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PubMed2001

The use of the Australian Basic Treatment Equivalent (BTE) workload measure for linear accelerators in Canada.

The Inter Society of Radiation Oncologists of North America (ISRON) workload standard for linear accelerators is the one most widely used; it regards the treatment of 250 or more patients per year as an acceptable limit. Nevertheless, there is concern that this standard does not represent the current workload of linear accelerators, given that the complexity of techniques and equipment has increased significantly since the ISRON model was developed in the late 1980s. Delaney et al. recently validated a workload indicator for Australian (AUS) centres, known as the basic treatment equivalent (BTE). They showed that this was a better predictor of workload and that there was less variation between centres using this model than there would have been by using fields/hour. This centre attempted to validate this model for use in a Canadian centre, by collecting treatment data on all linear accelerator-treated patients during February 1998. The linear accelerators at this centre delivered 2,295 fractions (6,928 fields) in 662 hours during February 1998. When 15 minutes was used as a denominator, the BTE model functioned as a better workload indicator than simple measures such as fields/hour. It also had better performance in reducing variability between machines. A BTE of 3,403 was calculated for these machines. The mean value for fields/hour, BTE/hour and BTE/fraction for this centre fell within the range of values quoted by AUS centres. The BTE/fraction value for this centre was relatively high compared with the AUS mean, indicating this centre's reliance on the use of a high number of complex techniques. We recommend that the model should be further refined for the Canadian context by developing BTE values with the use of local time and motion studies, including factors such as multileaf collimators and enhanced dynamic wedges.

Australia↗
PubMed2002

Effect of varying levels of mental workload on startle eyeblink modulation.

Previous research using punctuate reaction time and counting tasks has found that the startle eyeblink reflex is sensitive to attentional demands. The present experiment explored whether startle eyeblink is also modulated during a complex continuous task and is sensitive to different levels of mental workload. Participants (N = 14) performed a visual horizontal tracking task either alone (single-task condition) or in combination with a visual gauge monitoring task (multiple-task condition) for three minutes. On some task trials, the startle eyeblink reflex was elicited by a noise burst. Results showed that startle eyeblink was attenuated during both tasks and that the attenuation was greater during the multiple-task condition than during the single-task condition. Subjective ratings, endogenous eyeblink rate, heart period, and heart period variability provided convergent validity of the workload manipulations. The findings suggest that the startle eyeblink is sensitive to the workload demands associated with a continuous visual task. The application of startle eyeblink modulation as a workload metric and the possibility that it may be diagnostic of workload demands in different stimulus modalities is discussed.

Adult↗
PubMed2002

Age differences in perceived workload across a short vigil.

The main objective of this research was to investigate age differences in the perceived workload associated with the performance of a demanding, high event rate, vigilance task. Younger participants (n=26) aged 16 to 35 years (M=27.8) and older participants (n=24) aged 45 to 65 years (M=52.2) completed perceived workload scales (NASA-TLX) following a brief practice session (pretest) on the vigilance task, and then again following a test session (posttest) lasting nine minutes. In relation to the vigilance task, a statistically significant performance decrement was identified, but there was no evidence that performance differed according to age in respect to that decrement. However, a dissociation was found in relation to the perceived workload ratings: while no age differences were found in vigilance performance, the workload ratings revealed older participants to perceive a significantly greater increase in workload from pretest to posttest. These findings are considered theoretically in relation to the demands placed upon attentional resources, and their implications for both laboratory-based vigilance research, and workplace systems monitoring situations, are discussed.

Adolescent↗
PubMed1993

Heart rate and workload variations in actual and simulated flight.

The monitoring of heart rate in aviation research provides a global index of pilot workload. Heart rate variability is a promising measure but more complex to assess and therefore less often used, especially in dynamic task environments. The application of spectral analysis techniques of heart rate for workload assessment in aviation is illustrated and discussed. Ideally, workload assessment includes real-time or continuous measures to reveal variations in workload as pilots accomplish their tasks. Four studies are discussed that used heart rate measures for the assessment of: (1) training effectiveness; (2) stress of flight instruction; (3) simulator realism; and (4) flight task difficulty. Results indicate that cardiovascular measures are well suited to index different mental states of pilots as well as their dynamic responses to variations in workload.

Adult↗
PubMed2004

Fast-tracking (bypassing the PACU) does not reduce nursing workload after ambulatory surgery.

