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PubMed2001

Potential impact of magnetic resonance cholangiopancreatography on endoscopic retrograde cholangiopancreatography workload and complication rate in patients referred because of abdominal pain.

BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) has a significant mortality, morbidity, and failed cannulation rate. Magnetic resonance cholangiopancreatography (MRCP) is a safer, noninvasive method of imaging the pancreaticobiliary tree. A substantial number of patients are referred for ERCP because of abdominal pain, a high proportion of whom have normal ducts or pathology not requiring interventional ERCP. The aim was to assess the potential impact of MRCP on overall ERCP workload and patient outcome if MRCP were the primary investigation in patients referred for ERCP because of abdominal pain. PATIENTS AND METHODS: 1758 consecutive ERCPs performed in 1148 patients over a 3-year period in a single tertiary referral center in the pre-MRCP era were reviewed. Cannulation failure, ERCP findings, need for follow-up ERCP and all 30-day major complication rates were analyzed with regard to clinical indications. RESULTS: The overall workload comprised 1108 (63 %) successful initial ERCPs, 188 (11 %) failed cannulation attempts and 462 (26 %) follow-up ERCPs. Of the patients, 299 (27 %) had normal ERCP findings, 331 (30 %) had choledocholithiasis and 246 (22 %) had strictures. lf MRCP had been used as the primary imaging investigation in the 451 patients (39 %) referred for ERCP because of abdominal pain, we estimate that 197 patients (44 %) would have avoided ERCP, and the overall ERCP workload would have been reduced by 13 %. Initial MRCP in suspected gallstone pancreatitis and certain miscellaneous groups, it was estimated, would have further decreased ERCP workload by 9 %. Four of 40 major ERCP-related complications (3.5 %) and one of four ERCP-related deaths (0.35 %) would potentially have been avoided. CONCLUSIONS: Initial MRCP in patients referred with abdominal pain would potentially have avoided ERCP in 44 % of cases, reduced ERCP workload by 13 % and significantly reduced patient morbidity and mortality. The relatively small reduction in ERCP workload among these patients reflects the fact that over half of them had probable sphincter dysfunction, a significant proportion of whom might have benefited from biliary manometry and/or endoscopic intervention despite a normal MRCP. Furthermore, a small number of patients with calculi and subtle biliary and pancreatic strictures would be missed by this approach.

Abdominal Pain↗
PubMed1994

Mental workload and cognitive task automaticity: an evaluation of subjective and time estimation metrics.

The evaluation of mental workload is becoming increasingly important in system design and analysis. The present study examined the structure and assessment of mental workload in performing decision and monitoring tasks by focusing on two mental workload measurements: subjective assessment and time estimation. The task required the assignment of a series of incoming customers to the shortest of three parallel service lines displayed on a computer monitor. The subject was either in charge of the customer assignment (manual mode) or was monitoring an automated system performing the same task (automatic mode). In both cases, the subjects were required to detect the non-optimal assignments that they or the computer had made. Time pressure was manipulated by the experimenter to create fast and slow conditions. The results revealed a multi-dimensional structure of mental workload and a multi-step process of subjective workload assessment. The results also indicated that subjective workload was more influenced by the subject's participatory mode than by the factor of task speed. The time estimation intervals produced while performing the decision and monitoring tasks had significantly greater length and larger variability than those produced while either performing no other tasks or performing a well practised customer assignment task. This result seemed to indicate that time estimation was sensitive to the presence of perceptual/cognitive demands, but not to response related activities to which behavioural automaticity has developed.

Adult↗
PubMed1996

Diagnosticity and multidimensional subjective workload ratings.

