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PubMedDate not supplied

Changes in plasma lipids and dietary intake accompanying shifts in perceived workload and stress.

Plasma lipids, dietary intake, and self-reported stress and workload were assessed in 14 employees twice before major work deadlines (high workload), and once during a comparatively quiescent period of work (low workload). Increases in self-reported stress and workload between the high and low workload periods were significantly positively associated with increases in plasma total cholesterol, although lipid levels were not increased in the group as a whole during the high workload periods. Dietary intake of calories, total fat, and percentage of calories from fat were significantly higher during high workload during a period of high workload is associated with elevated total cholesterol and that dietary intake of foods which raise cholesterol levels is also increased. Further studies of larger groups of subjects may be required to show a frank increase in cholesterol with increased workload.

Adult↗

PubMed2005

Physician workload in primary care: what is the optimal size of practices? A cross-sectional study.

OBJECTIVE: To determine the impact of practice size and scope of services on average physician workload in primary care practices in The Netherlands, and to examine the associations between average physician workload, average assistant volume and organisational practice characteristics. METHODS: This was a cross-sectional study in 1188 general practices in The Netherlands. Measures included physician workload per week per 1000 patients, assistant volume per 1000 patients, practice size defined by number of registered patients (10 classes), scope of disease management services (seven classes), and nine organisational characteristics of the practice. RESULTS: Physician workload per 1000 patients differed across levels of practice size, but was not related with the range of disease management services provided. In the smallest practices physicians worked on average 26.2h per 1000 patients and in the largest practices 18.1h. A higher average assistant volume was overall not associated with a lower average physician workload. Large practices had lower assistant volume per 1000 patients, but provided a wider range of disease management services compared to small practices. Delegation of medical tasks was associated with reduced physician workload per 1000 patients, mainly in smaller practices, and with higher assistant volume per 1000 patients, particularly in larger practices. CONCLUSIONS: In The Netherlands the optimum regarding average physician workload was found in the largest practices, while no obvious association with scope of disease management services appeared. It may be that in large practices medical tasks were delegated to practice assistants to provide a wider scope of disease management services and in small practice to reduce average physician workload.

Cross-Sectional Studies↗

PubMed2000

Quantitative description of the workload associated with airway management procedures.

STUDY OBJECTIVES: To measure the workload associated with specific airway management tasks. SETTING AND INTERVENTION: Written survey instrument. PATIENTS: 166 Stanford University and 75 University of California, San Diego, anesthesia providers. MEASUREMENTS AND MAIN RESULTS: Subjects were asked to use a seven-point Likert-type scale to rate the level of perceived workload associated with different airway management tasks with respect to the physical effort, mental effort, and psychological stress they require to perform in the typical clinical setting. The 126 subjects completing questionnaires (overall 52% response rate) consisted of 43% faculty, 26% residents, 23% community practitioners, and 8% certified registered nurse-anesthetists (CRNAs). Faculty physicians generally scored lower workload measures than residents, whereas community practitioners had the highest workload scores. Overall, workload ratings were lowest for laryngeal mask airway (LMA) insertion and highest for awake fiberoptic intubation. Airway procedures performed on sleeping patients received lower workload ratings than comparable procedures performed on awake patients. Direct visualization procedures received lower workload ratings than fiberoptically guided procedures. CONCLUSIONS: These kinds of data may permit more objective consideration of the nonmonetary costs of technical anesthesia procedures. The potential clinical benefits of the use of more complex airway management techniques may be partially offset by the impact of increased workload on other clinical demands.

Adult↗

PubMed1999

Housestaff workload and procedure frequency in the neonatal intensive care unit.

OBJECTIVE: To investigate the association of clinical workload and the decision to perform procedures on infants in the neonatal intensive care unit (NICU). DESIGN: Prospective cohort study over one academic year, observing infants exposed to housestaff working under various levels of clinical workload. SUBJECTS: All 31 housestaff rotating on the NICU service during the academic year 1993 to 1994 were observed. A total of 785 infants were admitted to these housestaff. SETTING: One academic Level III intensive care nursery. MEASUREMENTS AND MAIN RESULTS: Clinical workload was operationalized as number of NICU infants cared for by the individual houseofficer on-call each night. The procedures of interest were number of umbilical artery catheters (UACs), intubations, lumbar punctures (LPs), and peripheral phlebotomy performed by the houseofficer on-call. Using multiple linear regression approaches, controlling for the average severity-of-illness of each of the NICU infants, the experience and residency program of the houseofficer on-call, and the individual attending, we found that increased clinical workload (number of NICU infants) resulted in a significantly greater probability that an admitted infant received an umbilical artery catheter (p = .02), but resulted in less probability that any NICU infant received a lumbar puncture (p = .0001) or peripheral phlebotomy (p = .0002). The decision to intubate an infant was not affected by the workload in the NICU. CONCLUSIONS: The clinical workload of housestaff in the NICU can affect decisions to perform procedures on infants in the NICU. For equivalently severely ill infants, there is a greater chance of receiving a UAC and less chance of being phlebotomized or receiving an LP when workload is high. Attending neonatologists need to be sensitive to possible effects of workload on patient care in the NICU.

