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PubMed1996

Effects of control order, augmented feedback, input device and practice on tracking performance and perceived workload.

Virtual interfaces to advanced human-machine systems will present operators with a variety of perceptual-motor challenges. To inform the virtual interface design processes, the present experiments examined the effects of track order, level of knowledge of performance, type of control device, and the extent of practice on tracking performance and associated mental workload. Tracking was assessed by root mean square error. Subjective workload was measured using both the NASA Task Load Index (TLX) and the Subjective Workload Assessment Technique (SWAT). Results indicated non-linear effects, where tracking error and subjective workload both increased non-proportionally with track order. Trackball use resulted in more accurate performance and was judged to be of lower subjective workload than input using a mouse. Augmented knowledge of performance had little effect on either performance or workload. There was a number of interactions affecting performance that were replicated in perceived workload. Over acquisition trials, second-order tracking exhibited continuous improvement. This capability was retained even after a 30-day rest interval. Decrease a workload followed performance improvement in both initial acquisition and subsequent retention phases. The two subjective workload scales were essentially equivalent in terms of their sensitivity to task manipulations. These results support the direct association between workload and performance and confirms the use of workload in helping to evaluate the influence of diverse task-related demands. The implications for the design of virtual interfaces to real-world systems are examined in the light of these findings.

Adult↗
PubMed1993

European isolation and confinement study. Workload and stress: effects on psychosomatic and psychobiological reaction patterns.

Six healthy males, the EMSInauts, were isolated in hyperbaric chambers for a period of 28 days at 5-msw overpressure. During that period they had to carry out meaningful operational and research tasks in addition to monitoring their psychological and physiological reactions. The actual workload was evaluated and compared with the planned workload, and its effects on symptomatology and psychobiology. The perceived workload and its effects on psychosomatic symptomatology and on some biological indices were monitored. Thus it was possible to evaluate how the workload carried during 4 weeks of isolation affected the psychological and biological well-being of the six EMSInauts. The following three types of assessments were performed: 1. Workload assessment: The objective workload was calculated based on the schedule which was revised daily, and the actual load calculated by the commander. A workload questionnaire was administered daily after each working session. 2. Psychosomatic assessment: Morning and evening questionnaires were administered daily. The state of health and of anxiety were also evaluated. 3. Biological indices: Cortisol, testosterone, adrenalin, and noradrenaline were determined once a week. In addition, cardiac activity was monitored every day. The workload assessment showed that on the average the planned workload was accomplished in slightly less than the scheduled time. The workload was not perceived as severe in terms of cognitive, emotional, and physical load. The group rated the support received from each other and from the mission control personnel as average, with minor changes during the isolation period. They gave a high rating to the amount of control they had over their activities. Fatigue and tension were scored in the middle range. The psychosomatic assessment showed that there were few symptoms, and these were mostly of low severity. The most common symptom was general fatigue. Furthermore, minor dizziness, headache and light tremor was in some cases reported. The sleep quality was good, but complaints about poor sleep increased somewhat with the passing of time. Few and mostly minor health problems were experienced during isolation. Only one EMSInaut had to miss one day of work due to a bout of flu. The state of anxiety was below that of the general population throughout the isolation period. The biological indices used showed no evidence of stress from the workload handled during the isolation period. The level of the "stress hormone" cortisol actually decreased during isolation. The adrenalin excretion, which tends to go up during acute stress, remained unchanged during this period. Neither was there any evidence of changes in cardiac activity throughout the isolation period.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Psychological↗
PubMed1986

Patient acuity indicators as predictors of pharmacy workload.

The feasibility of using two workload indicators from a nursing patient-classification system as a means of predicting pharmacy workload was studied. Frequency data for 13 pharmacy distribution and clinical activities were recorded daily for 28 consecutive days and compared with daily data for acuity of patient illness and number of standard hours of nursing care required on nine nursing units. The strength of the associations between (1) pharmacy workload and patient acuity and (2) pharmacy workload and standard hours of nursing care was determined by linear regression analysis. Both same-day and one-day-lagged analyses were performed; the one-day-lagged analyses looked at pharmacy workload on a given day in relation to nursing workload on the previous day. A total of 252 observations were available for analysis. Pharmacy workload and same-day standard hours of nursing care were correlated most strongly, although all of the analyses yielded large coefficients of correlation. Analysis of data from individual nursing stations yielded smaller coefficients of correlation, especially for the one-day-lagged analyses. At least 73% of the variance in pharmacy workload could be attributed to variance in nursing workload. The index of patient acuity of illness and the number of standard hours of nursing care are good predictors of pharmacy workload of the same and the following days; the potential exists to use these nursing workload indicators in determining pharmacy staffing requirements.