BACKGROUND: Postoperative day-case patients are usually allowed to recover from anaesthesia in a postanaesthesia care unit (PACU) before transfer back to the day surgical unit (DSU). Bypassing the PACU can decrease recovery time after day surgery. Cost savings may result from a reduced nursing workload associated with the decreased recovery time. This study was designed to evaluate the effects of bypassing the PACU on patient recovery time and nursing workload and costs. METHODS: Two hundred and seven consenting outpatients undergoing day surgery procedures were enrolled. Anaesthesia was induced and maintained with a standardized technique and the electroencephalographic bispectral index was monitored and maintained at 40-60 during anaesthetic maintenance. At the end of surgery, patients were randomly assigned to either a routine or fast-tracking (FT) group. Patients in the FT group were transferred from the operating room to the DSU (i.e. bypassing the PACU) if they achieved the FT criteria. All other patients were transferred to the PACU and then to the DSU. Nursing workload was evaluated using a patient care hour chart based on the type and frequency of nursing interventions in the PACU and DSU. A cost associated with the nursing workload was calculated. RESULTS: The overall time from end of anaesthesia to discharge home was significantly decreased in the fast-tracking group. However, overall patient care hours and costs were similar in the two recovery groups. CONCLUSION: Bypassing the PACU after these short outpatient procedures significantly decreases recovery time without compromising patient satisfaction. However, the overall nursing workload and the associated cost were not significantly affected.

Adolescent↗
PubMed1999

Nursing workload associated with adverse events in the postanesthesia care unit.

BACKGROUND: The authors used a nursing task inventory system to assess nursing resources for patients with and without adverse postoperative events in the postanesthesia care unit (PACU). METHODS: Over 3 months, 2,031 patients were observed, and each task/activity related to direct patient care was recorded and assigned points according to the Project Research in Nursing (PRN) workload system. PRN values for each patient were merged with data from an anesthesia database containing demographics, anesthesia technique, and postoperative adverse events. Mean and median PRN points were determined by age, sex, duration of procedure, and mode of anesthesia for patients with and without adverse events in the PACU. Three theoretical models were developed to determine the effect of differing rates of adverse events on the requirements for nurses in the PACU. RESULTS: The median workload (PRN points) per patient was 31.0 (25th-75th percentile, 25-46). Median workload was 26 points for patients with no postoperative events and 155 for > or = six adverse events. Workload varied by type of postoperative event (e.g., unanticipated admission to the intensive care unit, median workload = 95; critical respiratory event = 54; and nausea/vomiting = 33). Monitored anesthesia care or general anesthesia with spontaneous ventilation used less resources compared with general anesthesia with mechanical ventilation. Modeling various scenarios (controlling for types of patients) showed that adverse events increased the number of nursing personnel required in the PACU. CONCLUSIONS: Nursing care documentation based on requirements for individual patients demonstrates that the rate of postoperative adverse events affects the amount of nursing resources needed in the PACU.

Adult↗
PubMed1998

Psychosocial job factors, physical workload, and incidence of work-related spinal injury: a 5-year prospective study of urban transit operators.

STUDY DESIGN: Five-year prospective cohort study of 1449 transit operators. OBJECTIVES: To investigate psychosocial job factors as predictors of work-related spinal injuries, controlling for current and past physical workload. SUMMARY OF BACKGROUND DATA: The association between psychosocial job factors and spinal disorders may be confounded by physical workload. A 1991 prospective study of Boeing workers found psychosocial but not physical factors to be associated with spinal injuries. However, data on physical workload were limited. Recent cross-sectional studies of transit drivers showed both physical and psychosocial factors to be independently associated with back and neck pain. This study was designed to test these findings prospectively. METHODS: Spinal injuries were ascertained from workers' compensation records, employment history from company records, and psychosocial factors from questionnaires. Logistic regression models adjusted for age, gender, height, weight, vehicle type, and current and past physical workload. RESULTS: During follow-up, 320 drivers reported a first spinal injury. Spinal injury was predicted by psychological job demands (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.33-1.95); job dissatisfaction (OR, 1.56; 95% CI, 1.09-2.23); and the frequency of job problems (OR, 1.52; 95% CI, 1.02-2.26). Marginally significant associations were found for low supervisor support (OR, 1.30; 95% CI, 0.99-1.72) and female gender (OR, 1.49; 95% CI, 0.95-2.32). Compared with full-time work, part-time work was associated with a 2.7-fold reduced risk for spinal injury (OR, 0.37; 95% CI, 0.15-0.93). Cable car crews performing the heaviest physical labor had a threefold increased risk of spinal injury compared with bus drivers (OR, 3.04; 95% CI, 1.85-5.00). CONCLUSIONS: Physical workload and psychosocial job factors both independently predict spinal injury in transit vehicle operators.