Analysis of Variance↗

PubMed1992

Therapeutic intervention scoring system (TISS)--a method for measuring workload and calculating costs in the ICU.

The Therapeutic Intervention Scoring System (TISS) is an easily applicable method for measurement of workload in the intensive care unit (ICU). In the present study a modified TISS-scoring (mTISS) was performed daily during 1988-1989 on 2693 patients in a general ICU. Of these, 900 could be classified as 'true' ICU-patients (ICU-stay > or = 24 h or TISS > or = 20 points), whereas the rest were postoperative. In ICU-patients the average length of stay was 4.5 +/- 8.9 days and the average workload 114 +/- 218 mTISS-points. The workload was not significantly related to age or type of admission (scheduled vs unscheduled). Hospital non-survivors (13.6%) showed a significantly increased mean total mTISS-score (239 +/- 364, P < 0.001). Critically ill (TISS Class IV) patients (14% of the sample), with an average workload of 437 +/- 401 mTISS-points, consumed 53% of the total resources. Patients categorized (ICD-9) to respiratory and infectious diseases showed the greatest average workload (207 +/- 315 and 208 +/- 355 mTISS-points, respectively). A workload-index was also developed relating the actual workload to the ICU personnel. The cost of each mTISS-point was calculated. In conclusion, the present study showed that mTISS is a valuable tool when evaluating resource utilization in the ICU. Together with the proposed workload-index and calculation of costs, mTISS could be used for ICU management control.

Age Factors↗

PubMed2003

Ambiguous relation between physical workload and low back pain: a twin control study.

AIMS: To examine the association between self reported physical workload and low back pain (LBP) in younger twins. To investigate whether genetic factors interact with physical workload in relation to LBP. METHODS: A twin control study was performed within a population based twin register using 1910 complete monozygotic (MZ) and same sexed dizygotic (DZ) twin pairs aged 25-42 and discordant for LBP. LBP in the affected twins was divided into two groups: "LBP for </=30 days during the past year", and "LBP for >30 days during the past year". Physical workload was divided into four categories: "sitting", "sitting/walking", "light physical", and "heavy physical". Data were analysed in a matched design using conditional logistic regression. MZ and DZ twins were analysed separately and together in order to determine possible genetic influences in relation to physical workload and LBP. RESULTS: Statistically significant graded relations were found for increasing workload and LBP of longer duration but not for LBP of shorter duration (</=30 days during the past year). In both LBP groups the "sitting" and "sitting/walking" groups were not statistically different. MZ and DZ twins did not differ significantly with respect to LBP in the various workload groups. CONCLUSIONS: There is evidence for a dose-response relation between physical workload and LBP of longer duration. Attention to clinically relevant subgroups based on duration, for example, is necessary in epidemiological studies dealing with LBP. Physical workload might be more important than genetic factors in LBP.

Adult↗

PubMed1993

Experimental evaluation of a model of mental workload.

This study was designed to test predictions from a model of mental workload. The model predicts that mental workload grows as perceived distance from a task goal increases and the effective time for action decreases. Decreases in workload can be achieved by actions that bring the task goal into the region of acceptable time/distance constraints for successful resolution. We reported an experiment that tested these assertions using the Timepools performance task. Timepools generates a spatial representation of a shrinking temporal target to assess the effects of path length (i.e., the number of sequential targets to be acquired) and shrink rate (i.e., elapsed time during which the circle is halved in area) on reaction time (RT), movement time (MT), error rate, and the subjective perception of workload. Data from the experiment indicated systematic effects for task-related factors across performance and workload measures. Path length and shrink rate had differential effects on both RT and MT, which were also reflected in the components of the individual workload scales. The results support a general form of the workload model which may help researchers and practitioners in the difficult task of workload prediction.

