[Physicians' occupational conditions. High workload. Impossible to organize own work].
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Obstetric physicians are physicians whose training and particular expertise lie in the care of the medical complications of pregnancy. We present an audit of the work of our bi-weekly obstetric medicine clinic at Queen Charlotte's Hospital, London, over a 10-month period from July 1994 to April 1995 inclusive, and discuss the need for obstetric physicians, with reference to individual medical conditions which complicate pregnancy.
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Managing a single-room maternity care unit in today's declining length of stay climate is challenging due to the rapid change in acuity and census. Managers must validate staffing patterns used to meet the patient's requisite needs from admission to discharge. This tool was developed to determine proper staffing based on patient days, number of anticipated deliveries and patient care hours.
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Analysis of a waiting list based solely on the number of patients rather than the type and degree of difficulty can never give an accurate assessment of the work involved. It does not take account of the continued additions which occur from out patient clinic referrals. By applying an intermediate equivalent factor for loading to each case a better understanding and management of the waiting list can be obtained. There does not seem to be an exact relationship between the intermediate equivalent for any given case and the operating time.
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We mailed survey questionnaires to a random sample of medicolegal offices throughout the USA. The survey asked how many forensic pathologists were used, their American Board of Pathology forensic examination (Board) status, how many autopsies they performed, and, if payment were fee-for-service, what fees were paid for medicolegal autopsies. Response rate was 61%, with 188 offices returning questionnaires. The average fee, was $518 with a standard error of $27. The number of fee-for-service autopsies was split evenly between Board qualified and Board ineligible pathologists, accounting for about one-third of medicolegal autopsies nationwide. Although smaller offices used more pathologists ineligible for forensic Boards, they paid a premium for such qualification. Larger offices used more forensic Board qualified pathologists, but paid them less than those ineligible to take the examination! Overall there was no significant premium paid for Board qualification. The average fee paid is far less than the published estimates of the cost of an autopsy. The low fees paid may reflect: (1) the value of the teaching experience supplied to medical students and/or residents; (2) pathologists performing medico-legal examinations as community service; and (3) the lower marginal cost of additional autopsies.
1. An RVU system can forecast staffing needs for a busy ambulatory ophthalmology clinic. 2. The average amount of time needed for basic ophthalmic screening is 15 minutes. 3. Further studies should be conducted of infrequent tasks and for indirect care before an RVU system can be accurately used.
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The authors present a new multifactorial intensity and complexity of care model and meta-paradigm that is designed to examine costs, nursing work, and the variability in resource use across patients and environments. Relationships were observed among four key variables which included patient-nursing condition, medical condition, caregiver characteristics and the environment. Patient-nursing complexity and medical complexity are commonly measured by nursing diagnosis and DRG or Canadian case mix groupings (CMG) respectively. The complexities associated with the work environment had been the least previously studied factors. Environmental complexity factors include both supply and demand dimensions: scheduling and coordination of procedures, multiple and long procedures, and characteristics and composition of the caregiver team.
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