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PubMed2000

Open access carotid duplex scanning: throughput and resultant surgical workload.

It is now generally accepted that high-quality duplex scanning obviates the need for pre-operative angiography in the assessment of most cases of carotid disease. An information leaflet was circulated to all general practitioners and hospital doctors in early 1996. Indications, results of treatment and details of the open access service were described. This paper outlines the workload that followed, for both imaging and surgical departments.

Adolescent↗
PubMed2001

Predicting dental treatment workload of U.S. military personnel.

As the demographic composition of the U.S. armed forces shifts, so does dental treatment workload (DTW). To date, the effects of such shifts on DTW have been speculative. This study seeks to build regression models to predict the DTW of recruit and active duty military personnel as service demographic factors shift. The data come from a 1994-1995 random sample of 13,050 active duty and 2,711 recruit personnel. Dental treatment needs were charted for all participants. Patient demographic variables--age, sex, race, education, branch of service, and annual dental utilization (for all); home region and marital status (recruits only); and rank (active duty only)--were noted. Treatment needs were converted to composite time values. Respondent demographic factors were regressed on composite time values to determine which factors influence DTW using backward, stepwise, linear regression. Results show that DTW varies across demographic categories. The magnitude and direction of change in DTW as service demographic variables shift can be predicted with linear regression models.

Adolescent↗
PubMed2001

Practice size: impact on consultation length, workload, and patient assessment of care.

BACKGROUND: Variations in practice list size are known to be associated with changes in a number of markers of primary care. Few studies have addressed the issue of how single-handed and smaller practices compare with larger group practices and what might be the optimal size of a general practice. AIM: To examine variations in markers of the nature of the care being provided by practices of various size. DESIGN OF STUDY: Practice profile questionnaire survey. SETTING: A randomised sample of general practitioners (GPs) and practices from two inner-London areas, stratified according to practice size and patients attending the practice over a two-week period. METHOD: Average consultation length was calculated over 200 consecutive consultations. A patient survey using the General Practice Assessment Survey instrument was undertaken in each practice. A practice workload survey was carried out over a two-week period. These outcome measures were examined in relation to five measures of practice size based on total list size and the number of doctors providing care. RESULTS: Out of 202 pratices approached, 54 provided analysable datasets. The patient survey response rate was 7247/11,000 (66%). Smaller practices had shorter average consultation lengths and reduced practice performance scores compared with larger practices. The number of patients corrected for the number of doctors providing care was an important predictor of consultation length in group practices. Responders from smaller practices reported improved accessibility of care and receptionist performance, better continuity of care compared with larger practices, and no disadvantage in relation to 10 other dimensions of care. Practices with smaller numbers of patients per doctor had longer average consultation lengths than those with larger numbers of patients per doctor. CONCLUSION: Defining the optimal size of practice is a complex decision in which the views of doctors, patients, and health service managers may be at variance. Some markers of practice performance are related to the total number of patients cared for, but the practice size corrected for the number of available doctors gives a different perspective on the issue. An oversimplistic approach that fails to account for the views of patients as well as health professionals is likely to be disadvantageous to service planning.

Family Practice↗
PubMed2002

[Physicians' well-being is deteriorating. Results from a prospective intervention study. The mental energy decreases as workload increases].

The impact of the current transformation of health care on the well-being and working conditions of physicians has been analyzed in a 6-year prospective intervention study at the Orebro University Hospital (USO). Physicians' ratings of their work, organization and health have been compared with those of other health care professionals at USO, as well as with ratings by physicians in other hospitals. Feedback on survey results has been periodically provided to employees in all hospital departments as well as to hospital senior management. The results have formed the basis for a range of improvement initiatives. The study identified a number of positive changes, such as increased ratings on scales measuring social climate, skills development and participatory management. However, workload has increased and mental energy decreased during the same period.

Burnout, Professional↗
PubMed2003

[Cost and workload in the parasitology laboratory derived from attention to the immigrant].