Minnesota↗
PubMed2005

Emergency physicians' behaviors and workload in the presence of an electronic whiteboard.

BACKGROUND: As the demands on the emergency medicine (EM) system continue to increase, improvements in the organization of work and the access to timely clinical and system information will be required for providers to manage their workload in a safe and efficient manner. Information technology (IT) solutions are beginning to find their place in the emergency department (ED) and it is time to begin understanding how these systems are effecting physician behavior, communication and workload. METHODS: The study used a time-in-motion, primary task analyses to study faculty and resident physician behavior in the presence of an electronic whiteboard. The NASA-Task Load Index (TLX) was used to measure subjective workload and the underlying dimensions of workload at the end of each physician observation. Work, communication and workload were characterized using descriptive statistics and compared using Mann-Whitney U-tests. RESULTS: Physicians in our study performed more tasks and were interrupted less than physicians studied previously in conventional EDs. Interruptions interrupted direct patient care tasks less than other clinical activities. Temporary interruptions appear to be a major source of inefficiency in the ED, and likely a major threat to patient safety. Face-to-face interruptions persist even in the presence of advanced IT systems, such as the electronic whiteboard. Faculty physicians exhibited lower workload scores than resident physicians. Frustration was a significant contributing factor to workload in resident physicians. All physicians ranked temporal demands and mental demands as major contributing factors to workload. CONCLUSION: The results indicate that the electronic whiteboard improves the efficiency of work and communication in the ED. IT solutions may have great utility in improving provider situational awareness and distributing workload among ED providers. The results also demonstrate that IT solutions alone will not solve all problems in the ED. IT solutions will probably be most effective in improving efficiency and safety outcomes when paired with human-based interventions, such as crew resource management. Future studies must investigate team interaction, workload and situational awareness, and the association of these factors to patient and provider outcomes.

Electronics↗
PubMed2003

Surgeon workload and survival from breast cancer.

The formation of multidisciplinary breast teams across the UK is intended to concentrate the assessment and treatment of breast cancer into the hands of high volume specialists. We undertook a retrospective population-based study in order to determine the trends in surgeon breast cancer workload in Yorkshire, UK, and to investigate whether patients treated by low-workload surgeons had poorer survival. Of 11 329 female breast cancer patients diagnosed in 1989-1994 in Yorkshire, 6% were managed by surgeons with a mean annual workload of less than 10 new patients, while surgeons with workloads of 10-29, 30-49 and >50 treated 21, 21 and 52%, respectively. Over the study period, increasing number of patients were managed by surgeons with higher workloads. Patients treated by low-workload surgeons had poorer survival. Five-year survival was 60% in the lowest workload category compared to 68% in the highest category. The relative risk of death was increased by 15% (RR=1.15, 95% CI 1.03-1.28) and by 10% (RR=1.10, 95% CI 1.02-1.18) for patients managed by surgeons with workloads <10 and 10-29 cases per annum in comparison to patients managed by surgeons with workloads of >50. The results of this study suggest increasing site specialisation in breast cancer among general surgeons. It also provides further evidence that the management of patients by surgeons with low workloads decreases overall survival.

Adult↗
PubMed1999

The effects of shifts in the balance of care on general practice workload.