A new multidimensional subjective workload assessment instrument -- Workload Profile -- was introduced and evaluated against two unidimensional instruments -- Bedford and Psychophysical scaling. Subjects performed two laboratory tasks separately (single task) and simultaneously (dual task). The multidimensional procedure compared well with the unidimensional procedures in terms of sensitivity to task demands, concurrent validity with performance, and test-retest reliability. The results suggested that the subjective workload profiles would only have limited predictive value on performance. However, results of the canonical analysis demonstrated that the multidimensional ratings provided diagnostic information on the nature of task demands. Further, the diagnostic information was consistent with the a priori task characterization. This strongly supports the notion that mental workload is multidimensional and that subjects are capable of reporting the demands on separate workload dimensions. Theoretical implications on mental workload models and practical implications on the assessment approaches are discussed.

Adult↗
PubMed1998

Concurrent duration production as a workload measure.

In two experiments the suitability of prospective duration estimation to serve as a secondary task for workload measurement was tested. In the first experiment participants performed either a Stroop task or a card-sorting task with two levels of difficulty. While performing these tasks, participants were also engaged in either a duration-production or a duration-estimation task. Participants in a control group performed the non-temporal tasks without the timing tasks, and rated the level of workload associated with performance of these tasks. It was found that magnitudes of produced durations were highly correlated with subjective workload ratings and with performance indices, without interfering with performance. Similar findings were obtained in a flight simulation conducted by licensed pilots. Again, produced durations were sensitive to concurrent workload levels associated with flight performance and were correlated with subjective ratings of workload obtained by control participants via the Cooper-Harper scale. These findings concur with previous ones reported in the literature. A theoretical basis for these findings is provided and the potential use of concurrent duration production as a measure of workload is discussed.

Adolescent↗
PubMed1999

The effect of mental workload on the visual field size and shape.

Mental workload is known to reduce the area of one's visual field, but little is known about its effects on the shape of the visual field. Considering this, the visual fields of 13 subjects were measured concurrently under three levels of mental workload using a Goldmann visual perimeter. Tone counting tasks were employed to induce mental workload, avoiding interference with visual performance. Various methods of shape measurement and analysis were used to investigate the variation of the shape of the visual field as a function of mental load. As expected, the mean area of visual fields reduced to 92.2% in the medium workload condition and to 86.41% under heavy workload, compared to light load condition. This tunnelling effect was not uniform, but resulted in statistically significant shape distortion as well, as measured by the majority of the 12 shape indices used here. These results have visual performance implications in many tasks that are susceptible to changes in visual fields and peripheral vision. Knowledge of the dynamics of the visual field as a function of mental workload can offer significant advantages also in mathematical modelling of visual search.

Adult↗
PubMed2005

Impact of an electronic chart on the staff workload in a radiation oncology department.

BACKGROUND: In order to improve the efficiency of patient care, we developed an electronic medical record system, named the Comprehensive Radiation Oncology Management System (C-ROMS). C-ROMS was used together with a commercial record-and-verify system, LANTIS (Siemens Medical Systems Inc., Concord, CA, USA). The impact of the C-ROMS/LANTIS system on the staff workload in the Radiation Oncology Department was quantified and evaluated. METHODS: Thirty-four breast cancer patients were divided into two groups based on the method of the charting and the delivery of radiation treatment. The paper chart and manual treatment were used for one group, and the C-ROMS/LANTIS for the other. For each group of patients, the workload per patient for each staff group in the department-nursing/clerical staff, simulation staff, dosimetry/physics staff and technologist staff-was measured and compared. RESULTS: The average total staff workload with the C-ROMS/LANTIS system was 28.2% less than that with the paper chart/manual treatment method. The workloads for nursing/clerical staff, simulation staff and technologist staff were reduced by 85.7, 61.2 and 20.6%, respectively. The workload for dosimetry/physics staff was increased by 28.4%. CONCLUSION: The C-ROMS/LANTIS system significantly decreased the averaged total staff workload, and thus increased the efficiency of patient care.

Cancer Care Facilities↗
PubMed1992

Measuring physician mental workload: reliability and validity assessment of a brief instrument.

