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At least 19 recordsLinked to original sources
PubMed1975

The modification of pediatrician activity following the addition of the pediatric nurse practitioner to the ambulatory care setting: a time-and motion study.

Time and motion studies were performed before and after PNPs began working in the offices of three pediatricians and the emergency room of a municipal general hospital. Pediatricians' activities changed in different ways, but all benefited by the generation of available time. The three pediatricians in office settings gained the equivalents of 21.6%, 21.7%, and 36% of the working day by the addition of the PNP. Physicians working in the emergency room gained 14.7% during that time of day the PNP was present. PNP visits with patients were longer than those of the pediatricians, the average length of time being related directly to that of the associate physician. Patients interviewed perceived no difference in personal characteristics between pediatricians and PNPs in three of the four settings. In the fourth setting, both were at high levels, but the pediatrician ranked higher than the PNP.

Clinical Competence↗
PubMed1975

Medex: a time-motion study.

Six Medex working with family practitioners were followed by an observer for a total of 18 days to gain an objective profile of how Medex spent their workday. Medex on the average spent 30% of their time with office patients and saw 38% of all office patients. Medex saw between 25% and 100% of all pediatric office patients and spent on the average 37% of their office patient time with pediatric patients. On the average, Medex saw 8 pediatric and 11 adult office patients per day. Well-child examinations, the largest pediatric diagnostic category, accounted for 30% of Medex pediatric office patient time. Minor surgery accounted for the second largest portion of pediatric office patient time (21%) while respiratory illness ranked third (11%). In view of the increasing role family practitioners and their assistants will undoubtedly play in the provision of child health care, pediatricians are urged to work closely with family physicians in developing and implementing health care services for children.

Adolescent↗
PubMed1977

Comparability of two methods of time and motion study used in a clinical setting: work sampling and continuous observation.

Two methods of time and motion study, continuous observation and work sampling, were used to measure physician behavior in a prepaid group practice. Results of the two methods were compared to determine whether differences occurred because of method. No significant differences appeared in time/unit of patient service for 82 per cent of physicians studied, nor did the presence of the continuous observed affect the number of units of patient service/half day of observation. Nonpatient activities showed a slightly larger number of differences although 74 per cent of comparisons of mean activity times still showed none. Suggested causes for noted discrepancies may be circumstantial dissimilarities in the two study periods or observed proximity. Nonetheless, overall the two methods show a high degree of similarity. Unless there is particular interest in the exact content of the physician-patient encounter, when continuous observation is required, work sampling is preferred because of time, cost, and possible observed influence on nonpatient activities.

Group Practice↗
PubMed1977

Processing time related to patient attitude in a family practice residency model office.

This paper presents a time-motion study of patient processing in the Ball Memorial Family Practice Residency Model Office during a one-month time period. Time intervals including patient waiting time and patient processing time, ie, length of patient time spent in attendance by various health-care office personnel, were calculated. An assessment intended to reveal patients' attitudes in the context of their visits was performed. Correlation statistical analysis of the time-motion and attitude studies indicates that relatively negative patient attitudes are related to the length of time that the patient spends waiting for the doctor, the length of patient waiting time in the office, and the total time that the patient spends in the office.

Attitude↗
PubMed1976

Quality, efficiency, and cost of a physician-assistant-protocol system for managment of diabetes and hypertension.

Briefly trained physicians assistants using protocols (clinical algorithms) for diabetes, hypertension, and related chronic arteriosclerotic and hypertensive heart disease abstrated information from the medical record and obtained history and physical examination data on every patient-visit to a city hospital chronic disease clinic over a 18-month period. The care rendered by the protocol system was compared with care rendered by a "traditional" system in the same clinic in which physicians delegated few clinical tasks. Increased thoroughness in collecting clinical data in the protocol system led to an increase in the recognition of new pathology. Outcome criteria reflected equivalent quality of care in both groups. Efficiency time-motion studies demonstrated a 20 per cent saving in physician time with the protocol system. Coct estimates, based on the time spent with patients by various providers and on the laboratory-test-ordering patterns, demonstrated equivalent costs of the two systems, given optimal staffing patterns. Laboratory tests were a major element of the cost of patient care,and the clinical yield per unit cost of different tests varied widely.

Costs and Cost Analysis↗
PubMed1975

Time utilization of a population of general surgeons in community practice.