INTRODUCTION: To determine the cost and volume of work implied in providing a parasitological diagnosis when attending immigrants in a referral Tropical Medicine Unit. METHODS: The total number and type of samples, requests processed and parasitology laboratory costs were quantified after attending 1258 immigrants during the period January 1989 to December 2001. Estimation of laboratory workload for the total was made on the basis of results from 748 of these patients. A reference to relative value units (RVU) was established for each of the tests used in the parasitological diagnosis. The evaluation included costs related to disposable material and time spent by technicians and medical staff, but did not include costs related to sample extraction or processing of the test request. Modified indicators from the Catalogue of Microbiology studies of the Valencian Community for the year 2000 were used, establishing the equivalence of 1 RVU as the value of one urine culture 5 2.39 3 (398 pesetas). RESULTS: The overall cost was 99,680.99 3 (16,585,522 pesetas) or 45,934.94 RVU, and the cost per patient was 79.24 3 (13.185 pesetas) or 36.51 URV. The volume of work dedicated to attending immigrants was 9.7% of the total of samples received in the laboratory. CONCLUSIONS: The cost and volume of work involved in attending this group of patients in the parasitology laboratory was not high.

Adolescent↗
PubMed1992

Rule of halves: implications of increasing diagnosis and reducing dropout for future workload and prescribing costs in primary care.

Evidence from one practice and from the literature suggest that approximately half of most common chronic disorders are undetected, that half of those detected are not treated, and that half of those treated are not controlled: the 'rule of halves'. Workload in primary care would increase by at least 12% if all common and important chronic disorders were fully diagnosed, treated and followed up; the accompanying effects on prescribing costs would be complex, but not necessarily inflationary. The relationship between these data and the new general practitioner contract is discussed.

Adult↗
PubMed2004

A multi-method approach to assessing deadlines and workload variation among newspaper workers.

OBJECTIVES: Working under frequent deadlines was previously found to be associated with upper limb work-related musculoskeletal disorders (WMSDs) in newspaper workers. Further investigation was required so that concrete recommendations for change could be offered to the workplace parties (labour and management of a large metropolitan newspaper). STUDY DESIGN: The assessment was based on three methods. A questionnaire was used to clarify time-related aspects of work on deadlines for a larger group of workers. Experience sampling was used to document temporal variation in various aspects of physical and psychological demands over work shifts and deadline cycles. Focus groups were also conducted. RESULTS: Differences were found between the "High" and "Low" deadline groups: Those working with frequent deadlines more frequently were required: to work together with others, to perform tasks on a specific schedule and specific order, to work at a fast paced, to perceive their work as hectic and "hard". Experience sampling showed differential trends in workload across daily, weekly, and no deadline days. The lack of breaks for extended periods of time leading up to a deadline was noticeable. The focus groups were useful in highlighting issues not addressed by the other two methods and to understand the feasibility of various possible interventions. CONCLUSIONS: The integration of results from all methods lead to recommendations for issues upon which to focus prevention related activities where deadlines are present: delays in work flow from others, interruptions from technology related problems, excessive work, insufficient staff/insufficient time, extra/unexpected work, compromising of work quality for speed, and lack of time for breaks.

Cumulative Trauma Disorders↗
PubMed1992

The workload recording method. A laboratory management tool.

To provide the physician with an accurate, timely, and useful test result remains the primary goal of the laboratory. This article reviews the workload recording method developed by the College of American Pathologists to monitor the efficiency of personnel in the laboratory. Topics discussed include historical background, time studies, implementation and data collection, productivity ratios, and management applications.

Data Collection↗
PubMedDate not supplied

Linking nursing workload and performance indicators in ambulatory care.

More and more ambulatory care organizations are using nursing report cards to monitor and evaluate the quality and effectiveness of nursing care in the ambulatory setting. Nurse staffing levels is usually one of the items included in a nursing report card and the one most scrutinized by ambulatory care administrators. One strategy employed by the nursing leadership at the South Texas Veterans Healthcare System to justify nurse staffing levels is linking administrative staffing monitors with nurse-sensitive outcomes via workload and performance indicators. Through this approach, nurse leaders are able to justify nurse staffing level changes, needed technology changes, process improvements, and/or workflow needs to administrators with positive results and support.

