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PubMed1994

Use of artificial intelligence to analyze clinical database reduces workload on surgical house staff.

BACKGROUND: The current quantity and diversity of hospital clinical, laboratory, and pharmacy records have resulted in a glut of information, which can be overwhelming to house staff. This study was performed to measure the impact of artificial intelligence analysis of such data on the junior surgical house staff's workload, time for direct patient care, and quality of life. METHODS: A personal computer was interfaced with the hospital computerized patient data system. Artificial intelligence algorithms were applied to retrieve and condense laboratory values, microbiology reports, and medication orders. Unusual laboratory tests were reported without artificial intelligence filtering. RESULTS: A survey of 23 junior house staff showed a requirement for a total of 30.75 man-hours per day, an average of 184.5 minutes per service twice a day for five surgical services each with an average of 40.7 patients, to manually produce a report in contrast to a total of 3.4 man-hours, an average of 20.5 minutes on the same basis (88.9% reduction, p < 0.001), to computer generate and distribute a similarly useful report. Two thirds of the residents reported an increased ability to perform patient care. CONCLUSIONS: Current medical practice has created an explosion of information, which is a burden for surgical house staff. Artificial intelligence preprocessing of the hospital database information focuses attention, eliminates superfluous data, and significantly reduces surgical house staff clerical work, allowing more time for education, research, and patient care.

Artificial Intelligence↗
PubMed2003

Changes in the general surgical workload, 1991-1999.

HYPOTHESIS: The volume and types of procedures performed by general surgeons have changed from 1991 to 1999. Data Source Medicare data from 1991 through 1999. METHODS: Procedures from the Medicare database were defined as "general surgical" if the yearly volume performed by general surgeons exceeded 1000 cases. These procedures were divided into major and minor procedures. The total volume performed by all surgeons and the volume of cases performed by general surgeons were tabulated for each procedure. Procedures were also grouped into families. For major surgery, representative procedures with the highest volumes were selected for each family. For minor surgery, multiple high-volume procedures within families were selected and analyzed. RESULTS: The volumes for each major surgical family were totaled. Although the volume of representative major general surgical procedures performed by all surgeons rose by 17 544 cases, the volume performed by general surgeons decreased by 8846 cases (1.8%). The total and general surgical volumes for cholecystectomy and appendectomy increased, but the volumes for breast surgery, hernia repair, splenectomy, and colon resection decreased. The total volume increased but the general surgical volume decreased for vascular surgery, pulmonary surgery, and major amputations. CONCLUSIONS: From 1991 to 1999, there has been a decrease in the volume of major procedures performed by general surgeons. Part of this loss relates to reduced general surgical involvement in subspecialty surgery, but there were also reductions in colon surgery, breast surgery, hernia repairs, and splenectomy. The volume of appendectomies and cholecystectomies increased. The volume of minor procedures performed by general surgeons increased slightly, with gains in vascular and endoscopic surgery.

General Surgery↗
PubMed1998

The origin, content, and workload of e-mail consultations.

CONTEXT: Despite the common use of e-mail, little beyond anecdote or impressions has been published on patient-clinician e-mail consultation. OBJECTIVE: To report our experiences with free-of-charge e-mail consultations. DESIGN: Retrospective review of all e-mail consultation requests received between November 1, 1995, and June 31, 1998. SETTING AND PARTICIPANTS: Consecutive e-mail consultation requests sent to the Division of Pediatric Gastroenterology at the Children's Medical Center of the University of Virginia in Charlottesville. MAIN OUTCOME MEASURES: Number of consultation requests per month, time required to respond, who initiated the request and their geographic origin, and the kind of information requested in the consultation. RESULTS: During the 33-month period studied, we received 1239 requests, an average (SD) of 37.6 (15.9) each month. A total of 1001 consultation requests (81%) were initiated by parents, relatives, or guardians, 126 (10%) by physicians, and 112 (9%) by other health care professionals. Consultation requests were received from 39 states and 37 other countries. In 855 requests (69%), there was a specific question about the cause of a particular child's symptoms, diagnostic tests, and/or therapeutic interventions. In 112 (9%), the requester sought a second opinion about diagnosis or treatment for a particular child, and 272 consultations (22%) requested general information concerning a disorder, treatment, or medication without reference to a particular child. A total of 1078 requests (87%) were answered within 48 hours of the initial request. On average, reading and responding to each e-mail took slightly less than 4 minutes. CONCLUSION: E-mail provides a means for parents, guardians, and health care professionals to obtain patient and disease-specific information from selected medical consultants in a timely manner.

Communication↗
PubMed1993

Profiles of workload in general surgery from linked hospital statistics.