A time-motion study was performed on a population of general surgeons in suburban community practice whose median weekly operative work load had been previously determined to be 3.1 hernia equivalents (HE). The mean observed 6 day working week of this population of general surgeons was found to be 34.5 hours, of which 28.7 hours were devoted to professional activities for the total work week of 44.3 hours. Thirty-five percent of the mean observed working week was spent in office activities and 50 percent spent in hospital activities. During the mean observed week, 18.5 hours (54 percent) were devoted to patient care, of which 16.5 hours were judged to be devoted to surgical care. Surgeons with above-median operative work loads in the previous study devoted 67 percent more time to professional activities and twice as much time to surgical activities as surgeons with below-median work loads. The findings support the hypothesis that there appears to be an underutilization of costly and highly specialized medical skills in the particular community and suggest that the HE methodology is a valid measure not only of the operative work of surgeons in community practice but of total time devoted to surgical care.

Delivery of Health Care↗
PubMed1992

The potential for using non-physicians to compensate for the reduced availability of residents.

Both the number of residents and the amount of time existing residents have in which to carry out their activities may soon be decreasing. To consider the potential for alternative ways of staffing teaching hospitals, it is necessary to know how residents spend their time. The authors sought to learn this by conducting a time-motion study of eight internal medicine residents at two urban hospitals in New York City in 1988. The residents' activities were observed and coded by premedical students, and the authors independently classified the possible activities into (1) those that had to be done by a physician, (2) those that were educational only, and (3) those that could be done by a non-physician. A total of 1,726 activities of 67 kinds were coded, averaging 7.75 minutes each. The authors analyze and project their data using two models--the traditional model of care in which the physician is the primary medical manager of the patient, and an alternative model in which a midlevel practitioner, such as a nurse practitioner, would perform the day-to-day monitoring of patients. For example, the data indicate that in the traditional model, almost half of a resident's time is spent in activities that must be done by a physician, meaning that another kind of physician would be needed to do those activities if the resident were unavailable; but in the midlevel practitioner model, only around 20% of the activities would require a physician. The authors give detailed breakdowns of their data, estimate the kinds and numbers of non-physician health care professionals necessary to substitute for residents in appropriate activities, and review possible difficulties in implementing such substitutions.

Evaluation Studies as Topic↗
PubMed1977

The influence of a change in practice setting on pediatrician activity: a case study.

A time-and-motion study was performed of a pediatrician's activities in his fee-for-service solo practice and again after he joined a prepaid group practice. A comparison was made between time spent with fee patients in solo practice and time spent with fee patients continuing to see him in group practice. Total time per patient visit was not changed significantly by the group setting. Activities within the visit were modified in the group setting. History-taking and physical examination were reduced; counseling and charting were increased. Time spent in well-child visits in the group setting was significantly longer with the increased time spent in counseling. For sick visits there was no change in total time per visit nor in activities within the visit.

Fees and Charges↗
PubMed1975

Internuclear ophthalmoplegia and associated abnormalities in eye motion timing (differential delays).

Studies of the dynamic characteristics of horizontal saccadic eye motion give velocity, acceleration, and timing information. Average time differences between the motion of the eyes on left and right gaze, termed "differential delays," are statistical measures of the average differences of right-going and left-going velocity waveforms, and can be determined to within 0.5 msec. These relative time measurements give information that is not necessarily apparent from the velocity or acceleration data, and provide a sensitive measure of early oculomotor dysfunction. Patients with internuclear ophthalmoplegia have been shown to give characteristic abnormal values, and two such patients are described in detail to illustrate how these measurements may be used both to help in diagnosis and to characterize the presumed lesions.

Adult↗
PubMed1979

Transvesical Harris-Hryntschak prostatectomy with primary bladder closure and local vasoconstriction.

The simple, rapid and satisfactory method of the transvesical Harris-Hryntschak open prostatectomy is described. When this technique is used bleeding is reduced to an average of 85 ml. and visibility is improved by the local injection of a synthetic vasoconstrictor, ornithine-8 vasopressin, before enucleation. Hermostasis is obtained by tamponade with fine sutures occluding the bladder neck. Bladder closure is with heavy watertight, purse-string sutures. A "time and motion" study has reduced the usual operating time to 15 to 20 minutes with an intraoperative transfusion rate of 2.3%.

Administration, Topical↗
PubMed1992

Administering non-restricted medications in hospital: the implications and cost of using two nurses.

