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PubMed1997

ERCP: a review of technical competency and workload in a small unit.

BACKGROUND: ERCP is increasingly performed not only in large referral centers but also in smaller units. We sought to analyze the success rates of selective cannulation and intervention using the cumulative sum method and to document the workload in a small unit. METHODS: Indications, results, and interventions performed by one endoscopist were recorded for all patients undergoing ERCP at Dunedin Hospital. Selective cannulation and successful intervention were used as outcome measures and, using the cumulative sum method, compared to a target value of 90%. RESULTS: Over an 8-year period, 532 ERCPs were performed. Overall 91% and 81% of selective cannulation and interventions respectively, were successful. The cumulative sum method plot shows that satisfactory outcomes for selective cannulation were obtained after some 100 to 120 procedures and after some 120 interventions. ERCP was normal in 171 (32%) patients, stones were found in 169 (32%), and strictures in 81 (15%) patients. CONCLUSIONS: The cumulative sum method is a valuable tool to compare individual performance with a nominated target value and to ensure that an acceptable outcome is achieved and maintained. These results show that small units can develop and maintain expertise in ERCP if procedures are performed regularly.

Adolescent↗
PubMed1993

Emergency physician workload: a time study.

STUDY HYPOTHESIS: Physician service time varies with patient service category, length of stay, and intensity of service. DESIGN: Prospective time study of emergency physician services. Physicians recorded the beginning and ending times of each service episode offered to a patient (whether at the bedside or occurring elsewhere in the department). Each episode was defined as an "interaction," with the total service time offered to a patient being the sum of all interactions for that patient. Length of stay was the time interval from when the patient registered in the emergency department to when the patient was released. Intensity of service was calculated as service time divided by length of stay. SETTING: University-affiliated community teaching hospital. TYPE OF PARTICIPANTS: One thousand three hundred forty-seven ED patients were entered into the study for nonselected (514), walk-in (637), observation (52), laceration repair (102), or critical care (42) services. Six of 12 physicians in the group staffing the ED participated in the study. Patient data were entered onto study cards when the service was offered. Patients were entered into the study consecutively except when the physician became too busy to see one patient at a time and accurately enter time data; such interruptions occurred for 18% of the patients. RESULTS: Physician service time for nonselected service patients (24.2 minutes per patient; 95% CI, 23.1-25.3) was consistent with ACEP's findings for nonselected services offered by emergency physicians (22 minutes per patient). Physician service time did not vary significantly from the standard for laceration repair patients (25.0 minutes per patient; 95% CI, 22.6-27.4) but did vary significantly from the standard for walk-in (9.8 minutes per patient; 95% CI, 9.3-10.3; P < .05), observation (55.6 minutes per patient; 95% CI, 50.7-60.5; P < .05), and critical care patients (31.9 minutes per patient; 95% CI, 26.2-37.6; P < .05). Walk-in and laceration repair patients had a single physician-patient interaction (1.3 per patient and 1.1 per patient, respectively), consistent with a discrete service offered during episodic care. Observation and critical care patients had multiple physician-patient interactions (6.3 per patient and 2.6 per patient, respectively) over an extended period, which is consistent with additional services being offered during their period of observation/holding. CONCLUSION: Case mix of patient services affects emergency physician workload and should be considered in planning departmental staffing needs.

Connecticut↗
PubMed1997

Compensatory control in the regulation of human performance under stress and high workload; a cognitive-energetical framework.

This paper presents a cognitive-energetical framework for the analysis of effects of stress and high workload on human performance. Following Kahneman's (1973) model, regulation of goals and actions is assumed to require the operation of a compensatory control mechanism, which allocates resources dynamically. A two-level compensatory control model provides the basis for a mechanism of resource allocation through an effort monitor, sensitive to changes in the level of regulatory activity, coupled with a supervisory controller which can implement different modes of performance-cost trade-off. Performance may be protected under stress by the recruitment of further resources, but only at the expense of increased subjective effort, and behavioural and physiological costs. Alternatively, stability can be achieved by reducing performance goals, without further costs. Predictions about patterns of latent decrement under performance protection are evaluated in relation to the human performance literature. Even where no primary task decrements may be detected, performance may show disruption of subsidiary activities or the use of less efficient strategies, as well as increased psychophysiological activation, strain, and fatigue after-effects. Finally, the paper discusses implications of the model for the assessment of work strain, with a focus on individual-level patterns of regulatory activity and coping.

Adaptation, Psychological↗
PubMed1994

Productivity and workload measurement in ambulatory oncology.

The future of ambulatory patient classification and workload analysis will depend on the development of an accurate model of data collection, analysis, and reporting. The roles of ambulatory nurses and the delivery of ambulatory services is a foundation for tool development. The development of a consistent productivity system will make it easier to manage resource allocations and to determine appropriate staffing and space allocation.