BACKGROUND: The consequences of the move towards a primary-care-led NHS are shifts in activity from secondary care to primary care and more involvement of GPs in purchasing decisions. Although there are many anecdotal reports of an increasing primary care workload, there is little empirical evidence on the extent of such shifts. This paper reports the results of a survey of GPs in Grampian, in the north-east of Scotland, in which we attempted to gather information on the effects of shifts in the balance of care on general practice. OBJECTIVE: We aimed to examine GPs perceptions of the extent to which general practice workload has changed due to planned and unplanned shifts in the balance of care. METHODS: The design of the study was a self-reported questionnaire, which was administered in general practices in the Grampian Health Board, Scotland. The subjects were senior partners of all general practices and the main outcome measures were the types of changes which have taken place in general practice, their source, their effect on practice workload and how practices have reacted. RESULTS: A 60% response rate was achieved (52/86); 85% (44/52) of GPs claimed that their workload had increased due to shifts in the balance of care and that 72% of the shifts were initiated outside the practice. Geriatric care, early discharge and psychiatric and psychology services, as well as nursing home care, were reported to have had the greatest impact on workload. The main aspects of practice workload which had increased included the number of GP consultations, general stress at work and number of home visits, whereas the net income of the practice and health outcome of patients were reported to have decreased. Practices have dealt with the increase in workload by shifting tasks from GPs to nurses and absorbing the workload into existing practices/patterns. Responders reported that ideally more nursing and GP staffing would be required. Overall, GPs welcomed the shifts in the balance of care, were more concerned about poor communication rather than actual increases in workload and claimed that morale had fallen. CONCLUSION: GPs perceive that the move towards a primary-care-led NHS is increasing the workload in general practice. If the shift in the balance of care away from secondary care is to be successful, then more information is required about such shifts to support practices as change continues.

Attitude of Health Personnel↗
PubMed1995

Effects of workload preview on task scheduling during simulated instrument flight.

Our study examined pilot scheduling behavior in the context of simulated instrument flight. Over the course of the flight, pilots flew along specified routes while scheduling and performing several flight-related secondary tasks. The first phase of flight was flown under low-workload conditions, whereas the second phase of flight was flown under high-workload conditions in the form of increased turbulence and a disorganized instrument layout. Six pilots were randomly assigned to each of three workload preview groups. Subjects in the no-preview group were not given preview of the increased-workload conditions. Subjects in the declarative preview group were verbally informed of the nature of the flight workload manipulation but did not receive any practice under the high-workload conditions. Subjects in the procedural preview group received the same instructions as the declarative preview group but also flew half of the practice flight under the high-workload conditions. The results show that workload preview fostered efficient scheduling strategies. Specifically, those pilots with either declarative or procedural preview of future workload demands adopted an efficient strategy of scheduling more of the difficult secondary tasks during the low-workload phase of flight. However, those pilots given a procedural preview showed the greatest benefits in overall flight performance.

Aerospace Medicine↗
PubMed1998

Hemodynamic profile of submaximal constant workload exercise in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.

Constant workload exercise on an upright bicycle at submaximal levels of exercise intensity is frequently used in physical training programs. Nevertheless, only a few data are currently available on the hemodynamic changes induced by constant workload exercise in patients with heart failure. The aim of this study was to assess the hemodynamic response during submaximal constant-workload exercise at 2 different work rates in patients with heart failure. The hemodynamic profile was assessed by means of right-sided cardiac catheterization in 21 men with moderate heart failure during submaximal-constant workload exercise performed on an upright bicycle for 15 minutes. The intensity of constant work rate exercise was selected during a previous symptom-limited or maximal test. The first submaximal test was performed at the level of the anaerobic threshold workload, corresponding to 64% of peak work rate, and the other test at 70% of anaerobic threshold workload (42% of peak work rate). During both submaximal tests, a marked increase in right heart pressure was observed as compared with baseline. The increase in systolic pulmonary artery pressure was statistically not different between the 2 tests (from 40 +/- 18 to 66 +/- 20 mm Hg during exercise at the anaerobic threshold workload, and from 39 +/- 16 to 63 +/- 21 mm Hg during exercise under anaerobic threshold). The increase in pulmonary arterial wedge pressure was similar (from 20 +/- 10 to 35 +/- 13 mm Hg during exercise at the anaerobic threshold, and from 19 +/- 9 to 32 +/- 12 mm Hg during the other test). Cardiac output and heart rate were significantly higher during submaximal exercise at a higher workload, paralleling the behavior of oxygen uptake. Finally, the hemodynamic profile during submaximal exercise at the anaerobic threshold workload was quite similar to that observed during symptom-limited exercise. Thus, in patients with heart failure, submaximal exercise performed at a constant workload, even at low exercise intensity, may determine relevant pressure changes in pulmonary circulation.

Aged↗
PubMed1987

The subjective perception of workload in low-time private pilots: a preliminary study.

