Improving patient care over weekends by reducing on-call work load and better time management.
Ontology highlight
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.
| S-EPMC8545454 | biostudies-literature
Project description:Recent times have seen increasing interest in conversational assistants (e.g., Amazon Alexa) designed to help users in their daily tasks. In military settings, it is critical to design assistants that are, simultaneously, helpful and able to minimize the user's cognitive load. Here, we show that embodiment plays a key role in achieving that goal. We present an experiment where participants engaged in an augmented reality version of the relatively well-known desert survival task. Participants were paired with a voice assistant, an embodied assistant, or no assistant. The assistants made suggestions verbally throughout the task, whereas the embodied assistant further used gestures and emotion to communicate with the user. Our results indicate that both assistant conditions led to higher performance over the no assistant condition, but the embodied assistant achieved this with less cognitive burden on the decision maker than the voice assistant, which is a novel contribution. We discuss implications for the design of intelligent collaborative systems for the warfighter.
| S-EPMC7705099 | biostudies-literature
Project description:Hospital admissions over weekends have been associated with worse outcomes in different patient populations. The cause of this difference in outcomes remains unclear; however, different staffing patterns over weekends have been speculated to contribute. We evaluated outcomes in patients on maintenance dialysis therapy admitted over weekends using a national database.Retrospective cohort study.We included nonelective admissions of adult patients (?18 years) on maintenance dialysis therapy (n = 3,278,572) identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for 2005-2009 using the Nationwide Inpatient Sample database.Weekend versus weekday admission.The primary outcome measure was all-cause in-hospital mortality. Secondary outcomes included mortality by day 3 of admission, length of hospital stay, time to death, and discharge disposition.We adjusted for patient and hospital characteristics, payer, year, comorbid conditions, and primary discharge diagnosis common to maintenance dialysis patients.There were an estimated 704,491 admissions over weekends versus 2,574,081 over weekdays. Unadjusted all-cause in-hospital mortality was 40,666 (5.8%) for weekend admissions in comparison to 138,517 (5.4%) for weekday admissions (P < 0.001). In a multivariable model, patients admitted over weekends had higher all-cause in-hospital mortality (OR, 1.06; 95% CI, 1.01-1.10) in comparison to those admitted over weekdays and higher mortality during the first 3 days of admission (OR, 1.18; 95% CI, 1.10-1.26). Patients admitted over weekends were less likely to be discharged to home, had longer hospital stays, and had shorter times to death compared with those admitted over weekdays on adjusted analysis.Use of ICD-9-CM codes to identify patients, defining weekend as midnight Friday to midnight Sunday.Maintenance dialysis patients admitted over weekends have increased mortality rates and longer lengths of stay compared with those admitted over weekdays. Further studies are needed to identify the reasons for worse outcomes for weekend admissions in this patient population.
| S-EPMC3783620 | biostudies-literature
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.
| S-EPMC5415519 | biostudies-literature
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.
| S-EPMC4175223 | biostudies-literature
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.
| S-EPMC6231840 | biostudies-other
Project description:Junior doctors often feel they have little control over their working environment and can feel overwhelmed by the numerous barriers to their involvement with rota design. This project aimed to overcome these barriers to change by implementing a new FY1 on-call rota, designed by junior doctors, for the surgical department at the Royal Sussex County Hospital, Brighton. A new rota was necessary since the department had recently undergone an organisational restructuring that altered the out of hours work load for FY1 doctors. To address this, the proposed new rota increased FY1 presence during weekend daytime shifts. To assess junior opinion about the old rota and the proposed new rota, a survey was sent to 32 FY1 doctors analysing their views about each rota in terms of safety, the sufficiency of cover for various shifts, and their willingness to work the rota. A direct comparison between the two rotas was also requested. A statistically significant (p<0.05, n=12, two-tailed paired T-test) increase in people agreeing with the following statements about the new rota: "The rota is safe", "This rota has sufficient FY1 cover during the weekend day shifts", and "I would be prepared to work this rota." A direct comparison revealed that FY1 doctors felt that the new rota would be safer, they would be more willing to work the new rota, and that the new rota should be implemented. Implementation occurred for the August 2014 general surgical FY1 intake and post implementation audits showed that the new FY1s felt that cover across all shifts was improved and that the new rota was safe. This project demonstrates that altering rotas can improve junior doctor's perception of patient safety, and also shows that junior team members, with departmental support, can overcome barriers to change and implement new rotas.
| S-EPMC4645718 | biostudies-literature
Project description:Despite tremendous efforts in basic research and a growing number of clinical trials aiming to find effective treatments, amyotrophic lateral sclerosis (ALS) remains an incurable disease. One possible reason for the lack of effective causative treatment options is that ALS may not be a single disease entity but rather may represent a clinical syndrome, with diverse genetic and molecular causes, histopathological alterations, and subsequent clinical presentations contributing to its complexity and variability among individuals. Defining a way to subcluster ALS patients is becoming a central endeavor in the field. Identifying specific clusters and applying them in clinical trials could enable the development of more effective treatments. This review aims to summarize the available data on heterogeneity in ALS with regard to various aspects, e.g., clinical, genetic, and molecular.
| S-EPMC10930688 | biostudies-literature
Project description:Excessive N fertilization in intensive agricultural areas of China has resulted in serious environmental problems because of atmospheric, soil, and water enrichment with reactive N of agricultural origin. This study examines grain yields and N loss pathways using a synthetic approach in 2 of the most intensive double-cropping systems in China: waterlogged rice/upland wheat in the Taihu region of east China versus irrigated wheat/rainfed maize on the North China Plain. When compared with knowledge-based optimum N fertilization with 30-60% N savings, we found that current agricultural N practices with 550-600 kg of N per hectare fertilizer annually do not significantly increase crop yields but do lead to about 2 times larger N losses to the environment. The higher N loss rates and lower N retention rates indicate little utilization of residual N by the succeeding crop in rice/wheat systems in comparison with wheat/maize systems. Periodic waterlogging of upland systems caused large N losses by denitrification in the Taihu region. Calcareous soils and concentrated summer rainfall resulted in ammonia volatilization (19% for wheat and 24% for maize) and nitrate leaching being the main N loss pathways in wheat/maize systems. More than 2-fold increases in atmospheric deposition and irrigation water N reflect heavy air and water pollution and these have become important N sources to agricultural ecosystems. A better N balance can be achieved without sacrificing crop yields but significantly reducing environmental risk by adopting optimum N fertilization techniques, controlling the primary N loss pathways, and improving the performance of the agricultural Extension Service.
| S-EPMC2644255 | biostudies-literature