Ambulatory Care↗
PubMed1998

Development of four self-report measures of job stressors and strain: Interpersonal Conflict at Work Scale, Organizational Constraints Scale, Quantitative Workload Inventory, and Physical Symptoms Inventory.

Despite the widespread use of self-report measures of both job-related stressors and strains, relatively few carefully developed scales for which validity data exist are available. In this article, we discuss 3 job stressor scales (Interpersonal Conflict at Work Scale, Organizational Constraints Scale, and Quantitative Workload Inventory) and 1 job strain scale (Physical Symptoms Inventory). Using meta-analysis, we combined the results of 18 studies to provide estimates of relations between our scales and other variables. Data showed moderate convergent validity for the 3 job stressor scales, suggesting some objectively to these self-reports. Norms for each scale are provided.

Affect↗
PubMed1998

The impact of a high-dependency unit on the workload of an intensive care unit.

While there has been recent support for high-dependency unit development, there are few data reporting the impact of such development on existing critical care facilities. Therefore the aim of this study was to examine the workload and capacity constraints of an adult general intensive care unit before and after the development of an adjacent high-dependency unit. Following the opening of the high-dependency unit, the total number of patients admitted increased by 49%. On the high-dependency unit, more elderly patients were admitted for longer and more frequently following midweek elective surgery. On the intensive care unit, patients' initial severity of illness was lower and their duration of admission decreased; fewer patients were admitted directly from the general wards. The financial benefits of high dependency care may be eroded by the increased use of the critical care services.

APACHE↗
PubMed1995

Measurement systems in principle and in practice: the example of nursing workload.

There has been a rapid development of measurement systems in the health services in the United Kingdom (UK) over recent years, not always matched by a thorough understanding of the phenomenon being measured and rarely based on any assessment of reliability or validity. A particularly flagrant example of this process is the development of nursing workload measurement systems (NWMS). The estimates from four NWMS were examined. They were substantially different from each other for no obvious reason, and the difference between any of the estimates and the actual nursing hours worked could not be explained in terms of any other aspect of the nursing process. There is no evidence that the NWMS deployed in the UK are anything more than an expensive numbers game; without this kind of investigation of how they actually work in practice, it would be prudent to be wary about any of the measurement systems which have been proposed. Yet many of the measurement systems used in other sectors of the health service are equally untested.

England↗
PubMed1997

The role and resources required for the introduction of generic ward assistants using GRASP systems workload methodology: a quantitative study.

Non-nursing workers have been advocated as a means of ameliorating high nursing utilizations, whether the cause be budgetary or the inability to recruit trained staff. The creation of a generic worker who would undertake domestic, catering and non-nursing activities has been seen as a way of improving the ward environment and releasing trained staff and health care assistants from non-nursing activities, GRASP systems workload methodology was used to develop a job description and a tool to quantify the resources needed to introduce such workers. A quantitative research study and activity analysis was carried out on two sample wards to validate the tool. The results were validated by a 'within study' audit process comparative analysis and an activity qualitative analysis using a Likert attitudinal scale. Empirical analysis of the study's findings and the financial consequences were predicted across the Trust.

Delphi Technique↗
PubMed1999

Australia's breast surgery workload is changing: comparison of a metropolitan and a rural hospital.

BACKGROUND: Breast cancer is a common disease in our community and its incidence is increasing. As a result of the improvements in community awareness and introduction of screening, patients are being diagnosed with earlier breast cancer and with a higher incidence of pre-invasive disease. Improvements in radiology, often coupled with minimally invasive diagnostic modalities, have lessened the requirement for open diagnostic biopsies and also reduced the number of operations for benign breast disease. METHODS: An audit of the surgical workload at Prince of Wales/Prince Henry Hospitals and Tamworth Base Hospital was conducted to document and compare the above changes in the metropolitan and rural settings. This study was conducted between 1987 and 1996 to assess the effect of screening and improved technology over a 10-year period. RESULTS: The study found that a high percentage of malignant lesions are being diagnosed by fine-needle aspiration biopsy (FNAB) with a corresponding reduction in open biopsy rate at the Prince of Wales Hospital. There is a smaller percentage of benign operations in both settings with a reduction of equal proportion. The reporting of the pathology specimens has markedly improved at both institutions. There has been a reduction in the number of patients having modified radical mastectomy and there has been a corresponding increase in breast conservation surgery especially at the Prince of Wales/Prince Henry Hospitals, although there was an unexpectedly high incidence of breast conservation surgery at Tamworth Base Hospital in 1987. In 1996 the rates of breast conservation surgery were the same in both hospitals. CONCLUSIONS: There are minimal differences in the quality of surgical care being offered to patients at the Tamworth Base Hospital compared with the Prince of Wales Hospital and both institutions are within reach of the accepted best management practices available.