This study examined the reliability and validity of a brief six-item instrument to measure the mental workload experienced by residents for specific patient visits to an ambulatory care clinic. Participating in the study were twenty-two residents in postgraduate years 1 through 3 who were working in the general outpatient clinic of an inner city, private, nonprofit community hospital. Cronbach's alpha coefficient for the instrument was 0.80. Findings supported several theory-based hypotheses on determinants and performance consequences of mental workload. Mental workload was positively correlated with fatigue (r = 0.42, P = 0.03) and inversely correlated with residents' self-rated experience with patients' problems (r = -0.65, P less than 0.001). Residents' performance was measured through self-ratings and faculty physicians' ratings. Mental workload was inversely correlated with self-rated performance (r = -0.67, P less than 0.001). The correlation of mental workload with faculty physician ratings that reflected the technical dimension of patient care (physician examination, medications, and procedures) was r = -0.38 (P = 0.04). With mental workload squared, the correlation was r = -0.45 (P = 0.02) and the form of the relationship, consistent with the hypothesis, was a slightly downward sloping curve. Limitations of this research are discussed as well as suggestions for further research.

Adult↗
PubMed1994

Characteristics, workload, and job satisfaction of attending physicians from pediatric emergency medicine fellowship programs. Pediatric Emergency Medicine Collaborative Research Committee.

The purpose of this study was to determine the characteristics of academic Pediatric Emergency Medicine (PEM) faculty, the workload of these physicians, and the perceived effect this workload has had or will have on job satisfaction. A self-administered, seven-page, closed-end survey was used. participants were PEM departments with PEM Fellowship Training Programs. Surveys were completed by 37 PEM departments (84%). The average number of faculty per department was 7.33. Ninety-three percent of the faculty were board certified in Pediatrics, Emergency Medicine, or both. Only 15% of the faculty had an academic rank of associate or full professor. Fifty-four percent of the faculty had less than five years' experience. Average patient census per department was 43,400 per year. Physicians without administrative titles averaged 30 clinician hours per week. Attending physicians covered 85 to 100% of the overnight shifts in 17 programs (52%). Clinical workload was believed to be excessive in 17 programs (46%), with total number of hours given as the most common reason for this excess. In nine of these 17 programs, excess clinical workload had resulted in physician "burnout." Physicians from only eight programs (22%) believed they could practice PEM after 50 years of age. Shift work and overnight shifts were given as the most common reason. Stressed physician groups were significantly associated with programs whose attending physicians covered > or = 85% of the night shifts (P < 0.04) and reported excessive clinical workload (P < 0.002). Job satisfaction perceived by PEM faculty appears to be dependent on addressing the clinical workload and the adverse effects of overnight and shift work.

Burnout, Professional↗
PubMed1997

Physical workload and ergonomic factors associated with prevalence of back and neck pain in urban transit operators.

STUDY DESIGN: Back and neck pain was studied cross-sectionally in 1,449 urban transit drivers by linking medical data, self-reported ergonomic factors, and company records on job history. OBJECTIVES: The goal was to examine the relation between physical workload, ergonomic factors, and the prevalence of back and neck pain. SUMMARY OF BACKGROUND DATA: Researchers, to date, have not found an independent effect of ergonomic factors on back and neck pain while accounting for the effects of past and current physical workload. METHODS: Self-reported ergonomic factors, vehicle type, physical workload (measured as duration of driving), height, weight, age, and gender were analyzed in relation to back and neck pain, using multivariable logistic regression models. RESULTS: Physical workload showed a positive dose-response relation with back and neck pain after controlling for vehicle type, height, weight, age, and gender. The odds ratio for 10 years of driving was 3.43. Additional adjustment for ergonomic factors decreased this odds ratio to 2.55. Six out of seven ergonomic factors were significantly related to the prevalence of back and neck pain after adjustment for age, gender, height, weight, and physical workload. Problems with adjusting the seat had the largest effect (odds ratio = 3.52). Women had back and neck pain twice as frequently as men. CONCLUSION: The results support the hypothesis of a causal role of physical workload for the development of back and neck pain. Ergonomic factors partially mediated the risk of back and neck pain associated with driving, suggesting a potential for prevention of back and neck pain by ergonomic redesign of transit vehicles. Elevated risks for back and neck pain for female drivers were not explained by anthropometric and ergonomic factors.