Control of pilot workload may prevent performance failure of VRF pilots in adverse weather. Measurement of workload and the prediction of performance failure are the first steps. Twelve low-time non-instrument rated pilots were progressively tasked with flight maneuvers under simulated instrument meteorological conditions to the point of performance failure. For each of 3 simulated flights, 14 maneuvers, presented in groups, were performed. Perceived workload was reported by the Subjective Workload Assessment Technique. We obtained 500 workload scores. Workload scores varied significantly between the groups of maneuvers. Instrument landing system approaches had the highest workloads, with descents the second highest. Workload scores were significantly higher when associated with performance failure. The Subjective Workload Assessment Technique proved to be a sensitive workload measure. It showed some promise as a predictor of performance breakdown.

Adult↗
PubMed2005

Clinical and procedural predictors of nurse workload during and after invasive coronary procedures: the potential benefit of a systematic radial access.

BACKGROUND: Invasive coronary procedures are increasing in number and complexity over time. This trend translates in an increased need for economical and human resources, among which is nurse staffing the most affected. AIMS: To identify possible predictors of nurse workload, during and after diagnostic and interventional procedures. METHODS: Two hundred and sixty consecutive patients were included: 52 and 208 patients underwent femoral and radial access, respectively. Nurse workload was calculated with a self-developed model. RESULTS: Cathlab nurse workload was 103 [63--156] min. Independent predictors of increased Cathlab nurse workload were: femoral access, failed radial access and cross-over, interventional procedures, procedural time, urgent procedures. Cathlab nurse workload was 174 [134--218] and 86 [58--126] min, for femoral and radial access, respectively (p<0.001). Among the overall population, 174/260 patients (44 females, mean age 66+/-11 years) were hospitalised at our Center after the procedure. Fifty-six and 118 patients had femoral and radial access, respectively. Ward nurse workload was 457 [226--954] min. Independent predictors of increased Ward nurse workload were: access-site complication, length of in-hospital stay, admission to CCU, interventional procedures. Ward nurse workload was 386 [226--652] and 720 [314--1375] min, respectively for radial and femoral access (p<0.001). CONCLUSIONS: A systematic radial access is an effective strategy for reducing nurse workload, both during, by simplifying nurse tasks in the CathLab, and after coronary invasive procedures, by preventing access-site complications, shortening in-hospital stays, and reducing admissions to CCU.

Aged↗
PubMed2001

Diagnostic yield of the lactate stress test in respiratory chain disorders under absolute and relative workload.

Usually, the lactate stress test is carried under a constant, low workload maintained for 15 min, although there are indications that the lactate response to exercise is a function of the relative workload, and that a workload for only 5 min does not decrease its sensitivity. Thus, this study compared the diagnostic yield of the lactate stress test when carried out under a constant workload of 30 W (LSTA) and under a workload of 30% of maximum (LSTR), and when the workload was maintained for 5 and 15 min. In 16 patients with respiratory chain disorders, 12 women, four men, aged 27--88 years, the LSTA and LSTR were carried out on 2 different days, within 48 h. For both tests serum lactate was determined before, during and after a 15-min workload on a bicycle. Upper reference limits at rest, 5, 10, 15 min after starting, and 15 min after finishing the exercise were 1.9, 2.0, 2.0, 2.0, and 1.6 mmol/l for the LSTA, and 2.3, 3.0, 3.2, 3.4 and 2.7 mmol/l for the LSTR. The sensitivity was 88% for the LSTA and 63% for the LSTR. The specificity of the LSTA was 94%. The diagnostic yield of both tests was similar when the workload was maintained for 5 or 15 min. In conclusion, the LSTA should be preferred to the LSTR. Three lactate determinations during 15 min have no advantage over a single lactate determination after a 5 min workload of 30 W.

Adult↗
PubMed2004

A 16-year follow-up study of physical capacity in relation to perceived workload among ageing employees.

The main purpose of this study was to ascertain musculoskeletal and cardiovascular capacity among ageing employees in relation to workload over a period of 16 years. The data were obtained by physical capacity tests and ratings of perceived exertion (RPE) during working day. The study group consisted of 89 subjects, who were all employed in the municipal branch and were on average 51.9 years old at the beginning of the follow-up period in 1981 and 67.3 years in 1997, when the most of the subjects had retired (with only two subjects still working). During the 16-year follow-up period, age-related decline in physical capacity was observed. Nevertheless the improvement in flexibility of spine and in isometric trunk muscle strength compared with the same age subjects was more common among the subjects with high workload than among the subjects with low workload. However, among the subjects with high workload, physical capacity was poorer than among the subjects with low workload, especially among the women. The results suggest the conclusion that there are differences in workers' physical capacity in relation to their perceived workload during working life. These differences remained when the subjects had retired. Interestingly, those who had high workload had lower muscle strength than those who had low workload. This may indicate that high physical workload does not have any training effect on the muscle strength of ageing workers.