Data from the Oxford Record Linkage Study between 1976 and 1986 were used to analyse statistical profiles of hospital care, taking account of multiple admissions per patient. Admission rates were higher in the elderly than the young, they were higher for men than women, and they increased over time. Episode-based admission rates increased by 15.5 per cent and person-based rates by 11.6 per cent. Most of the increase therefore represented a real rise in the number of people treated rather than an increase in multiple admissions per person. In the latest year of the study there was a mean of 125 admissions per annum per 100 male patients admitted and of 118 admissions per annum per 100 female patients admitted. The mean length of stay per admission and the total time spent in hospital per person per annum declined substantially from 1976 to 1986. Admission rates for prostatectomy, colectomy and varicose vein surgery increased significantly and those for appendicectomy, cholecystectomy and peptic ulcer decreased significantly.

Adolescent↗
PubMedDate not supplied

Impact of emergency admissions on elective surgical workload.

BACKGROUND: Day case surgery is the most cost-effective approach for all minor, most intermediate and some major surgery. AIMS: To examine the effect of the current 'escalation' policy of opening the surgical day ward to A&E admissions at the expense of planned surgery. PATIENTS AND METHODS: A retrospective study was carried out on all elective general surgical operations planned for January through March 2003. The number of cases cancelled and the reasons for cancellation were documented. RESULTS: The total number of patients booked for surgery was 836, 66.6% of which were day cases (557 patients). Overall 338 patients accounting for 40.4% of all planned cases were cancelled. Day case cancellations accounted for 68.9% of all cancellations (233 patients). Bed unavailability was the main reason due to the overflow of A&E admissions, accounting for 92% of cancelled patients and 73.8% of day ward cancellations. CONCLUSIONS: The cancellation of surgery creates untold hardship for patients who plan their working and family lives around the proposed operation date. Most are cancelled at less than 24 hours notice. The cost implications to the community are immense but have not been calculated. The separation of emergency and planned surgery is essential through adequate observation ward access.

Ambulatory Surgical Procedures↗
PubMed2001

Requests for body computed tomography: increasing workload, increasing indications and increasing age.

Increasing numbers of increasingly elderly patients were being examined in our Body CT department. At the same time, some of our clinical colleagues perceived that their patients might be discriminated against on the basis of their age when allocating CT time. We therefore studied the population trends in our department over a 10-year period. The ages of patients attending the Body CT department were collected from the hospital's computer information system from 1995 to 2000 and from handwritten logbooks for the months of September 1988 and 1998. Comparison was made with population trends within the hospital and local demographic data. There has been an average increase of 11% per annum in the number of examinations performed in the Body CT unit. The average age of patients examined increased from 52.7 years in 1988 to 58.9 years in 1998. The largest increase occurred in the over 75-year population (18% rise per annum). Hospital and local demographic population profiles changed little during the same period. We are performing increasing numbers of body CT examinations on increasingly elderly patients. This is probably due to an increased willingness to investigate and treat elderly patients, rather than changes in the local population. There is no evidence of a general discriminatory policy on the basis of age.

Adolescent↗
PubMed1998

[Workload and stress in caring for the elderly: status of research and research agenda].

Providing adequate care of the aged, geriatric caregivers take a key position for the transfer of gerontological knowledge into practice. However, little attention has been focussed on the work conditions and staff distress by gerontologists. The purpose of this paper is to review studies on occupational stress relating to professional geriatric caregivers. Based on relevant research concepts and paradigms, findings of the international literature are summarized. The review shows that occupational stress is affected by a number of work-related factors from behavior problems of the residents to time pressure and organizational deficits. The stress in turn can cause burnout, mental health problems, somatic complaints, and increased turnover. Social support and control at the workplace are supposed to contribute essentially to stress reduction. There are few empirical studies dealing with occupational stress among geriatric caregivers in Germany. Strengths and weaknesses of the studies will be analyzed and suggestions offered for future research in this area. Extending research is needed particularly on the work conditions in the increasing field of geriatric outpatient community services. Inspite of its theoretical and methodological shortcomings, the findings highlight the need for strategies to prevent physical and mental health problems, burnout, and job turnover. It is a challenge for gerontological research to obtain more knowledge on the work-related factors leading to stress as well as to establish effective intervention strategies to reduce its long-term consequences.

Aged↗
PubMed2000

[Workload and health of older employees in service occupations].

Presented are the results of a representative survey of the German work force (N = 34,343) regarding work load and work-related diseases. The study comprises females and males aged 45 years and older, who are occupied in the service sector (N = 8310). The findings show that older workers in this economic sector have to bear considerable physical and mental work loads that are often higher than those for the total labor force. The results presented point to the need to encourage and practice a more comprehensive health promotion for older workers in the service sector.

Aged↗