.013). There was an increase in the number of patients aged > 70 years (19%/28%, p < 0.001), and a decrease in the number of patients < 60 years (58%/41%, p < 0.001). During the same time period, the IS increased two-fold. Measurement of nursing workload showed an increase over time. The number of nursing days per year increased (1980/1995: 7454/8681, p < 0.019), as did the relative amount of patients in category I (49%/71%, p < 0.001), whereas the portion of patients in category II (41%/28%, p < 0.019) and category III (10%/0%) decreased. During the same time period, mortality at ICU discharge decreased (9.0%/7.0%, p < 0.002). CONCLUSIONS: During the last 16 years, there has been a marked increase in workload at this medical-surgical ICU. Despite an increase in the number of severely sick patients (as defined by the nursing grading system) and patient age, ICU mortality and LOS declined from 1980 to 1995. This may be ascribed to improved patient treatment or care. Whether an increasingly liberal discharge policy (transfer to newly opened intermediate care units, transfer of patients expected to die to the ward) or a more rigorous triage (denying admission to patients with a very poor prognosis) are confounding factors cannot be answered by this investigation. The present data provide support for the tenet that there is a trend toward more complex therapies in increasingly older patients in tertiary care ICUs. Calculations for the number or nurses needed in an ICU should take into acount the increased turnover of patients and the changing patient characteristics.

Adult↗

PubMed2001

Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge.

OBJECTIVES: Mortality after ICU discharge accounts for approx. 20-30% of deaths. We examined whether post-ICU discharge mortality is associated with the presence and severity of organ dysfunction/failure just before ICU discharge. PATIENTS AND METHODS: The study used the database of the EURICUS-II study, with a total of 4,621 patients, including 2,958 discharged alive to the general wards (post-ICU mortality 8.6%). Over a 4-month period we collected clinical and demographic characteristics, including the Simplified Acute Physiology Score (SAPS II), Nine Equivalents of Nursing Manpower Use Score, and Sequential Organ Failure Assessment (SOFA) score. RESULTS: Those who died in the hospital after ICU discharge had a higher SAPS II score, were more frequently nonoperative, admitted from the ward, and had stayed longer in the ICU. Their degree of organ dysfunction/failure was higher (admission, maximum, and delta SOFA scores). They required more nursing workload resources while in the ICU. Both the amount of organ dysfunction/failure (especially cardiovascular, neurological, renal, and respiratory) and the amount of nursing workload that they required on the day before discharge were higher. The presence of residual CNS and renal dysfunction/failure were especially prognostic factors at ICU discharge. Multivariate analysis showed only predischarge organ dysfunction/failure to be important; thus the increased use of nursing workload resources before discharge probably reflects only the underlying organ dysfunction/failure. CONCLUSIONS: It is better to delay the discharge of a patient with organ dysfunction/failure from the ICU, unless adequate monitoring and therapeutic resources are available in the ward.

APACHE↗

PubMed2004

Hand workload and the metacarpal cortical index. a study of middle-aged teachers and dentists.

We studied load-related predictors (handedness, occupation and workload history) of cortical bone mass as estimated by the metacarpal cortical index (MCI). After being randomly selected from trade-union registers, 295 female dentists and 248 teachers, aged 45-63 years (mean 54 years), participated in the study. The MCI was defined from the second metacarpal of both hands by analogue radiographs. Data regarding anthropometric measures, handedness, occupational exposure, number of pregnancies, hormonal therapy and contraceptive use, the presence of chronic diseases, dietary factors, smoking and leisure time physical activity were collected by questionnaire. Weight was measured. The dentists' workload was assessed in detail in 10-year periods. Multivariate methods were used in the statistical analysis. The metacarpal index averaged 0.62 in the right hand and 0.61 in the left hand (P = 0.02) among the right-handed subjects, while no differences by hand were observed among the left-handed or mixed-handed. The MCI of the teachers and dentists did not differ from each other, when we controlled for potential confounders. The MCI decreased similarly by age in both occupational groups. Among the dentists, workload history was inversely associated with the MCI in multivariate analyses by age group. Computer use was a positive predictor for MCI among dentists aged 55-63 years. Occupational factors seem to have contradictory effects on the MCI. Too heavy or one-sided manual work may be deleterious for cortical bone mass.