Adult↗
PubMed2001

The association between physical workload and low back pain clouded by the "healthy worker" effect: population-based cross-sectional and 5-year prospective questionnaire study.

STUDY DESIGN: A population-based cross-sectional and 5-year prospective questionnaire study. OBJECTIVE: To investigate self-reported physical workload as a risk factor for low back pain. SUMMARY OF BACKGROUND DATA: Both physical and psychosocial workplace factors are considered risk factors for low back pain. However, today no consensus has been reached regarding the exact role of these factors in the genesis of low back pain. METHODS: Questionnaire data were collected at baseline for 1397 (and after 5 years for 1163) men and women aged 31--50 years at baseline. Low back pain ("any low back pain within the past year," "low back pain < or = 30 days in total during the past year," "low back pain > 30 days in total during the past year") was analyzed in relation to physical workload (sedentary, light physical, and heavy physical work) using logistic regression and controlling for age, gender, and social group. The proportions of workers changing between the workload groups over the 5-year period were analyzed in relation to low back pain status. RESULTS: At baseline no statistically significant differences in low back pain outcomes were found for workers exposed to sedentary, light physical, or heavy physical work. This was true for all age, gender, and social groups. At follow-up there was a statistically significant dose-response association between any low back pain and longstanding low back pain within the past year and increasing physical workload at baseline also after controlling for age, gender, and social group. Subjects with heavy physical workload at baseline changed statistically significantly more often to sedentary work if they experienced low back pain for more than 30 days out of the past year. CONCLUSIONS: Having a sedentary job might have a protective or neutral effect in relation to low back pain, whereas having a heavy physical job constitutes a significant risk factor. Because of migration between exposure groups (the "healthy-worker" effect), longitudinal studies are necessary for investigating the associations between physical workload and low back pain.

Cross-Sectional Studies↗
PubMed2006

The Warwick system of prospective workload allocation in cellular pathology--an aid to subspecialisation: a comparison with the Royal College of Pathologists' system.

BACKGROUND: Guidelines on staffing and workload for histopathology and cytopathology departments was published by the Royal College of Pathologists (RCPath) in July 2003. In this document, a system is provided whereby the workload of a cellular pathology department and individual pathologists can be assessed with a scoring system based on specialty and complexity of the specimens. A similar, but simplified, system of scoring specimens by specialty was developed in the Warwick District General Hospital. The system was based on the specimen type and suggested clinical diagnosis, so that specimens could be allocated prospectively by the laboratory technical staff to even out workload and support subspecialisation in a department staffed by 4.6 whole-time equivalent consultant pathologists. METHODS: The pathologists were asked to indicate their reporting preferences to determine specialist reporting teams. The workload was allocated according to the "prospective" Warwick system (based on specimen type and suggested clinical diagnosis, not affected by final diagnosis or individual pathologist variation in reference to numbers of blocks, sections and special stains examined) for October 2003. The cumulative Warwick score was compared with the "retrospective" RCPath scoring system for each pathologist and between specialties. Four pathologists recorded their time for cut-up and reporting for the month audited. RESULTS: The equitable distribution of work between pathologists was ensured by the Warwick allocation and workload system, hence facilitating specialist reporting. Less variation was observed in points reported per hour by the Warwick system (6.3 (range 5.5-6.9)) than by the RCPath system (11.5 (range 9.3-15)). CONCLUSIONS: The RCPath system of scoring is inherently complex, is applied retrospectively and is not consistent across subspecialities. The Warwick system is simpler, prospective and can be run by technical staff; it facilitates even workload distribution throughout the day. Subspecialisation within a small-sized or medium-sized department with fair distribution of work between pathologists is also allowed for by this system. Reporting times among pathologists were shown by time and motion studies to be more consistent with Warwick points per hour than with RCPath points per hour.

