Improving patient care over weekends by reducing on-call work load and better time management.
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ABSTRACT:
SUBMITTER: Gardezi SA
PROVIDER: S-EPMC4645702 | biostudies-literature | 2014
REPOSITORIES: biostudies-literature
Publications
Improving patient care over weekends by reducing on-call work load and better time management.
BMJ quality improvement reports 20140611 1
The Royal College of Physicians states that "handover, particularly of temporary 'on-call' responsibility, has been identified as a point at which errors are likely to occur."[1] Working a weekend on-call covering medical wards is often busy and stressful for all junior doctors. The high volume of routine and unplanned tasks make the situation even worse. In Nevill Hall hospital Abergavenny, we measured the workload on a junior doctor for medical ward cover on weekends by counting the number of ...[more]
Similar Datasets
Project description:At the Northern General Hospital, there are sixteen medical wards, spread over approximately half a mile. Weekend care for inpatients on these wards is provided by a team of four junior doctors, of different levels of training. We undertook a quality improvement project to reduce the amount of time junior doctors spent performing routine tasks at weekends. This may increase their available time for direct patient care. The study was performed over a period of nine weeks on two medical wards - Diabetes & Endocrine (W1) and Care of the Elderly Rehabilitation (W2). We monitored the bleeps received by the covering junior doctors during the weekend daytime shifts from the two study wards. We noted that a proportion of bleeps were routine tasks that could have been performed during weekday working hours. We also noted that W2 recorded fewer bleeps than W1 ward. This seemed to be because W2 batched junior doctors' jobs together. Firstly, we attempted to reduce the amount of routine work left undone each weekend. We provided a poster to remind Junior Doctors to complete such work during the week. Secondly, on W1 we replicated the job-batching system already in place on W2. A Doctors' Book was introduced in which nursing staff recorded the tasks that needed doing. This saved them from having to bleep the doctor repeatedly. The two changes resulted in a reduction in the number of bleeps generated by each ward and the number of visits required by the Junior Doctors to W1. Simple changes can reduce the amount of time junior doctors spend performing routine work at weekends. We implemented two such changes and achieved a reduction in the number of bleeps experienced by junior doctors and the number of times they had to return to one ward.
| S-EPMC4652691 | biostudies-literature
Project description:Work schedules in the service sector are routinely unstable and unpredictable, and this unpredictability may have harmful effects on health and economic insecurity. However, because schedule unpredictability often coincides with low wages and other dimensions of poor job quality, the causal effects of unpredictable work schedules are uncertain. Seattle's Secure Scheduling ordinance, enacted in 2017, mandated greater schedule predictability, providing an opportunity to examine the causal relationship between work scheduling and worker health and economic security. We draw on pre- and postintervention survey data from workers in Seattle and comparison cities to estimate the impacts of this law using a difference-in-differences approach. We find that the law had positive impacts on workers' schedule predictability and stability and led to increases in workers' subjective well-being, sleep quality, and economic security. Using the Seattle law as an instrumental variable, we also estimate causal effects of schedule predictability on well-being outcomes. We show that uncertainty about work time has a substantial effect on workers' well-being, particularly their sleep quality and economic security.
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Project description:Advances in bioacoustic technology, such as the use of automatic recording devices, allow wildlife monitoring at large spatial scales. However, such technology can produce enormous amounts of audio data that must be processed and analyzed. One potential solution to this problem is the use of automated sound recognition tools, but we lack a general framework for developing and validating these tools. Recognizers are computer models of an animal sound assembled from "training data" (i.e., actual samples of vocalizations). The settings of variables used to create recognizers can impact performance, and the use of different settings can result in large differences in error rates that can be exploited for different monitoring objectives. We used Song Scope (Wildlife Acoustics Inc.) to build recognizers and vocalizations of the wood frog (Lithobates sylvaticus) to test how different settings and amounts of training data influence recognizer performance. Performance was evaluated using precision (the probability of a recognizer match being a true match) and sensitivity (the proportion of vocalizations detected) based on a receiver operating characteristic (ROC) curve-determined score threshold. Evaluations were conducted using recordings not used to build the recognizer. Wood frog recognizer performance was sensitive to setting changes in four out of nine variables, and small improvements were achieved by using additional training data from different sites and from the same recording, but not from different recordings from the same site. Overall, the effect of changes to variable settings was much greater than the effect of increasing training data. Additionally, by testing the performance of the recognizer on vocalizations not used to build the recognizer, we discovered that Type I error rates appear idiosyncratic and do not recommend extrapolation from training to new data, whereas Type II errors showed more consistency and extrapolation can be justified. Optimizing variable settings on independent recordings led to a better match between recognizer performance and monitoring objectives. We provide general recommendations for application of this methodology with other species and make some suggestions for improvements.