Age Factors↗

PubMed1993

Human locomotion and workload for simulated lunar and Martian environments.

Human locomotion in simulated lunar and Martian environments is investigated. A unique human-rated underwater treadmill and an adjustable ballasting harness simulate partial gravity in order to better understand how gravity determines the biomechanics and energetics of human locomotion. This study has two research aspects, biomechanics and energetics. The fundamental biomechanics measurements are continuously recorded vertical forces as exerted by subjects of the treadmill which is instrumented with a force platform. Experimental results indicate that peak vertical force and stride frequency decrease as the gravity level is reduced. Foot contact time is independent of gravity level. Oxygen uptake measurements, VO2, constitute the energetics, or workload, data for this study. As theory predicts, locomotion energy requirements for lunar (1/6-g) and Martian (3/8-g) gravity levels are significantly less than at 1-g. The observed variation in workload with gravity level is nonmonotonic, however, in over half the subject population. The hypothesis is offered that energy expenditure increases for lunar, as compared with Martian, locomotion due to the subject "wasting energy" for stability and posture control in simulated lunar gravity. Biomechanics data could influence advanced spacesuit design and planetary habitat design, while workload data will help define oxygen requirements for planetary life support systems.

Adult↗

PubMed1995

The influence of supply-related characteristics on general practitioners' workload.

The workload of general practitioners (GPs) is usually defined in terms of the number of hours worked (divided in time spent on different practice tasks), rates of contact (office consultation and home visit rates) and length of consultations. They are influenced by two groups of factors: demand-related influences and supply-related influences. Demand-related influences refer to the list sizes of GPs and the composition of the practice population. Supply-related influences refer to the way GPs themselves manage their workload. In this article the relative influence of demand- and supply-related variables on the workload of Dutch GPs is assessed. The data for this analysis has been collected as part of the Dutch National Survey of Morbidity and Interventions in General Practice. We draw on four data sources: a three months recording of all contacts between GPs and their patients, a census of the practice population of the GPs, a mailed questionnaire among GPs and a one week diary kept by the GPs. The population consists of 168 GPs. The number of hours spent by GPs on practice activities is mainly determined by demand-related characteristics. List size and the percentage of elderly on the list are positively related to the time spent on direct patient care. Running a free flow consultation hour is the only factor on the supply side with an additional effect. GPs supervising a trainee and those with a larger percentage of elderly and publicly insured patients on their list spent more hours on other activities such as practice administration, deliberation and reading medical literature. List size and the percentage of elderly on the list have a negative influence on the office contact rate, while the percentage of low educated patients on the list and the number of practice secretaries per GP have a positive impact. Furthermore, GPs without a free flow consultation hour and those working in health centres tend to have smaller office contact rate than the others. Home visit rates are smaller when the practice secretaries provide a higher percentage of consultations in the practice, in single handed practices and in the case of female GPs. However, the percentage of elderly on the list is the main determinant of the home visit rate. The average length of consultations is not substantially affected by either supply- or demand-related characteristics.

Adult↗

PubMed1992

Assessing pilot workload. Why measure heart rate, HRV and respiration?

The application of heart rate and respiratory measures to the human factors of flight is discussed. The concept of pilot workload is related to the concept of arousal and distinguished from physical workload. Finds from studies of pilot workload using heart rate measures are reviewed for flight, simulated flight and related real-life challenges. Measurement techniques and transducers are discussed from the perspective of field measurement. Recommended procedures are presented as are directions for future work.

Aircraft↗

PubMedDate not supplied

Emergency department workload--a transatlantic comparison.

This paper compares the workload of the emergency department of a Level One trauma center in the United States and a large city hospital in the United Kingdom. The referral pattern and diagnostic classification of 5,000 patients presenting to both departments were compared, as were the transportation systems at the two sites. It was shown that similarities existed in many areas. Major trauma formed only a small proportion of the overall workload of both departments. The conclusion is that although the two emergency care systems have fundamental differences in terms of organization and finance, the workloads are remarkably similar. Interesting differences arose in areas such as use of helicopter transport, psychiatric and drug and alcohol related admissions, and in the number of patients brought to hospital under police escort.