Ambulatory Care↗
PubMed2006

Operative workload of a paediatric otolaryngology department over a five-year period.

INTRODUCTION: The KK Women's and Children's Hospital (KKWCH) is Singapore's only tertiary institution dedicated wholly to the provision of healthcare for women and children. Since its opening in 1997, the clinical caseloads and the complexity of medical conditions managed by the various departments has increased considerably. This review aims to analyse the operative caseloads in the Department of Otolaryngology over five years from 2000 to 2004. METHODS: This is a retrospective review of the KKWCH Department of Otolaryngology operative records from year 2000 to 2004. The data on the type of operation and their frequency were collated, and the data are presented in a descriptive format. RESULTS: There was an increase in the number of operations performed from 656 in year 2000 to 1,148 in 2004, an increase of 75 percent. The increase in the staffing and operating clinical hours (in 2003 and 2004) plus the significant demand for paediatric otolaryngology service probably contributed to this increase. Tonsillectomy, with or without adenoidectomy, continues to be the most common procedure being performed in children, with myringotomy and tympanostomy tube insertion being the second commonest. Together, the ten most common operative procedures constitute 78.2 percent of all paediatric otolaryngological operative workload in the department over a five-year period. CONCLUSION: The data provided a review of the current pattern of otolaryngological surgical disease in the Singapore paediatric population, which may require operative intervention. Understanding and monitoring of this trend is important, as it allows the proper allocation of appropriate resources for the prevention and treatment of common paediatric surgical otolaryngological conditions.

Humans↗
PubMed2006

Oxegen 2004: the impact of a major music festival on the workload of a local hospital.

This prospective observational study was undertaken to assess the impact of a major music festival on the workload of a local hospital. Data were collected on all attendances at Naas General Hospital from the nearby Oxegen 2004 music festival. Patient demographics, disposition and diagnoses were recorded. Emergency department activity levels were compared before, during and after the festival. Seventy-two attendees were referred to Naas emergency department over a 3-day period, representing a 45% increase in the hospital's emergency department attendance rate. Thirty-seven of these attendees (51%) required inpatient or tertiary centre services. Thirty-four attendees (47%) were noted as having consumed alcohol and/or used illicit substances. We conclude that despite the provision of on-site medical facilities, major music events are associated with a significant increase in local health care activity and expenditure.

Adolescent↗
PubMed2006

Antibiotic-resistant infections in primary care are symptomatic for longer and increase workload: outcomes for patients with E. coli UTIs.

BACKGROUND: Antimicrobial resistance is considered to be one of the major threats to public health. However, the practical implications for patients and workload in primary care are largely unknown. AIM: To determine outcomes for patients managed in primary care with an antibiotic resistant compared to an antibiotic sensitive Escherichia coli (E. coli) urinary tract infection (UTI). DESIGN: Nested case control study with prospective measurement of outcomes. SETTING: Ten general practices in South Wales. METHOD: Patients consulting with symptoms suggestive of UTI identified through systematic sampling, and with a laboratory proven E. coli infection, were followed up by interview 1 month after their consultations and by searching of their medical records. RESULTS: Nine hundred and thirty-two patients were interviewed and had their medical records reviewed. The risk of patients reporting 'feeling poorly', 'frequency or pain on urinating' and being 'out of action' for more than 5 days after consulting was significantly increased for patients with resistant compared to sensitive infections. After adjusting for risk factors, there was an increased risk of 'frequency or pain on urinating' and 'being out of action' for those infected with a resistant E. coli. The median number of maximum reported days with at least one symptom was 12 days for patients with E. coli infections resistant to trimethoprim, 7 days for infections resistant to ampicillin, 7 days for infections resistant to any antibiotic, and 5 days for infections sensitive to all tested antibiotics. Even if treated with an appropriate antibiotic, infections caused by a resistant strain were symptomatic for longer. For those infected with an organism resistant to at least one antibiotic, the odds ratio (OR) for re-visiting their GP within the next 30 days for the UTI was 1.47 (95% confidence interval [CI] = 1.10 to 1.95). The OR was 1.49 (95% CI = 1.11 to 2.00) for ampicillin resistance and 2.48 (95% CI = 1.70 to 3.59) for trimethoprim resistance. CONCLUSIONS: Resistant E. coli UTIs are symptomatic for longer and cause increased work load in general practice.