Cytodiagnosis↗
PubMed2004

Effects of clinical service reorganisation on cellular pathology workload.

AIMS: To assess changes in volume and complexity of cellular pathology workload after clinical service reorganisation and alterations in pathology reporting practices, and to identify objective measures of change applicable to all cellular pathology departments. The ear, nose, and throat (ENT), head and neck (HN) specialty was chosen for assessment. METHODS: Cellular pathology workload from the ENT-HN surgical specialty was assessed numerically and the complexity in examination of cancer resection specimens was evaluated. Medical and technical time inputs in the reporting of ENT-HN cancer resections were measured prospectively, and the histological and cytological workload arising from the management of such cases was obtained. RESULTS: The 88.83% increase in ENT-HN specimens contrasted with a 13.53% increase in total surgical workload. Substantial increases in work complexity were found when measured as blocks/slides for each case and number of histochemical/immunohistochemical requests. On average, examination of one ENT-HN cancer case consumed 55% of one pathologist's work session and over one 10th of a technician's working week. On average, each cancer generated 3.3 histological and 1.06 cytological specimens. CONCLUSIONS: Evidence is provided of the increase in cellular pathology workload and in its complexity. This study lists objective measures of complexity applicable to all pathology subspecialties. Given the workforce crisis and expanding clinical needs, realistic workload calculations should include measurement of complexity and not just volumes.

England↗
PubMed1998

U.S. radiologists' workload in 1995-1996 and trends since 1991-1992.

PURPOSE: To measure U.S. radiologists' workload and the variation and trends in workload. MATERIALS AND METHODS: A stratified, random sample of 794 radiology practice groups were surveyed about hiring and workload in 1996; 78% responded. Responses were weighted to represent all U.S. radiologists. Types of procedures performed in Medicare patients in 1991 and 1995 were analyzed. RESULTS: In 1995-1996, the average workload per full-time equivalent diagnostic radiologist was 11,600 procedures +/- 200 (standard error) annually, an apparent (but not statistically significant) 5% increase from 4 years earlier. Average relative value units per Medicare procedure increased by 8%, due to the increasing role of magnetic resonance imaging, computed tomography, and interventional radiology. The annual average number of procedures varied substantially by group type (e.g., 13,200 procedures +/- 500 in groups of two to four radiologists vs 10,300 +/- 300 in groups of 11 or more radiologists). Within any group type, radiologists at the 75th percentile in terms of workload typically performed at least 50% more procedures than did radiologists at the 25th percentile. CONCLUSION: Given the large variability in the annual number of procedures within and across group types, averages should not be taken as norms. Contrary to concerns about a possible surplus of radiologists, the workload per radiologist has increased substantially in the past few years.

Humans↗
PubMed2000

Radiology groups' workload in relative value units and factors affecting it.

PURPOSE: To measure diagnostic radiology groups' workload in physician work relative value units (RVUs) and identify factors affecting it. MATERIALS AND METHODS: In 1996 and 1997, the authors surveyed diagnostic radiology and radiation oncology groups regarding finances, workload, and basic characteristics. The study was based on approximately 100 diagnostic radiology groups. The authors analyzed the distribution of workload in different categories of groups, conducting multiple statistical analyses. RESULTS: The annual numbers of procedures were approximately 10%-15% lower than those in a comparison survey with a good response rate. The annual number of RVUs per full-time equivalent (FTE) diagnostic radiologist was highly variable in every group category, as was the number of RVUs per clinical work hour. Multivariate regression analysis indicated that variation in the annual number of hours worked did not explain variation in annual workload. RVUs per FTE radiologist were higher the greater the percentage of a group's workload from interventional, computed tomographic, and magnetic resonance imaging procedures. CONCLUSION: Given the likely response bias, the annual workload per FTE radiologist probably averaged approximately 4,000 RVUs in academic groups and approximately 6,000 in nonacademic groups, but the large, unexplained variance means the average values should not be taken as norms.