Aircraft↗

PubMed2006

Driver experience and cognitive workload in different traffic environments.

How do levels of cognitive workload differ between experienced and inexperienced drivers? In this study we explored cognitive workload and driver experience, using a secondary task method, the peripheral detection task (PDT) in a field study. The main results showed a large and statistically significant difference in cognitive workload levels between experienced and inexperienced drivers. Inexperienced, low mileage drivers had on average approximately 250 milliseconds (ms) longer reaction times to a peripheral stimulus, than the experienced drivers. It would, therefore, appear that drivers with better training and experience were able to automate the driving task more effectively than their less experienced counterparts in accordance with theoretical psychological models. It has been suggested that increased training and experience may provide attention resource savings that can benefit the driver in handling new or unexpected traffic situations.

Adult↗

PubMed2005

Relationships between patient dependency, nursing workload and quality.

The nature and value of dependency-acuity-quality (DAQ) demand-side nursing workforce planning methods are set in the context of nursing workforce planning and development. Extensive DAQ data from one of the largest UK nursing workforce studies (347 wards) involving 64 high-quality and 62 low-quality hospital wards, are reconsidered in a workload and quality context. Results generate new insights; for example, poor quality care is more likely to be a feature of larger wards with fluctuating workloads than smaller wards with consistently high workloads owing to inflexible nurse staffing. Nursing activity and staffing differences between high- and low-quality wards are highlighted. Recommendations are made to improve nursing management and practice as well as the next phase of DAQ studies.

Dependency, Psychological↗

PubMed1997

Fatigue, workload and adaptive driver systems.

This paper is directed to the further understanding of the problems of fatigue and workload and their role in diminishing driving capability. We present a specific strategy designed to defend against the adverse effects of fatigue and workload extremes through the use of adaptive driver systems. To begin, the work presents a brief critique of Muscio's constraints on developing a test of fatigue. In criticizing these constraints, we point to the commonalities between all energetic reflections of human performance and use advances in stress theory to explain the problems of and resolution to the question of fatigue. We link fatigue and chronic workload and use this coadunation as a basis for the operation of adaptive driver systems which are specifically designed to combat driving impairment. A specific program is then explained in detail and illustrations are given as to how an extension of previous efforts can address the problem of the drowsy and chronically fatigued driver. Future recommendations are articulated.

Accidents, Occupational↗

PubMed2002

Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units: a prospective evaluation.

BACKGROUND: UK recommendations suggest that large neonatal intensive-care units (NICUs) have better outcomes than small units, although this suggestion remains unproven. We assessed whether patient volume, staffing levels, and workload are associated with risk-adjusted outcomes, and with costs or staff wellbeing. METHODS: 186 UK NICUs were stratified according to volume of patients, nursing provision, and neonatal consultant provision. Primary outcomes were hospital mortality, mortality or cerebral damage, and nosocomial bacteraemia. We studied 13515 infants of all birthweights consecutively admitted to 54 randomly selected NICUs. Multiple logistic regression analyses were done with every primary outcome as the dependent variable. Staff wellbeing and stress were assessed by anonymous mental health index (MHI)-5 questionnaires. FINDINGS: Data were available for 13334 (99%) infants. High-volume NICUs treated the sickest infants and had highest crude mortality. Risk-adjusted mortality and mortality or cerebral damage were unrelated to patient volume or staffing provision; however, nosocomial bacteraemia was less frequent in NICUs with low neonatal consultant provision (odds ratio 0.65, 95% CI 0.43-0.98). Mortality was raised with increasing workload in all types of NICUs. Infants admitted at full capacity versus half capacity were about 50% more likely to die, but there was wide uncertainty around this estimate. Most staff had MHI-5 scores that suggested good mental health. INTERPRETATION: The implications of this report for staffing policy, medicolegal risk management, and ethical practice remain to be tested. Centralisation of only the sickest infants could improve efficiency, provided that this does not create excessive workload for staff. Assessment of increased staffing levels that are closer to those in adult intensive care might be appropriate.

Bacteremia↗

PubMed2003

Performance of different radiotherapy workload models.