Adult↗

PubMed2006

Does the attention General Practitioners pay to their patients' mental health problems add to their workload? A cross sectional national survey.

BACKGROUND: The extra workload induced by patients with mental health problems may sometimes cause GPs to be reluctant to become involved in mental health care. It is known that dealing with patients' mental health problems is more time consuming in specific situations such as in consultations. But it is unclear if GPs who are more often involved in patients' mental health problems, have a higher workload than other GPs. Therefore we investigated the following: Is the attention GPs pay to their patients' mental health problems related to their subjective and objective workload? METHODS: Secondary analyses were made using data from the Second Dutch National Survey of General Practice, a cross sectional study conducted in the Netherlands in 2000-2002. A nationally representative selection of 195 GPs from 104 general practices participated in this National Survey. Data from: 1) a GP questionnaire; 2) a detailed log of the GP's time use during a week and; 3) an electronic medical registration system, including all patients' contacts during a year, were used. Multiple regression analyses were conducted with the GP's workload as an outcome measure, and the GP's attention for mental health problems as a predictor. GP, patient, and practice characteristics were included in analyses as potential confounders. RESULTS: Results show that GPs with a broader perception of their role towards mental health care do not have more working hours or patient contacts than GPs with a more limited perception of their role. Neither are they more exhausted or dissatisfied with the available time. Also the number of patient contacts in which a psychological or social diagnosis is made is not related to the GP's objective or subjective workload. CONCLUSION: The GP's attention for a patient's mental health problems is not related to their workload. The GP's extra workload when dealing in a consultation with patients' mental health problems, as is demonstrated in earlier research, is not automatically translated into a higher overall workload. This study does not confirm GPs' complaints that mental health care is one of the components of their job that consumes a lot of their time and energy. Several explanations for these results are discussed.

Adult↗

PubMed2006

Correlation of workload with disagreement and amendment rates in surgical pathology and nongynecologic cytology.

In gynecologic cytology, workload limits are imposed as a surrogate to limit error rates. Whether workload correlates with error rates in surgical pathology and nongynecologic cytology is not known. We reviewed and compared the disagreement and amendment rates based on blinded review for 5 pathologists with the number of cases reviewed during that same period. A total of 2,659 general surgical pathology and nongynecologic cytology cases underwent blinded review. There were 105 disagreements identified and 28 amendments issued. Workload varied from 455 to 649 cases per month. Neither the disagreement nor the amendment rate correlated with total workload during the period of the study (Pearson rank correlation r = 0.58 and 0.12, respectively). There is no correlation between workload and disagreement or amendment rates. Workload seems to be a poor surrogate for error rates in the range of workload examined in this study. Such data suggest that workload limits would have no effect at limiting or reducing error rates in surgical pathology or nongynecologic cytology.

Cytodiagnosis↗

PubMed2005

Task workload and cognitive abilities in dynamic decision making.

Researchers often treat workload as a task-dependent variable. To evaluate the effect of workload on individuals' performance, researchers commonly use several methods, such as varying the complexity or number of tasks that test participants are asked to handle or placing individuals under time constraints. Only rarely have researchers investigated workload as a variable dependent on individuals' cognitive abilities. This study investigated workload during dynamic decision making in terms of its dependence on both task workload and cognitive abilities. The findings demonstrate detrimental effects of both high task workload and low cognitive abilities. Further, the results show that high workload is more detrimental in individuals with low cognitive abilities than in individuals with high cognitive abilities. Potential applications of this research include the design of new workload studies and new training protocols in which psychometric tests are used.

Adaptation, Psychological↗

PubMed1999

Effects of cueing and knowledge of results on workload and boredom in sustained attention.

Two models of recently reported high workload associated with vigilance tasks are the direct-cost and indirect-cost views. The former attributes high workload to the need for continuous observation in discriminating signals from neutral events; the latter attributes it to efforts to combat the boredom associated with monotonous vigilance tasks. These opposing views were tested by providing observers with reliable cueing, which rendered observation necessary only when low-probability critical signals were imminent, or with knowledge of results (KR) regarding performance efficiency. On the basis of cue and KR differences in elicited observation activity and motivational value, the direct-cost model led to the anticipation that cueing would result in a high-boredom, low-workload profile and a greater reduction in workload than KR. The indirect-cost model led to the prediction that cueing would result in a high-boredom, high-workload profile and a lesser reduction in workload than KR. The results clearly supported the direct-cost view that the workload of vigilance is task-induced. Consequently, efforts to combat high workload in complex automated systems requiring substantial monitoring by operators should focus specifically upon task-related determinants.