Adult↗
PubMed2006

Development of coded action concepts to support workload and cost prediction applications.

We propose to use a compositional terminology model to encode care-directive concepts or "actions" from patient care standards. Action concepts are made up of one or more work items that can be part of a work list or care plan. The nature of an action is specified by the elements of the terminology model. Actions can have implied financial value. The projected total actions that a patient requires will form the basis for workload and cost prediction.

Costs and Cost Analysis↗
PubMed2006

Log files analysis to assess the use and workload of a dynamic web server dedicated to end-stage renal disease.

A Multi-Source Information System (MSIS), has been designed for the Renal Epidemiology and Information Network (REIN) dedicated to End-Stage Renal Disease (ESRD). MSIS aims at providing reliable follow-up data for ESRD patients. It is based on an n-tier architecture, made out of a universal client, a dynamic Web server connected to a production database and to a data warehouse. MSIS is operational since 2002 and progressively deployed in 9 regions in France. It includes 16,677 patients. We show that the analysis of MSIS web log files allows evaluating the use of the system and the workload in a public-health perspective.

France↗
PubMedDate not supplied

[Utilization of the results or research about nursing workload in a surgical suite, based on the methodology of the "Projet de Recherche en Nursing" (PRN87)].

The aim of this study was to evaluate actual levels of nursing care delivered in a functionally aggregated Surgery Area of the Tor Vergata University Hospital in Rome, by measuring nursing workload according to the "Projet de Recherche en Nursing" (PRN87) methodology. The study was performed between February 1st and June 26, 2004. The results of the study have highlighted the fact that nursing staff is often improperly used, for example to perform many administrative activities, thereby reducing the quality and amount of direct nursing care.

Hospitals, University↗
PubMed1991

[Nursing workload and nurse-patient ratio in intensive, subintensive and postintensive care units].

2710 patients were admitted during 1988 in 14 ICU of a crowded urban area. We determined nursing workload and nurse/patient ratio applying the TOSS score at the end of the 1st and 9th day of ICU stay. 1934 patients were admitted for intensive treatment, the mean nursing need was 805 min/day ranging from 744 to 946 min/24 h meaning a N/P ratio 1:1 or slightly less. 766 sub-intensive patients admitted for intensive monitoring needed 481 min/24 h of nursing (range 411-546) meaning 1:2 1:3 N/P ratio. The score at the 9th day, showed 263 post-intensive patients who needed 501 min (422 to 603 min), significantly higher than the sub-intensive need. We discuss these indications according to the official guidelines on this topic stated by the Minister of Public Health.

Critical Care↗
PubMed1991

General surgery with a special interest in vascular surgery: an audit of relative workload.

In a district general hospital (DGH) almost all vascular surgery is provided by general surgeons with a vascular interest and training. There is a growing view, however, that vascular surgeons should be 'pure' to the exclusion of other surgery. In an attempt to define the relationship between general and vascular work in a DGH we have analysed, prospectively, out-patient, in-patient and theatre workload over a three-month period. Eight-hundred-and-forty-four patients (277 new, 567 follow-up) were seen in the clinics. Nine per cent of new vascular referrals and 33 per cent of new general referrals were booked for admission. There were 356 admissions (50 per cent 'emergencies') representing a wide spectrum of general surgery. Elective and emergency vascular cases stayed in hospital for twice and four times longer, respectively, than general patients. Vascular patients represented 26 per cent of the caseload but accounted for 46 per cent of the bed occupancy. Vascular operations made up only 21 per cent of the total theatre caseload (233 procedures) but consumed 34 per cent of theatre time. The vascular unit in a DGH deals with a substantial number and wide variety of general surgical cases. Vascular surgery, however, consumes disproportionately large amounts of out-patient and theatre time and hospital beds. This has implications both for the planning of vascular services and also for the resource allocation within the hospital.

Aged↗