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Project description:BackgroundThere is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge.MethodsThe Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance.ResultsIneffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change.ConclusionsThis study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care.
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Project description:BACKGROUND:Workplace programs designed to improve the health and psychological well-being of employees are becoming increasingly popular. However, there are mixed reports regarding the effectiveness of such programs and little analysis of what helps people to engage with such programs. OBJECTIVE:This evaluation of a particularly broad, team-based, digital health and well-being program uses mixed methods to identify the elements of the program that reduce work stress and promote psychological well-being, sleep quality, and productivity of employees. METHODS:Participation in the Virgin Pulse Global Challenge program during May to September 2016 was studied. Self-reported stress, sleep quality, productivity, and psychological well-being data were collected both pre- and postprogram. Participant experience data were collected through a third final survey. However, the response rates for the last 2 surveys were only 48% and 10%, respectively. A random forest was used to estimate the probability of the completion of the last 2 surveys based on the preprogram assessment data and the demographic data for the entire sample (N=178,350). The inverse of these estimated probabilities were used as weights in hierarchical linear models in an attempt to address any estimation bias caused by the low response rates. These linear models described changes in psychological well-being, stress, sleep, and productivity over the duration of the program in relation to gender and age, engagement with each of the modules, each of the program features, and participant descriptions of the Virgin Pulse Global Challenge. A 0.1% significance level was used due to the large sample size for the final survey (N=18,653). RESULTS:The final analysis suggested that the program is more beneficial for older people, with 2.9% greater psychological well-being improvements observed on average in the case of women than men (P<.001). With one exception, all the program modules contributed significantly to the outcome measures with the following average improvements observed: psychological well-being, 4.1%-6.0%; quality of sleep, 3.2%-6.9%; work-related stress, 1.7%-6.8%; and productivity, 1.9%-4.2%. However, only 4 of the program features were found to have significant associations with the outcome measures with the following average improvements observed: psychological well-being, 3.7%-5.6%; quality of sleep, 3.4%-6.5%; work-related stress, 4.1%-6.4%; and productivity, 1.6%-3.2%. Finally, descriptions of the Virgin Pulse Global Challenge produced 5 text topics that were related to the outcome measures. Healthy lifestyle descriptions showed a positive association with outcomes, whereas physical activity and step count tracking descriptions showed a negative association with outcomes. CONCLUSIONS:The complementary use of qualitative and quantitative survey data in a mixed-methods analysis provided rich information that will inform the development of this and other programs designed to improve employee health. However, the low response rates and the lack of a control group are limitations, despite the attempts to address these problems in the analysis.
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Project description:BACKGROUND: The work of house staff is being increasingly scrutinized as duty hours continue to be restricted. OBJECTIVE: To describe the distribution of work performed by internal medicine interns while on call. DESIGN: Prospective time motion study on general internal medicine wards at a VA hospital affiliated with a tertiary care medical center and internal medicine residency program. PARTICIPANTS: Internal medicine interns. MAIN MEASURES: Trained observers followed interns during a "call" day. The observers continuously recorded the tasks performed by interns, using customized task analysis software. We measured the amount of time spent on each task. We calculated means and standard deviations for the amount of time spent on six categories of tasks: clinical computer work (e.g., writing orders and notes), non-patient communication, direct patient care (work done at the bedside), downtime, transit and teaching/learning. We also calculated means and standard deviations for time spent on specific tasks within each category. We compared the amount of time spent on the top three categories using analysis of variance. KEY RESULTS: The largest proportion of intern time was spent in clinical computer work (40 %). Thirty percent of time was spent on non-patient communication. Only 12 % of intern time was spent at the bedside. Downtime activities, transit and teaching/learning accounted for 11 %, 5 % and 2 % of intern time, respectively. CONCLUSION: Our results suggest that during on call periods, relatively small amounts of time are spent on direct patient care and teaching/learning activities. As intern duty hours continue to decrease, attention should be directed towards preserving time with patients and increasing time in education.
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