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Patient Load (patient + load)
Selected AbstractsNurse absenteeism and workload: negative effect on restraint use, incident reports and mortalityJOURNAL OF ADVANCED NURSING, Issue 6 2007Lynn Unruh Abstract Title.,Nurse absenteeism and workload: negative effect on restraint use, incident reports and mortality Aim., This paper is a report of a study to assess the impact of nurse absenteeism on the quality of patient care. Background., Nurse absenteeism is a growing management concern. It can contribute to understaffed units, staffing instability, and other factors that could have a negative impact on patient care. The impacts of absenteeism on the quality of nursing care have rarely been studied. Method., Retrospective monthly data from incident reports and staffing records in six inpatient units for 2004 were analysed. Dependent variables were the numbers of restraints, alternatives to restraints, incident reports, deaths, and length of stay. Explanatory variables were nurse absenteeism hours, patient days per nursing staff, and interaction between these variables. Controls were patient acuity and unit characteristics. Fixed effects regressions were analysed as regular or negative binomial models. Findings., Neither high Registered Nurse absenteeism nor high patient load was related to restraint use when taken separately. However, high Registered Nurse absenteeism was related to restraint use when patient load was high. Registered Nurse absenteeism was related to a lower use of alternatives to restraints. Incident reports were increased by high patient load, but not absenteeism, or absenteeism given patient load. When both patient load and absenteeism were high, deaths were higher also. Conclusion., Absenteeism alone may not be a strong factor in lowering quality, but the combination of high Registered Nurse absenteeism and high patient load could be a factor. Staffing and absenteeism may be part of a vicious cycle in which low staffing contributes to unit absenteeism, which contributes to low staffing, and so on. [source] Duty Hours in Emergency Medicine: Balancing Patient Safety, Resident Wellness, and the Resident Training Experience: A Consensus Response to the 2008 Institute of Medicine Resident Duty Hours RecommendationsACADEMIC EMERGENCY MEDICINE, Issue 9 2010Mary Jo Wagner MD Abstract Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education (ACGME), the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated. The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous on-site supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked. One recommendation from the IOM was a required 5-hour rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes. ACADEMIC EMERGENCY MEDICINE 2010; 17:1004,1011 © 2010 by the Society for Academic Emergency Medicine [source] Dentists' preferences of anterior tooth proportion,a Web-based studyJOURNAL OF PROSTHODONTICS, Issue 3 2000Stephen F. Rosenstiel BDS Purpose This study aimed to determine dentists' esthetic preferences of the maxillary anterior teeth as influenced by different proportions. The goal was to link choices to demographic data as to the experience, gender, and training of the dentist. Materials and Methods Computer-manipulated images of the 6 maxillary anterior teeth were generated from a single image and assigned to 5 tooth-height groups (very short, short, normal height, tall, and very tall). For each group, 4 images were generated by manipulating the relative proportion of the central incisors, lateral incisors, and canines according to the proportions 62% (or "golden proportion"), 70%, 80%, and "normal" or not further altered. The images were randomly ordered on a web page that contained a form asking for demographic data and fields asking for a ranking of the images. Dentists were asked via e-mail to visit the web page and complete the survey. The responses were tabulated and analyzed with repeated measures logistic regression with the alpha at 0.05. A subset of North American respondents was chosen for further analysis. Results A total of 549 valid responses were received and analyzed from dentists in 38 countries. There were statistically significant differences in all groups for the variables of proportion, group (tooth height), and their interaction. The 80% proportion was judged best for the Very Short and Short groups. Three of the choices were almost equally picked for the Normal Height and Tall groups, and the golden proportion was judged best for the Very Tall group. The variables of year of graduation, gender, professional activity, generalist or specialist, or number of patients were not significantly correlated with the choices for the North American respondents. Conclusions Dentists preferred the 80 percent proportion when viewing short or very short teeth and the golden proportion when viewing very tall teeth. Golden proportion was worst for normal height or shorter teeth and the 80% proportion for tall or very tall teeth. They picked no clear-cut best for normal height or tall teeth, and their choices could not be predicted based on gender, specialist training, experience, or patient load. [source] Reliability and validity of the Thai version of the WHO-Five Well-Being Index in primary care patientsPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2009Ratana Saipanish md Aims:, Because of the high patient load in Thailand, we need a practical measurement to help primary physicians detect depression. This study aimed to examine the reliability and validity of the Thai version of the World Health Organization-Five Well-Being Index (WHO-5-T), which is short and easy to use as a screening tool for major depression in primary care patients. Methods:, The English version of the WHO-Five Well-Being Index was translated into Thai. Back-translations, cross-cultural adaptation and field testing of the pre-final version with final adjustments were performed accordingly. The WHO-5-T was administered randomly to 300 patients in our primary care clinic. Then the patients were further assessed using the Mini International Neuropsychiatric Interview and the Hamilton Rating Scale for Depression as the gold standard of diagnosis and symptom severity, respectively. Results:, Completed data were obtained from 274 respondents. Their mean age was 44.6 years [standard deviation (SD) = 14.7] and 73.7% of them were female. The mean WHO-5-T score was 14.32 (SD = 5.26). The WHO-5-T had a satisfactory internal consistency (Cronbach's alpha = 0.87) and showed moderate convergent validity with the Hamilton Rating Scale for Depression (r = ,0.54; P < 0.001). The optimal cut-off score of the WHO-5-T <12 revealed a sensitivity of 0.89 and a specificity of 0.71 in detecting depression. The area under the curve in this study was 0.86 (SD = 0.03, 95% confidence interval 0.81 to 0.89). Conclusions:, The Thai version of the WHO-Five Well-Being Index was found to be a reliable and valid self-assessment to screen for major depression in primary care setting at a cut-off point of <12. [source] System Complexity As a Measure of Safe Capacity for the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 11 2006Daniel J. France PhD Objectives System complexity is introduced as a new measure of system state for the emergency department (ED). In its original form, the measure quantifies the uncertainty of demands on system resources. For application in the ED, the measure is being modified to quantify both workload and uncertainty to produce a single integrated measure of system state. Methods Complexity is quantified using an information-theoretic or entropic approach developed in manufacturing and operations research. In its original form, complexity is calculated on the basis of four system parameters: 1) the number of resources (clinicians and processing entities such as radiology and laboratory systems), 2) the number of possible work states for each resource, 3) the probability that a resource is in a particular work state, and 4) the probability of queue changes (i.e., where a queue is defined by the number of patients or patient orders being managed by a resource) during a specified time period. Results An example is presented to demonstrate how complexity is calculated and interpreted for a simple system composed of three resources (i.e., emergency physicians) managing varying patient loads. The example shows that variation in physician work states and patient queues produces different scores of complexity for each physician. It also illustrates how complexity and workload differ. Conclusions System complexity is a viable and technically feasible measurement for monitoring and managing surge capacity in the ED. [source] | ||||||||||