Age Factors↗
PubMed1993

The influence of workload on the mental state of the primary health care physician.

The work factors involved in physicians' mental workload were analysed. The study settings were 116 physicians (general practitioners, paediatricians and residents in family programmes working in out-patient clinics) (Primary Health Care Centres) in Spain. The questionnaire used measured the mental workload and the work activity over a period of 5 days. The mental workload covered seven dimensions: mental effort, physical effort, difficulty, priority, modify standards of visit, overlap, and stress. Its Cronbach's alpha coefficient was 0.80. The mental workload correlated positively with all variables measuring the workload activity. However, when the multiple regression analysis (stepwise met) was assessed, only the number of room visits, the referrals by nurse to physician, the room emergencies, the level of administrative tasks, the patients with complex pathologies, and the workload adequacy remained significant. The physicians' years of experience did not correlate with mental workload. The influence of diverse work activities in each of the mental workload dimensions was investigated. We conclude that the number of patient visits and organizational factors determine physicians' mental workload.

Adult↗
PubMed2002

Evaluation of staff workload during resuscitation of trauma patients.

OBJECTIVE: Evaluating the medical staff workload during resuscitation of trauma patients is one of the important quality assurance activities to provide adequate medical manpower, especially for patients with life-threatening or severe injuries. Nevertheless, there is no method available to measure and calculate the amount of workload during resuscitation. We sought to develop a new framework of Workload Scoring System (WSS) to evaluate and quantify the medical staff workload during resuscitation. METHODS: From July 1996 to July 1998, the records of 11,800 trauma patients were prospectively collected from our computer-stored medical record system. The Workload Scoring System points with reference to age, different triage category on the basis of triage version of the Revised Trauma Score (RTS), level category on the basis of Injury Severity Score (ISS), and Abbreviated Injury Scale (AIS) in six body regions were calculated to survey the medical staff workload. RESULTS: The WSS points were 18.51 +/- 0.80 for triage I, 11.88 +/- 0.17 for triage II, and 6.90 +/- 0.04 for triage III trauma patients. The WSS points were 23.10 +/- 0.67 for Level I, 20.34 +/- 0.25 for Level II, 12.87 +/- 0.08 for Level III, and 6.03 +/- 0.02 for Level IV trauma patients. There were statistically significant differences among triage I, II, and III trauma patients, and among Level I, II, III, and IV trauma patients (p < 0.01). The worse the physiologic status and the greater the anatomic damage, the more medical staff workload was needed. Multiple regression with linear model may predict WSS points as an equation of -8.920 + 1.375 ISS + 1.785 RTS + 0.424 Age (r2 = 0.621), which accounts for 62.1% of the variance in WSS points. CONCLUSION: WSS provides a valuable tool to measure and quantify the medical staff workload during resuscitation as a function of -8.920 + 1.375 ISS + 1.785 RTS + 0.424 Age. The greatest benefit of this methodology is to forecast the expected medical staff workload to allocate sufficient medical manpower to provide the desired trauma care.

Analysis of Variance↗
PubMed2006

Tracking workload in the emergency department.

OBJECTIVE: The primary objective of this study was to create a methodology for measuring transient levels of physician workload in a live emergency department (ED) environment. BACKGROUND: Characterizing, defining, and measuring aspects of this interrupt-driven work environment represent the preliminary steps in addressing impending issues concerning ED overcrowding, efficiency, and patient and provider safety. METHODS: A time-motion task analysis was conducted. Twenty emergency medicine (EM) physicians were observed for 180-min intervals in an ED of an academic medical center. Near continuous workload measures were developed and used to track changing workload levels in time. These measures were taken from subjective, objective, and physiological perspectives. The NASA-Task Load Index was administered to each physician after observational sessions to measure subjective workload. Physiological measurements were taken throughout the duration of the observation to measure stress response. Additional information concerning physicians' patient quantity and patient complexity was extracted from the ED information system. RESULTS: Graphical workload profiles were created by combining observational and subjective data with system state data. Methodologies behind the creation of workload profiles are discussed, the workload profiles are compared, and quantitative and qualitative analyses are conducted. CONCLUSION: Using human factors methods to measure workload in a setting such as the ED proves to be challenging but has relevant application in improving the efficiency and safety of EM. APPLICATION: Techniques implemented in this research are applicable in managing ED staff and real-time monitoring of physician workload.