PURPOSE: The purpose of this study was to evaluate the performance of different radiotherapy workload models using a prospectively collected dataset of patient and treatment information from a single center. METHODS AND MATERIALS: Information about all individual radiotherapy treatments was collected for 2 weeks from the three linear accelerators (linacs) in our department. This information included diagnosis code, treatment site, treatment unit, treatment time, fields per fraction, technique, beam type, blocks, wedges, junctions, port films, and Eastern Cooperative Oncology Group (ECOG) performance status. We evaluated the accuracy and precision of the original and revised basic treatment equivalent (BTE) model, the simple and complex Addenbrooke models, the equivalent simple treatment visit (ESTV) model, fields per hour, and two local standards of workload measurement. RESULTS: Data were collected for 2 weeks in June 2001. During this time, 151 patients were treated with 857 fractions. The revised BTE model performed better than the other models with a mean [observed -predicted] of 2.62 (2.44-2.80). It estimated 88.0% of treatment times within 5 min, which is similar to the previously reported accuracy of the model. CONCLUSION: The revised BTE model had similar accuracy and precision for data collected in our center as it did for the original dataset and performed the best of the models assessed. This model would have uses for patient scheduling, and describing workloads and case complexity.

Appointments and Schedules↗

PubMed1998

Acoustic analysis of induced vocal stress by means of cognitive workload tasks.

The purpose of this study was to determine the acoustic effects on voice of three tasks of cognitive workload and their possible relationship to stress. Acoustic analysis was used to measure stress and workload in four experimental tasks and two experiments. In the first experiment, subjects performed cognitive workload tasks under a stressful condition, performing the tasks as rapidly as possible without errors and with the knowledge that any errors committed would reduce their grade in a course. The second condition was to perform the same tasks but without the condition of stress related to the final grade. Four testing conditions were included. One was a baseline measure in which subjects spelled the Spanish alphabet. The second was the reading of a tongue twister, the third was the reading of a tongue twister with delayed auditory feedback, and the fourth was spelling the Spanish alphabet in reverse order. In each condition the subjects prolonged the vowel /a/ for, approximately 5 sec. All subjects performed a test to determine their overall level of anxiety. The results suggest that in conditions of experimentally induced stress there is an increase in the fundamental frequency (F0) relative to baseline, an increase in jitter and shimmer, an increase in the high-frequency harmonic energy, and a decrease in spectral noise.

Adolescent↗

PubMed1998

The increasing workload required to maintain infrainguinal bypass graft patency.

BACKGROUND: To assess the impact upon the provision of a vascular service of the workload associated with maintaining infrainguinal bypass graft patency. DESIGN: A computerised prospective audit. MATERIALS AND METHODS: Between January 1990 and December 1995, all patients with infrainguinal bypass grafts were entered into a prospective computerised audit to monitor interventions for the maintenance of graft patency. Excluded from the study were interventions during the first 30 postoperative days and procedures not directly related to the graft. A graft surveillance programme was in operation throughout. RESULTS: During the study period a total of 131 patients with 144 grafts were admitted on 330 occasions and required 401 separate interventional procedures. There were 227 procedures in 72 femorodistal grafts, 116 in 38 below-knee femoropopliteal grafts and 58 interventions in the group of 34 above-knee femoropopliteal grafts. Radiological interventions accounted for almost 70% of this workload. CONCLUSION: The workload associated with the maintenance of infrainguinal bypass grafts increased considerably during the study period, and seems likely to increase further. Such interventions should therefore be considered when planning for vascular service provision.

Anastomosis, Surgical↗

PubMed2000

Council tax valuation band as marker of deprivation and of general practice workload.

This study tests the hypothesis that Council Tax Valuation Banding (CTVB) is a measure both of UK socioeconomic status and of general practice workload. It is a retrospective cohort study based in a UK semi-rural general practice, North Wiltshire. The study group is a randomised selection of UK general practice patients. The outcome measures are socio-demographic and primary care workload parameters versus CTVBs by logistic regression analyses in a sample of 378 patients (90% participation rate). People who pay little or no council tax are significantly less likely to live in owner-occupied homes or to have access to a car than their counterparts. There is also a significant inverse association between CTVB and demand for general practitioner services. CTVB could be an accessible, universal, non-census marker of UK socioeconomic status and of general practice workload that would have validity in the context of primary care resource allocation and is a concept worthy of further investigation.