Australia↗
PubMed2003

Estimation of the general practice workload of a metropolitan teaching hospital emergency department.

BACKGROUND: A transparent and easily replicated method of estimating the number of, and costs associated with, low acuity presentations to an emergency department is required to assist evaluation of the utilization of emergency department services. This study presents two independent estimates of the number of, and costs associated with, low acuity presentations to an emergency department. METHODS: A retrospective analysis was conducted using emergency department information system data from a metropolitan mixed paediatric/adult teaching hospital emergency department/trauma centre. Low acuity patient presentation estimates were calculated by: Method one: The product of (A) total self-referred presentations for triage categories three, four and five and (B) the difference between the self-referred and general practitioner-referred discharge rates from the emergency department. Total low acuity patient presentations = (A x B). Method two: Summing the number of self-referrals with presenting problems never referred by general practitioners. Costs were calculated using Commonwealth cost weights. RESULTS: Method one gave a low acuity patient estimate of 12.5% (95% CI 12.0-13.0%) and method two 10.6% (95% CI 10.2-11.0%) of total presentations. Costs were 10.5% (method one) and 8.5% (method two) of total costs. Adjusted for assessment time, costs were 6.8% (method one) and 5.5% (method two) of total costs. Low acuity patients were more common outside of normal working hours, method one: 14.4% (95% CI 13.5-15.2%) versus 10.0% (95% CI 9.4-10.6%), P < 0.001; method two: 11.4% (95% CI 10.9-12.0%) versus 8.5% (95% CI 7.8-9.2%), P < 0.001. Provision of alternative daily 0900-2400 general practice services would change low acuity patients by no more than 2-3% of total presentations and change low acuity patient costs by no more than 2% of total costs. CONCLUSIONS: Low acuity patients form a small, relatively constant part of the emergency department workload. The provision of alternative after-hours services for low acuity patients would be unlikely to significantly reduce the overall work load of this metropolitan emergency department.

Emergency Service, Hospital↗
PubMed1999

Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit.

Acquisition of methicillin resistant Staphylococcus aureus (MRSA) in the intensive care unit of a tertiary referral centre was monitored over a 19-month period. The incidence of new cases of MRSA correlated with peaks of nursing staff workload and times of reduced nurse/patient ratios within the unit. This implies that nurse understaffing contributes significantly to the spread of MRSA in an ITU setting.

Cross Infection↗
PubMedDate not supplied

[Psychosocial workload, sick leave, and health-related well being: an empirical study from the perspective of gender research].

PURPOSE: The aim of this study was to test hypotheses on the consequences of gender role expectations with regard to the extent of work stress, selected health-related measures and their associations. METHOD: Data on psychosocial workload (questionnaire of effort-reward imbalance), sick leave (self-reports of the duration of medically certified sick leave during the past two years) and health-related well being were collected in a representative sample of German full-time employees (n = 666). Hypotheses were tested using analyses of variance (ANOVA) and covariance (ANCOVA) and moderated linear regression analyses. RESULTS: Women reported lower health-related well-being as compared to men while effort-reward imbalance and sick leave did not differ between the sexes. Parents reported slightly longer durations of sick leave during the past two years than childless participants (not significant). The results of stratified linear regression analyses show stronger associations between effort-reward imbalance and both health-related measures for women with children than for men with children, while single men and women do not differ in this regard. CONCLUSIONS: Evidence of this kind can be useful for the purposeful planning and implementation of health promotion measures at work. Women with children would be a group deserving special attention. The findings also point to continuing differences in gender role expectations in the family context.

Adolescent↗
PubMed2003

Modular data logger system for physical workload measurements.

Direct technical measurements of physical workload have advantages in studies of work-related musculoskeletal disorders. A data logger has been developed, based on 20 and 40 Mbyte PCMCIA (Personal Computer Memory Card International Association) flash memory cards, for electromyography (EMG), inclinometry and goniometry. They are provided with an input for marking of events that can be used for synchronization with other loggers and with video recordings. To make the data easier to access by the preceeding analysis software, application software has also been developed that reorganizes the data. The loggers are easy to operate and enable whole-day ambulatory field recordings without any need for reduction or compression of the data.

Electronic Data Processing↗
PubMed2004

Physical workload during use of speech recognition and traditional computer input devices.