Acoustic Stimulation↗

PubMed2000

[The cervico-vaginal cytology workload. A complex task in planning laboratory activities].

Measurement of professional work efforts are desired by health care administrators as a means of comparing the efficiency of the laboratory activities in an attempt to predict proper staffing levels and funding. In view of the complexity of measuring pathology workload, it is not surprising that the evaluation of this effort has never been adequately quantitated and that, as a consequence, literature data are scant. We reviewed all available information on cervical cytology workload. Most data refer to cytoscreener workload while very few indications concerning the cytopathologist's performance can be obtained. The vast majority of reported figures derive from the English literature and show extreme variability: for cytoscreener/cytotechnologist, the workload figures are between 3,000-15,000/year, 40-150/day and 3-20/hour. In addition, data are scarcely comparable since the true "object" of the workload measurement is not always evident: just Pap-test microscopic screening or pre- and post-analytical procedures too? In the Italian milieu , a reasonable cytoscreener workload would range from 6 slide/hour (i.e. 45-50/day or 10,000/year) if the duty is limited to the screen only, to 4 slide/hour (i.e. 30-35/day or 7,000/year) for people involved in slide preparation or ancillary duties. For both events, upper and lower workload limits are suggested. We conclude that professional attention must be given to determine appropriate workloads in order to minimize suboptimal performance and improve the cost-effectiveness of laboratory activities.

Clinical Laboratory Techniques↗

PubMed2000

Variations in GP nursing home patient workload: results of a multivariate analysis.

The number of old people living in UK nursing homes has increased substantially over the past 15 y. There is evidence that such patients generate larger workloads for primary carers than do those of similar age and sex living in their own homes. Clearly, any extra workload involved in providing primary care services to nursing home patients, needs to be reflected in the resources afforded general practitioners (GPs) who are tasked with its provision. By the same token variations in workloads between patients need to be examined and explained for any insights these might provide on funding issues. To examine and explain variations in GP workload associated with nursing home patients and determine the implications of these for GP funding, a 12 month case control study of all nursing home residents over 65 y old registered with nine general practices was undertaken. A multivariate regression analysis was used to examine variations in GP workload associated with 270 nursing home patients. Multivariate regression models explaining the variation in workload cost per month in terms of the GP practice delivering care and patients age and sex had little explanatory power (R(2)=0.07). A fuller method including the patient's Barthel score and initial diagnosis as additional explanatory variables added little to the explanatory power of the model (R(2)=0.12). The ability of the multivariate models used here to explain the variation in GP workload was poor. GPs may require an allowance to compensate for differences in workload associated with nursing home patients but adjusting these payments for differences in age, sex, initial diagnosis or the other variables included in this analysis would not appear to be supported.

Aged↗

PubMed1992

[Effect of workload on physicians' drug prescribing].

The possible effect of workload on the prescribing of drugs by physicians was studied in 10 primary care pediatricians during a 1-month period. The intraphysician variability revealed a positive correlation (p less than 0.05) between workload and prescription of antibiotics in the case of 2 of the physicians and a negative correlation (p less than 0.05) between workload and prescription of all drug items in another physician. The prescribing of the other 7 was not affected by changes in daily workload. The interphysician variability study revealed a significantly increased rate of prescription of analgesics/antipyretics by physicians with increased monthly workload (r = 0.91, p less than 0.001). These results suggest that although the prescribing habits of a minority of physicians may be affected by their workloads, prescription rates remain stable for the individual physician on most occasions. However, physicians with high workloads tend to prescribe more analgesics/antipyretics than those with low workloads.

Analgesics↗

PubMed1993

An audit of the surgical workload on a renal unit.