Cohort Studies↗

PubMed2002

Obstetric anaesthetists' workload.

The current recommendation of one consultant session per 500 deliveries with full sessional cover for units over 3000 deliveries is arbitrary and is not based on workload. The Audit Commission has questioned the wide variability of anaesthetic staffing on labour wards. The aim of this study was to investigate whether there is a relationship between current workload and obstetric anaesthetic staffing in five maternity units. In 1998, a 2-week diary of workload in the participating obstetric units was assessed in terms of staffing and clinical and nonclinical activities. The busiest time was 08:00 to 12:30. The working patterns between consultants and trainees varied considerably. Time spent on nonclinical activity by consultants averaged 51%. Any calculation of consultant sessions will need to take into account nonclinical activities. Other factors requiring consideration are the number of high-risk cases, as well as the number and experience of trainees.

Anesthesiology↗

PubMed2002

Surgical workload and outcome after resection for carcinoma of the oesophagus and cardia.

BACKGROUND: Performing cancer surgery in high-volume centres may lead to improved outcomes. This study explored the relationship between annual workload and outcome following resection for carcinoma of the oesophagus and cardia. METHODS: The study was a retrospective case-note review of 1125 patients who had surgery for cardio-oesophageal cancer in the West Midlands region of England. Outcome measures were 30-day mortality and long-term survival. RESULTS: The overall 30-day mortality rate was 10.0 per cent with a median survival of 14 months and a 5-year survival rate of 17.2 per cent. Increasing age, advanced stage of disease and emergency resection independently affected outcome adversely. Forty-one infrequent operators (fewer than four resections per year) performed 146 resections (13.0 per cent), 18 intermediate operators (between four and 11 resections per year) performed 488 resections (43.4 per cent) and five frequent operators (12 or more resections per year) performed 491 resections (43.6 per cent). The 30-day mortality rate was greatest in the infrequent group (15.1 per cent) compared with both the intermediate group (6.6 per cent; adjusted odds 0.40, P = 0.004) and the frequent group (11.8 per cent; odds 0.73, P = 0.28). There were no differences in survival rates between the groups, and no difference in outcome between high- and low-volume hospitals. CONCLUSION: In this unselected population-based series there was little evidence of a trend of improving 30-day mortality rate with increasing workload, or between workload and long-term survival.

Adenocarcinoma↗

PubMed2003

Strength, workload, anaerobic intensity and the immune response to resistance exercise in women.

AIM: The mechanism linking exercise intensity to the magnitude of the immune response is not completely understood. The purpose of this investigation was to determine whether the immune response to resistance exercise was associated with (1) changes in workload or (2) anaerobic exercise intensity. METHODS: Previously untrained women underwent 6 months of resistance training for lower and upper body (TOTAL, n = 34) or for upper body alone (UPPER, n = 30). Lymphocyte subsets [T (CD3+), CD4+, CD8+, NK and B], functional markers (CD45RA+ and CD45RO+), and mitogen (phytohemagglutinin-M, concanavalin A and pokeweed mitogen) and superantigen (staphylococcus a. cowans)-stimulated proliferation were measured from blood samples collected pre- and post-exercise for a squat resistance exercise consisting of six sets of 10 repetitions at 75% of one repetition maximum. This protocol was performed before (T0) and after 3 (T3) and 6 months (T6) of training. RESULTS: Lymphocyte recruitment to the circulation and proliferation following resistance exercise did not differ between training groups at any time, although the TOTAL group performed at a higher workload as training progressed. With respect to anaerobic intensity, exercise-induced increases in NK, CD4+, CD8+ and B lymphocyte concentrations were 42 (P = 0.07), 76 (P < 0.05), 72 (P < 0.05) and 242% (P < 0.01) greater in women in the highest compared with the lowest post-exercise lactate quartiles. Lymphocyte proliferation did not differ between lactate quartiles. CONCLUSIONS: Anaerobic intensity, rather than increased strength and workload, is associated with the number of lymphocytes recruited to the circulation, but not T and B cell proliferation responses.

Adolescent↗