Accidents, Occupational↗
PubMed1997

What will a primary care led NHS mean for GP workload? The problem of the lack of an evidence base.

Ongoing negotiations on the general practitioner contract raise the question of remunerating general practitioners for increased workload resulting from the shift from secondary to primary care. A review of the literature shows that there is little evidence on whether a shift of services from secondary to primary care is responsible for general practitioners' increased workload, and scope for making generalisations is limited. The implication is that general practitioners have little more than anecdotal evidence to support their claims of greatly increased workloads, and there is insufficient evidence to make informed decisions about remunerating general practitioners for the extra work resulting from the changes. Lack of evidence does not, however, mean that there is no problem with workload. It will be increasingly important to identify mechanisms for ensuring that resources follow workload.

Family Practice↗
PubMed2002

Morale among general practitioners: qualitative study exploring relations between partnership arrangements, personal style, and workload.

OBJECTIVES: To explore general practitioners' experiences of wellbeing and distress at work, to identify their perceptions of the causes of and solutions to distress, and to draw out implications for improving morale in general practice. DESIGN: Three stage qualitative study consisting of one to one unstructured interviews, one to one guided interviews, and focus groups. SETTING: Fife, Lothian, and the Borders, South East Scotland. PARTICIPANTS: 63 general practitioner principals. RESULTS: Morale of general practitioners was explained by the complex interrelations between factors. Three key factors were identified: workload, personal style, and practice arrangements. Workload was commonly identified as a cause of low morale, but partnership arrangements were also a key mediating variable between increasing workload and external changes in general practice on the one hand and individual responses to these changes on the other. Integrated interventions at personal, partnership, and practice levels were seen to make considerable contributions to improving morale. Effective partnerships helped individuals to manage workload, but increasing workload was also seen to take away time and opportunities for practices to manage change and to build supportive and effective working environments. CONCLUSIONS: Solutions to the problem of low morale need integrated initiatives at individual, partnership, practice, and policy levels. Improving partnership arrangements is a key intervention, and rigorous action research is needed to evaluate different approaches.

Attitude of Health Personnel↗
PubMed2004

Impact of nurse practitioners on workload of general practitioners: randomised controlled trial.

OBJECTIVE: To examine the impact on general practitioners' workload of adding nurse practitioners to the general practice team. DESIGN: Randomised controlled trial with measurements before and after the introduction of nurse practitioners. SETTING: 34 general practices in a southern region of the Netherlands. PARTICIPANTS: 48 general practitioners. INTERVENTION: Five nurses were randomly allocated to general practitioners to undertake specific elements of care according to agreed guidelines. The control group received no nurse. MAIN OUTCOME MEASURES: Objective workload, derived from 28 day diaries, included the number of contacts per day for each of three conditions (chronic obstructive pulmonary disease or asthma, dementia, cancer), by type of consultation (in practice, telephone, home visit), and by time of day (surgery hours, out of hours). Subjective workload was measured by using a validated questionnaire. Outcomes were measured six months before and 18 months after the intervention. RESULTS: The number of contacts during surgery hours increased in the intervention group compared with the control group (P < 0.06), particularly for patients with chronic obstructive pulmonary disease or asthma (P < 0.01). The number of consultations out of hours declined slightly in the intervention group compared with the control group, but this difference did not reach significance. No significant changes became apparent in subjective workload. CONCLUSION: Adding nurse practitioners to general practice teams did not reduce the workload of general practitioners, at least in the short term. This implies that nurse practitioners are used as supplements, rather than substitutes, for care given by general practitioners.

Family Practice↗
PubMed2001

Workload, organisation, and cost of haematology laboratory out of hours services.

BACKGROUND: The cost of out of hours services makes up a considerable proportion of the total laboratory budget and this has encouraged haematologists to examine workload patterns and the organisation and cost of out of hours services. AIM: To review current levels of out of hours workload and examine the organisation and cost of the service in the South Thames region. METHOD: Data collection was by questionnaire and data analysis by Microsoft Excel. RESULTS: A variety of methods of organising and financing out of hours services were identified. There was a large variation in workload between different centres. There has been a rise in total workload and out of hours workload over a three year period. The most common tests to take place outside routine hours are full blood counts and clotting screens. The method of providing out of hours services did not affect total numbers of out of hours tests. There were considerable costs associated with time off in lieu for on call staff. CONCLUSIONS: The variation and increase in out of hours tests is not related to the way that out of hours services are provided, but is more likely to result from changes in medical practice. There are pronounced differences between centres in the numbers of different types of tests performed out of hours, which are not related to the numbers of acute beds. There is no single model of out of hours service provision that suits all situations.

