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PubMed1990

Using workload analysis and acuity systems to facilitate quality and productivity.

Reimbursement, budget, and nurse availability constraints no longer support the quality-at-any-cost concept. However, clear definitions of clinical and satisfaction outcomes, nursing responsibilities that contribute to those outcomes, and reasonable time targets for staff contributions can help nurses at all levels analyze and prioritize work load to build new or update existing acuity systems. The author describes specific methods nurse executives and managers can use to involve and guide staff members in (1) determining realistic and compatible standards of care, performance, and resource productivity, (2) integrating quality-based time standards into acuity systems, and (3) using acuity information to manage delivery of a targeted, desired level of ongoing quality care.

Administrative Personnel↗
PubMed1990

Impact of community violence on the workload of a district general hospital.

Clinical observation suggests that deliberate violence against the person is increasing in both incidence and severity in the community. Over a six-year period there was a trend towards an annual increase in the number of attendances at the Waveney Hospital as the result of assaults. A retrospective study for a six-month period (August 1987 to January 1988) defined the pattern of attendance, injuries and treatment for 284 cases. Most of the victims were young males who presented outside normal working hours with superficial injuries. Admission was required in 12% of patients.

Adolescent↗
PubMed1989

Adequacy of vitamin supply under maximal sustained workloads: the Tour de France.

In the Tour de France competing cyclists must pedal about 4000 km over a period of three weeks with only one day allowed for rest. The course includes 30 mountains, the highest of which reaches an altitude of approximately 2700 m. The energy expenditure values of these cyclists range from a mean of 25.4 MJ/day to peak values of 32.7 MJ/day. These are the highest values that have ever been reported for a period longer than seven days. On the basis of the food records of 5 cyclists, it turned out that 62 En.% is derived from CHO, 15 En.% from protein, and 23 En.% from fat. Since the food choice is primarily focused on digestibility and energy content, this results in a frequent consumption of sweet cakes and CHO-rich fluids. Some 49% of the energy is consumed in between meals. Such a nutritional pattern leads to a lowering of the nutrient density especially with respect to the B-vitamins. Intake of vitamins B1, B2, B6, and C, including contribution from enriched sport drinks, was 1.97 mg, 4.96 mg, 2.40 mg, and 158 mg, respectively. Besides this, intramuscular injections of megadosis vitamins of B1, B2, B6, nicotinamide, pantothenic acid, and especially B12 did increase the intake drastically. This was reflected in high blood concentrations of vitamins. Except for folic acid, vitamins (B1, B2, B6, and B12) exceeded the upper limits of the values from a reference group, particularly B12, which exceeded the reference values by up to 400%. During the Tour, vitamin concentrations remained essentially unchanged.

Bicycling↗
PubMed1989

HIV infection and Scottish general practice: workload and current practice.

To estimate the effect of human immunodeficiency virus (HIV) infection on general practice, a postal survey was undertaken of one in three of all principals in Scotland. Of the 834 general practitioners who responded (78% response rate), 31% were working in practices with patients known to be infected with HIV. The estimated prevalence of known HIV infection in general practice was 19 per 100,000 population, and the estimated annual consultation rate for HIV related problems (including consultations by the 'worried well') was seven per 1000 population. Both statistics showed considerable variation between health boards, with peaks in Lothian and Tayside. Few practices had drawn up policies relevant to HIV infection, and the use of procedures for controlling infection was variable. Policies about HIV and for infection control tended to be more common in areas where the prevalence of HIV infection was higher. Most respondents were offering both opportunistic health education and counselling about HIV infection, especially to patients at high risk. Although general practitioners are responding positively to the increasing demands of HIV infection, there is an urgent need for policies, both national and local, to guide specific aspects of practice.

Acquired Immunodeficiency Syndrome↗