Musculoskeletal symptoms among computer users are frequently found. The aim was to investigate the musculoskeletal workload during computer work using speech recognition and traditional computer input devices (keyboard/mouse). Ten experienced computer users (nine female, one male) participated. They performed three different computer tasks: (1). text entry and (2). text editing of a standard text and (3). a self-selected work task. These tasks were performed twice using speech recognition and traditional computer input devices (keyboard/mouse). Additionally, a task consisting of reading aloud of the standard text was performed. Surface EMG from the forearm (m. extensor carpi ulnaris, m. extensor carpi radialis), the shoulder (m. trapezius) and the neck extensor muscles was recorded, in addition to the voice-related muscles (m. scalenii, m. cricothyroideus). Using speech recognition during text entry and text editing reduced the static muscle activity of the forearm, neck and to some extent the shoulder muscles. Furthermore, tendencies to longer periods of muscle activity pause (relative time with EMG gaps) in the forearm and shoulder muscles were found. This was seen at the expense of a tendency to an increased static activity and a decreased relative time with EMG gaps in m. cricothyroideus. Finally, during use of speech recognition the hand was tied to the keyboard/mouse for a shorter period of time, while the eyes were viewing the screen for a longer period of time compared to the condition with traditional computer input devices. It is recommended to use speech recognition as a supplementary tool to traditional computer input devices.

Computer Peripherals↗
PubMed2005

Longitudinal changes in critical flicker fusion frequency: an indicator of human workload.

The aim of the study was to verify a hypothesis that critical flicker fusion frequency (CFFF) is season-related because of changes in the intensity and duration of sunlight. CFFF has a wide application in different fields, generally as an indicator of human workload. Therefore, confirmation of previous observations that CFFF is subject to a seasonal rhythm could make theoretical as well as practical sense. The analysis was based on data obtained from 23 male participants, aged 28-60 years. The study lasted 12 months. CFFF was measured with the flicker test. The results of statistical analysis indicate that CFFF changes over time. There are two forms of those changes: a linear trend and oscillations around the trend. Moreover, individual differences in the longitudinal course of CFFF (in trends as well as in oscillations) are observed. The conclusion is that CFFF is subject to longitudinal changes, whose pattern depends on individual differences. Additionally, the individual character of the CFFF changes over time allow the assumption that sunlight is probably not as significant a factor as expected, one that can modify the hypothetical pattern of season-related CFFF fluctuation. The obtained results are important for the methodology of experiments with CFFF and for the interpretation of the results of the flicker test.

Adult↗
PubMed1992

Acceptable workloads for three common mining materials.

A series of psychophysical lifting studies was conducted to establish maximum acceptable weights of lift (MAWL) for three supply items commonly handled in underground coal mines (rock dust bags, ventilation stopping blocks, and crib blocks). Each study utilized 12 subjects, all of whom had considerable experience working in underground coal mines. Effects of lifting in four postures (standing, stooping under a 1.5 m ceiling, stooping under a 1.2 m ceiling, and kneeling) were investigated together with four lifting conditions (combinations of lifting symmetry and lifting height). The frequency of lifting was set at four per min, and the task duration was 15 min. Posture significantly affected the MAWL for the rock dust bag (standing MAWL was 7% greater than restricted postures and kneeling MAWL was 6.4% less than stopped); however, posture interacted with lifting conditions for both of the other materials. Physiological costs were found to be significantly greater in the stooped postures compared with kneeling for all materials. Other contrasts (standing versus restricted postures, stooping under 1.5 m ceiling versus stopping under 1.2 m ceiling) did not exhibit significantly different levels of energy expenditure. Energy expenditure was significantly affected by vertical lifting height; however, the plane of lifting had little influence on metabolic cost. Recommended acceptable workloads for the three materials are 20.0 kg for the rock dust bag, 16.5 kg for the ventilation stopping block, and 14.7 kg for the crib block. These results suggest that miners are often required to lift supplies that are substantially heavier than psychophysically acceptable lifting limits.

Accidents, Occupational↗
PubMed1993

Physical workload, perceived exertion, and output of cut wood as related to age in motor-manual cutting.

Physical workload, output of cut wood, and perceived exertion were studied among 15 younger (mean age 29 years) and 16 older (mean age 59 years) lumberjacks, using a chainsaw and paid on a piece-rate basis. Oxygen consumption was measured with portable equipment, while heart rate was measured telemetrically. The oxygen consumption for all working phases was 1.8 +/- 0.2 l/min (means +/- SD) (younger) and 1.5 +/- 0.2 l/min (older), which corresponded to 49 +/- 4% and 53 +/- 7% of maximal oxygen consumption estimated in ergometer bicycle exercise test. A negative relationship was found between relative oxygen consumption at work and maximal oxygen consumption (ml/kg/min). Mean heart rates for all working phases were 138 +/- 10 beats/min (younger) and 126 +/- 17 (older). The heart rate differed between the working phases, and was significantly higher for both groups during bunching than during the other operations. The output of cut wood did not differ significantly between the groups. Slight but significantly relationships were found between output of cut wood and maximal oxygen consumption (ml/kg/min) and oxygen consumption (ml/kg/min) during work. Rating of perceived exertion (RPE) and simultaneous heart rate recordings during cycle tests and field studies showed significant correlations between heart rate and RPE values during cycling in both groups. RPE values and heart rate in the field showed a slight correlation (younger) and not at all (older).

Adult↗