Cost-Benefit Analysis↗
PubMed1994

P300 as a measure of workload during a simulated aircraft landing task.

The P300 component of the event-related brain potential was assessed as a measure of mental workload using 12 subjects who flew simulated visual flight rules final approaches and landings under workloads varied by manipulating turbulence and hypoxia. P300 was elicited with auditory and visual "oddball" subsidiary tasks requiring the detection of infrequent tones or flashes of an artificial horizon. The results showed that root mean square error flying performance was systematically degraded by both workload manipulations. P300 amplitude exhibited a complex pattern that was not strongly related to performance. By contrast P300 latency covaried closely with performance, increasing as a function of workload in both modalities. These results suggest that P300 latency indexes the slowing of perceptual/cognitive processing caused by workload and that this measure is sensitive to an important aspect of flying.

Adult↗
PubMed2006

Relationship between resident workload and self-perceived learning on inpatient medicine wards: a longitudinal study.

BACKGROUND: Despite recent residency workload and hour limitations, little research on the relationship between workload and learning has been done. We sought to define residents' perceptions of the optimal patient workload for learning, and to determine how certain variables contribute to those perceptions. Our hypothesis was that the relationship between perceived workload and learning has a maximum point (forming a parabolic curve): that either too many or too few patients results in sub-optimal learning. METHODS: Residents on inpatient services at two academic teaching hospitals reported their team and individual patient censuses, and rated their perception of their learning; the patient acuity; case variety; and how challenged they felt. To estimate maximum learning scores, linear regression models with quadratic terms were fit on learning score. RESULTS: Resident self-perceived learning correlated with higher acuity and greater heterogeneity of case variety. The equation of census versus learning score, adjusted for perception of acuity and case mix scores, showed a parabolic curve in some cases but not in others. CONCLUSION: These data suggest that perceived resident workload is complex, and impacted by additional variables including patient acuity and heterogeneity of case variety. Parabolic curves exist for interns with regard to overall census and for senior residents with regard to new admissions on long call days.

Acute Disease↗
PubMed2002

Recent trends in workload, input costs, and expenditures in the Air Force Medical Service Direct Care System.

A study was conducted to examine the relationship between two types of trends in the Air Force Medical Service Direct Care System (AFMS/DCS): trends in expenditures, total and by categories; and trends in medical workload, defined as the sum of inpatient admissions and outpatient clinic visits. Expenditure and medical workload data were extracted from the Medical Expense and Performance Reporting System Executive Query System. Medical inflation data were obtained from the Bureau of Labor Statistics Producer Price Index series. Between fiscal years 1995 and 1999, the AFMS/DCS experienced a 21.2% decrease in medical workload, but total (nominal) expenditures declined only 3.6%. Of all expenditure categories, only inpatient medical care, outpatient medical care, and military-funded private sector care for active duty personnel (supplemental care) have any direct relationship with AFMS/DCS medical workload. Real expenditures for the three categories above decreased by 20.3% during the 5-year period. Accounting for inflation and considering only expenditures related to medical workload, these results suggest that the AFMS/DCS is spending approximately 20% less money to do approximately 20% less work.

Aerospace Medicine↗
PubMed2002

[The association between physical workload and low back pain clouded by the "healthy worker" effect].

INTRODUCTION: Both physical and psychosocial workplace factors are considered risk factors for low back pain (LBP). However, today, no consensus has been reached regarding the exact role of these factors in the genesis of LBP. MATERIAL AND METHODS: Questionnaire data were collected at baseline for 1,397 (and after five years for 1,163) men and women aged 31-50 years at baseline. LBP (any LBP within the past year; LBP < or = 30 days in total during the past year; LBP > 30 days in total during tha past year) was analysed 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 af workers changing between the workload groups over the five-year period were analysed in relation to LBP status. RESULTS: A baseline no statistically significant differences in LBP outcomes were found for workers exposed to sedentary, light physical, or heavy physical work. This was true for both genders and all age and social groups. At follow-up these was a statistically significant dose-response association between any LBP and long-standing LBP during the past year and increasing physical workload at baseline, also after controlling for age, gender and social group. Subjects with a heavy physical workload at baseline changed significantly more often to sedentary work, if they had experienced LBP for more than 30 days out of the past year. DISCUSSION: Having a sedentary job might have a protective or neutral effect in relation to LBP, whereas having a heavy physical job constitutes a significant risk factor. Because og migration between exposure groups (the "healthy worker" effect), longitudinal studies are necessary for investigating the associations between physical workload and LBP.