Analysis of Variance↗
PubMed2004

Data envelopment analysis to determine by how much hospitals can increase elective inpatient surgical workload for each specialty.

We apply data envelopment analysis to discharge data from the 115 hospitals in the rural state of a study hospital to answer three questions. We use a case study to investigate the usefulness and limitations of data envelopment analysis for assessing three common questions regarding hospital market capture for elective inpatient surgery. (i) The hospital studied in this paper performs 40% of the neurosurgery and 25% of the inpatient urology surgery in its state. Workloads are twice that of the hospitals with the next largest workloads. In contrast, the hospital performs 9% of its state's cardiac surgery and has a workload half that of the largest volume hospital. The cardiac surgeons want more operating room time, faster turnovers, and capital investment for minimally invasive equipment. Controlling for the distance patients would need to travel for care, would increasing capacity likely increase cardiac surgery workload? (ii) The study hospital has fewer hospitalizations for thoracic surgery than for any other specialty. Is thoracic surgery inpatient workload of 121 lung resections large or small compared with those of orthopedics' 213 hip replacements, urology's 132 nephrectomies, and cardiac surgery's 304 coronary artery bypass grafts? (iii) The hospital's busiest specialty by discharges is orthopedics. How sensitive is the hospital's orthopedic workload to changes in decision making at nearby competing hospitals?

Craniotomy↗
PubMedDate not supplied

What do nurses mean by workload and work overload?

This paper describes 31 nurses' views of workload and work overload, identifying ten dimensions of workload and four dimensions of work overload. Findings suggest that researchers and nurse administrators do not include all of the dimensions that nurses think of when they use the word "workload". Nurse administrators who listen to nurses' experience of workload may be able to find strategies to help nurses deal with their workload. The theme of lack of control ran through the nurses' accounts of work overload. To retain nurses, employers need to allow nurses some control over their workload and some time to include in their nursing the things they enjoy the most.

Adult↗
PubMed1999

Double trade-off curves with different cognitive processing combinations: testing the cancellation axiom of mental workload measurement theory.

The accomplishment model of average mental workload--a formal axiomatic measurement theory--was used as a basis for developing and testing secondary task indices of mental workload (H. A. Colle & G. B. Reid, 1997). Its cancellation axiom implies global sensitivity, which is an important theoretical and practical criterion for mental workload indices. Performance levels of different secondary tasks were empirically equated in mental workload and then used to test the cancellation axiom. Cognitive processing similarity--including orthographic, phonemic, and semantic processing of pairs of operator and secondary tasks--was manipulated in three experiments. Equivalencies between secondary tasks were independent of secondary-operator task similarity, consistent with the cancellation axiom and the global sensitivity of these secondary tasks. The results suggest that standardized secondary task techniques can be developed for the practical measurement of mental workload. Actual or potential applications of this research include the development of functionally useful and realistic secondary task measures of mental workload.

Humans↗
PubMedDate not supplied

Assessing workload through physiological measurements in bus drivers using an automated system during docking.

The aim of the experiment was to test the effect of an automated system of bus docking on drivers' mental workload. Reduced workload is thought to be brought about by helping the driver to maneuver, as he or she is required only to monitor proper functioning of the system. However, the true impact of the system on drivers must be studied to guarantee good acceptance and minimal distraction from traffic. Workload was estimated by electrodermal activity recording while drivers tested 5 scenarios involving (or not involving) the docking system. Results showed that docking precision was improved when the system was used. When drivers monitored the functioning of the system, their workload was higher than that observed during manual docking; however, reduced workload was evidenced after a learning process. The docking system was also shown to increase workload in the event of dysfunction, especially when drivers had to take over control. Despite this particular situation, and after habituation, such a system could be integrated into buses to improve safety during boarding and egress.

Automation↗