In an effort to improve patient safety, some hospitals require that two nurses rather than one administer all medications. Such a policy has not been subjected to an economic evaluation. The authors conducted a cross-over study comparing error rates when medication was administered by two nurses as against a single nurse. During a 46 week study period, 319 errors were detected among 129,234 medications administered in a geriatric assessment and rehabilitation unit, giving an overall error rate of 2.5 per 1000 medications. The vast majority of errors detected were relatively minor and had no serious adverse consequences. The error rate per 1000 medications administered by a single nurse was 2.98 (95% CI: 2.45-3.51) and was statistically significantly higher than 2.12 (95% CI: 1.69-2.55) per 1000 for two nurses. A time and motion study indicated that when two nurses rather than one administered medication an additional 17.1 h of nursing time was required per 1000 medications administered. The authors conclude that the use of two nurses to administer medication does statistically significantly reduce the medication error rate, but the clinical advantages are dubious and in our view such a policy cannot be recommended.

Economics, Nursing↗
PubMed1975

Patient material in multidisciplinary intensive care units.

The patient material in the multidisciplinary intensive care unit of Uppsala University Hospital is compared with the material from a recently performed nation-wide study on different intensive care units. A registration chart to record intensive care work and a time and motion study of nursing personnel are presented. It is concluded that such records are necessary to allow valid comparisons of the need for intensive care beds and personnel in hospitals of different sizes and degrees of specialization.

Critical Care↗
PubMed1979

Characteristics of "old timer" hockey play.

Many Canadian adults play Old Timer hockey to improve and/or maintain their cardiorespiratory fitness. This review examined the intensity and duration of play that characterizes adult noncontact hockey. The exercise intensity was assessed by continuously monitoring the heart rate response via telemetry. The duration of play was studied utilizing time-motion analysis, during the typical Old Timer game, the forwards spent 28 minutes on the ice when the heart rate was at least at 60% KM intensity. The forwards averaged 85% KM intensity during game activity. The mean heart rate response of the goaltenders was 143 beats per minute or 64% KM intensity.

Adult↗
PubMed1978

The cost of a primary care teaching program in a prepaid group practice.

Costs were determined for a teaching program in general pediatrics and general internal medicine for advanced residents in a prepaid group practice, the Medical Care Group of Washington University. A time and motion study was conducted to measure the productivity of faculty physicians before and after the establishment of the teaching program. There was a statistically significant loss in productivity for internists and an apparent loss, though not significant, for pediatricians as a result of their teaching effort, but the productivity of the residents more than compensated for the loss. The residual positive value of a full time equivalent (FTE) pediatric resident after reimbursement of all possible lost productivity by faculty pediatricians represented 43.9 per cent of a FTE pediatrician. For a FTE resident in internal medicine the residual positive value was 49.7 per cent of a FTE internist.

Costs and Cost Analysis↗
PubMed1992

Workplace upper limb disorders: a prospective study with intervention.

A prospective longitudinal study was carried out to investigate the occurrence of upper limb disorders in an electromechanical plant between 1980 and 1988. It included clinical and epidemiological studies, measurement of vibration produced by the power tools used, ergonomic assessment of the works and time and motion studies. Simultaneously during the same period remedial actions were taken through multidisciplinary interventions when the specific causal factors were known. The study shows the clinical entities of the disorder, identifies the risk factors and evaluates the results of the interventions. It assists in establishing a cause and effect relationship for the condition and demonstrates the way a preventive strategy could be developed.

Adult↗
PubMed2025

The cost and cost trajectory of genome sequencing and bioinformatics analysis for Indigenous children with suspected rare diseases.

PURPOSE: Indigenous peoples are underrepresented in reference genome libraries. Consequently, rare disease diagnosis may require bespoke bioinformatics analyses of genome sequences. Establishing diagnostic cost is crucial to support policy development for equitable diagnosis of rare diseases. We estimated the cost and cost trajectory of diagnostic genome sequencing and bioinformatics for Indigenous participants with suspected rare diseases. METHODS: We conducted a microcosting study of Indigenous children and their families receiving genome sequencing through Canada's Silent Genomes Project. Invoice data informed the costs of genome sequencing. We conducted a time-and-motion study for bioinformatics analyses, including labor, computing, and data storage costs. RESULTS: With standard bioinformatics, costs ranged from C$3645 (SD: 455) for singletons to C$7402 (SD: 566) for trios. With advanced, bespoke bioinformatics, costs ranged from C$5344 (SD: 634) for singletons to C$9760 (SD: 822) for trios. Genome sequencing was a primary cost driver; however, sequencing costs decreased by 61% over 4 years. Bioinformatics costs ranged from 21.3% to 58.3% of the total costs. The time required for bioinformatics ranged from 71 hours to 215 hours for standard and advanced analyses, respectively. CONCLUSION: Genome sequencing costs decreased over time. Bioinformatics is a significant cost driver, particularly for bespoke analyses arising from nonrepresentative reference libraries.

Humans↗