Adult↗
PubMed2003

Inflight workload assessment: comparison of subjective and physiological measurements.

INTRODUCTION: Assessment of pilot workload during flight is an important aviation safety consideration. The aim of this study was to assess inflight pilot workload using both physiological and multidimensional subjective-ratings measurements (heart rate and NASA Task Load Index, respectively), comparing relative sensitivity during the four phases of flight: take-off, cruise, approach, and landing. METHODS: Ten male pilots volunteered to participate in the trials, which took place in a Boeing 747-400 flight simulator. Electrocardiography was performed throughout the test using the portable Cardiovis ECG system. Mean heart rate (HR) and incremental heart rate (delta HR) were considered indices of physiological workload. RESULTS: Peak HR was observed during take-off (83.2 bpm) and landing (88.6 bpm); moreover, delta HR was also greatest (14.2 bpm and 18.8 bpm). The Task Load Index (TLX) scale revealed that mental and performance demands were essential components of workload during flight. In addition, temporal demand was an important component of workload during take-off and physical demand was significant during cruise. Analysis of correlation revealed that the delta HR is significantly related to TLX scores (r = 0.81, n = 40). CONCLUSIONS: Management of the individual sources of stress, which tend to become predominant during different flight phases, should be emphasized in periodic recurrent training. For example, a pilot must be trained to cope with the increased temporal stresses associated with take-off. In addition, the recommendations will be concerned with maintaining vigilance, task allocation between pilots, and inflight rest during long-haul cruise.

Adult↗
PubMed2004

Mental workload in air traffic control: an index constructed from field tests.

BACKGROUND: Mental workload assessment is a recurrent issue in air traffic control (ATC). Studies of ATC have used either objective aspects, i.e., numbers and distribution of aircraft, or subjective factors, such as self-imposed performance and stress levels, with mixed results. This is partly due to the difficulty in bringing together comparable data pertaining to both air traffic, with its ever-changing distribution, and judgement or quickly fluctuating psychophysiological variables. METHODS: We propose a method of mental load estimation devised to take into account both objective traffic variables and the additional load imposed by subjective effects, including the seriousness of conflicts and the time-pressure for their resolution. First, we developed a traffic load index (TLI) to identify time boundaries during which additional load may occur. Then we quantified the additional load according to the air traffic situation. RESULTS: TLI was developed from analysis of 25 h of recordings of radar control sessions involving 25 professional air traffic controllers at a major airport. Results were then compared with a simple objective index (number of aircraft) and subjective workload ratings (NASA-TLX test). The whole population (intersubjects analysis) showed a better correlation between the TLI and the self-rated workload than for the number of aircraft alone. Among the controllers who rated more than one level of workload through the TLX-test, 77.8% showed better correlation between TLI and TLX than between N and TLX (intrasubjects analysis). CONCLUSION: Workload estimation should integrate both objective task variables and subjective evaluations associated with them.

Accidents, Aviation↗
PubMed2004

A simple virtual instrument to monitor surgeons' workload while they perform minimally invasive surgery tasks.

Monitoring the workload of surgeons while they perform minimally invasive surgery (MIS) tasks can help them learn to reduce effort as they improve performance and can help develop better human-technology interfaces for MIS. To monitor workload, we developed a personal computer based virtual instrument (VI) that uses orientation sensors worn on the surgeon's left and right upper arms to measure upper arm flexion, abduction, and outward rotation angles. From these sensors, we compute indices of effort and integrated effort. One effort index is the upper arm elevation angle. The time integral of this index provides a corresponding integrated effort index. A second effort index is hand velocity. Hand trajectory length is the corresponding integrated effort index. We used the workload monitor VI to study 29 volunteer surgeon subjects while they performed a knot-tying task in a laparoscopic trainer at a standard MIS station. For five of these subjects, we also monitored the workload indices while they performed simulated MIS tasks on a virtual reality Procedicus MIST System. For the subject group, integrated effort, but not level of effort, decreased with increased performance. At each performance level, some subjects worked much harder than others, suggesting that these subjects could benefit by learning to reduce their effort levels. The workload measures from the arm sensors augmented the performance measures provided by the MIST system.

General Surgery↗