OBJECTIVE: To assess the surgical workload on a renal unit, with particular reference to non-transplant-related surgery and to assess the workload in relation to surgical staffing levels. DESIGN: Prospective audit of all surgical procedures carried out on patients in acute or chronic renal failure, and on transplanted patients, within a one year period. SETTING: A purpose-built renal unit serving a population of 1.7 million. MAIN OUTCOME MEASURES: The number of surgical procedures, both transplant and non-transplant-related, according to type and severity, with particular reference to the levels of surgical staffing. RESULTS: Transplant-related surgery accounted for only 6.5 per cent of the total surgical workload (general, vascular and renal) of the 'transplant surgeons'. Taking into account only the renal-related workload, transplant-related surgery accounted for just 16.5 per cent of the workload, the remainder being related to vascular access and peritoneal access for dialysis, and general surgical procedures on patients in renal failure and transplanted patients. The surgical workload undertaken by a relatively small number of staff was high, representing 531 Intermediate Equivalents per Service Equivalent Value per annum. CONCLUSIONS: When assessing workload and adequacy of surgical staffing on a Renal Unit, care should be taken to account for all surgical activity on renal patients and not just that related to transplantation since only 16.5 per cent of the surgical workload is transplant-related.

Acute Kidney Injury↗

PubMed1998

Increased general practice workload due to a primary care led National Health Service: the need for evidence to support rhetoric.

Recent policy initiatives have focused on shifts in the balance of care from secondary care to primary care. A consequence of such shifts is increased workload in primary care. The aim of this paper is to appraise the literature critically to assess whether changes in the balance of care have led to additional work for general practices. In particular, the implications of this literature for the measurement of workload in general practice are highlighted. After an extensive, systematic literature search, only 12 studies that met the review criteria were identified. Although the studies pointed to negligible effects on the number of general practitioner (GP) visits, they failed to capture the many other attributes of a practice's work that are likely to be influenced by a shift in the balance of care. These include both qualitative (e.g. stress and mental effort) and quantitative (i.e. the use of resources in the practice, such as GPs, nurses and other staff's time and administration) measures of workload. The studies may therefore have under-estimated the effect on practice workload. To identify correctly the impact on workload of shifts in the balance of care, studies evaluating shifts need to improve their measurement of general practice workload. Furthermore, an extended definition of workload needs to be developed and tested, and workload monitored over time.

Family Practice↗

PubMedDate not supplied

The development of a Canadian hospital pharmacy workload measurement system.

The aim of the proposed study is to establish a national workload measurement system for hospital pharmacy in Canada. No reliable method presently exists to determine staffing requirements for hospital pharmacy. In order to establish staffing guidelines, a method of scientifically assessing and measuring hospital pharmacy workloads is needed. It is proposed to develop worlkload measurement data for hospital pharmacy according to the Canadian Workload Recording Method of Statistics Canada. The Canadian Workload Recording Method was developed to provide a scientific basis for measuring clinical laboratory workload, thus promoting effective laboratory management. This method is now being applied to other health professions. Data for hospital pharmacy will be collected from various hospital pharmacy departments across Canada based on standardized definitions of modern hospital pharmacy practice. The proposed study will be carried out over a period of two years by a research group located at the College of Pharmacy, University of Saskatchewan, Saskatoon, in cooperation with the Canadian Society of Hospital Pharmacists. Workload measurement data of pharmacy services in Canadian hospitals will serve as a valuable management tool for hospital pharmacy directors, hospital administrators and federal-provincial funding agencies in the determination of total manpower needs and resources for hospital pharmacy. Also, information obtained will be of administrative assistance in the areas of: (a) development of standardized methods of recording hospital pharmacy management information; (b) generation of valid and reliable data to allow comparative studies of hospital pharmacy departments in terms of productivity and utilization of manpower; (c) determination of the proper staffing ratio between pharmacists and supportive personnel; and (d) development of short and long-term planning goals for the hospital pharmacy department. The Canadian Workload Recording Method was designed to reflect current practice by a system of continuous monitoring and review by the user. As new pharmaceutical services develop, additional workload studies can be conducted to establish new standards demonstrating the impact of future programs on manpower requirements.

Canada↗

PubMed1988

Workload and student course ratings in dental school.

Many faculty members express concern that the workload or difficulty of a course influences student ratings of the course. Research conducted in this area, however, shows that greater workloads are associated with higher course ratings and the workload/difficulty dimension of teaching does not seem to constitute a bias in student ratings. This study examined the extent to which workload was related to dental student course ratings. Over a three-year period, student course ratings were collected in 191 didactic courses. Based on student ratings of comparative workload, these courses were categorized as having high, medium, or low workloads. Courses with low workloads received significantly higher ratings from students for 11 of the 13 rating items. In contrast to previous research at the undergraduate level, student ratings in the dental school were significantly affected by the workload of a course. In the dental school setting, therefore, workload may serve as a biasing factor of student ratings. These findings have implications for providing rating feedback to course directors, administrators, and curriculum committees.

Attitude↗