Emergency Service, Hospital↗
PubMed2004

Effect of job rotation on work demands, workload, and recovery of refuse truck drivers and collectors.

Job rotation is often advocated to reduce workload, but its efficacy has seldom been investigated. The aim of this study is to compare the work demands, workload, and recovery among truck driving, refuse collecting, and rotating between these two jobs, between days and during the day. Three teams of 3 employees each participated in this study. Work demands were assessed by systematic observation of tasks and activities. Workload was quantified by means of heart rate, oxygen uptake, subjective ratings, and urinary excretion rates of catecholamines. Recovery was quantified by excretion rates of catecholamines after work. Job rotation between driving and collecting is an effective measure to reduce physical workload as compared with collecting only and to decrease mental workload as compared with driving only. However, job rotation resulted in increased physical workload as compared with driving only. Job rotation did not increase mental workload as compared with collecting only. No effects were seen on recovery. No differences were found between rotating between days and during the day. Actual or potential applications of this research include the recommendation that before job rotation is introduced, its efficacy be determined in terms of well-chosen workload measures because a reduction in work demands does not directly imply a reduction in workload. Therefore, job rotation might be less effective than expected.

Adult↗
PubMed2002

Workload, error detection, and experienced stress in a simulated pharmacy verification task.

The relationships among workload, stress, and performance efficiency are topics of applied interest and theoretical importance to researchers concerned with human performance. Such interest extends to a variety of occupational areas including inpatient, outpatient, and community pharmacies. In that context, these relationships have become a consumer health issue given concerns that workload contributes to job stress and a significant decline in dispensing accuracy. In the present study, 102 trained college-aged individuals evaluated simulated pharmacy prescriptions for errors under conditions of either low workload (72 orders over 120 min. on task) or high workload (120 orders over 120 min. on task) in a high-fidelity simulated pharmacy environment. Overall, cumulative and detection theory indices of error detection were compatible with estimates from pharmacy field studies. When rates of sensitivity and specificity for detection were examined, substantial variations in the identification of errors (sensitivity) and difficulties with detection of data-entry mistakes were observed in the high workload condition, but only modest effects emerged for the low workload condition. Although increases in objective workload were associated with modest declines in detection accuracy, objective workload did not significantly affect negative mood (Mood Adjective Checklist) or perceived workload (NASA-Task Load Index) as expected.

Adult↗
PubMed1995

A 10-year analysis of case load and weighted workload in a single Health Board.

This study analysed the general surgical activity in a single Health Board in terms of caseload (case counting) and Intermediate Equivalent (IE) workload. Endoscopy and surgery performed wholly within the specialist vascular and urological units were excluded. Some 180,466 procedures were prospectively recorded through the Lothian Surgical Audit over a 10-year period (1983-92). They have now been weighted to reflect workload according to the British United Provident Association's schedule of procedures. 5,058 (2.8 percent) procedures could not be 'matched' and in a further 2,400 (1.4 percent) there was an error in the Lothian Surgical Audit code leaving 172,968 operations for analysis. The total number of operations (caseload) performed annually fell by 12 percent over the 10-year period. This fall was entirely due to a 28 percent decrease in the number of minor operations. The total annual IE weighted workload rose by 2.7 percent for the 10-year period. Analysis by IE workload revealed that the fall in minor operations had been compensated for by an increase in complex major operations (CMO). The total caseload of CMO had increased from 224 (1.0 percent) to 551 (2.9 percent). This represented an increase in the proportion of workload from 5.3 percent to 12.45 percent. Thus a 1.9 percent increase in case load represented a 7.1 percent increase in IE workload. In the final year major and complex major operations formed 24.6 percent of the caseload which represented 53.2 percent of IE weighted activity. This study suggests that IE workload based on the BUPA schedule is a valid and reproducible method of weighting that accurately reflects the changing workload of different case mixes. This differential must be appreciated to ensure accurate allocation of resources. In future surgical activity,including waiting lists,should be assessed by weighted workload rather than case numbers.

General Surgery↗