Simulation and patient assignment

Sundaramoorthi, Durai; Rosenberger, Jay M.; Chen, Victoria C. P.; Buckley-Behan, Deborah F.; Kim, Seoung Bum

doi:10.1097/01.numa.0000388667.17910.16

Cited by 8 publications

(6 citation statements)

References 1 publication

(1 reference statement)

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“…7 Part of the challenge to improving work assignment may simply be an inability to track work load. In a related sense, nursing has struggled with creating standardized nursing intervention terminologies for use in electronic health records.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Care Work Assignment Based on Work Rate Instead of Work Load

et al. 2011

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BACKGROUND:We previously reported a new management variable, work rate, defined as work load due per hour, based on cumulative standard treatment times. We found that work rates were unachievable (ie, exceeded 1 hour of scheduled work per hour of available labor) for 75% of scheduled due times, despite presumed achievable average work load. OBJECTIVE: To determine the optimal strategy for creating work assignments based on work rate. METHODS: A focus group used root-cause analysis to identify ways to balance assignments based on work rate. We surveyed employees to assess their willingness to start earlier. We determined the ratio of scheduled to unscheduled work during a 12-month period. The scheduled work comprised administering smallvolume nebulizer, metered-dose inhaler, noninvasive ventilation, and mechanical ventilation. The unscheduled work consisted of all other modalities. We also developed a spreadsheet model to assess the effect of shifting the start time on work-rate distribution in a representative 24-hour period. RESULTS: The focus group determined that starting treatments 1 hour earlier would help. Fifteen of the 24 clinicians surveyed responded, and 13 of the respondents were willing to start earlier. The scheduled work load averaged approximately 55% of the total work load, but there was high variability per assignment area (range 0 -99%). The spreadsheet model showed that shifting treatment start times improved the distribution of work rate throughout the day, but did not guarantee that labor demand never outstrips supply. CONCLUSIONS: Our studies to date suggest that: basing assignments on average work load leads to periods of unachievable work rate, resulting in missed treatments and staff dissatisfaction. We have only limited ability to reduce peaks in work rate, but staggering treatment times is effective. Fair assignment of work should differentiate scheduled from unscheduled work.

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Section: Discussionmentioning

confidence: 99%

Respiratory Care Work Assignment Based on Work Rate Instead of Work Load

et al. 2011

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“…After checking the abstracts, nine relevant articles remained. 1,5,6,8,9,12,13,15,16 By performing forward and backward searches on these articles, six other relevant articles were found. [2][3][4]7,10,11 All relevant articles had been published between 1973 and 2013.…”

Section: Literature Searchmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11][12] Operations researchers in Texas [3][4][5][6][7][8][9] have applied integer programming, 4,5 stochastic programming, 6 heuristics, 7 and Markov decision theory 7 to create nurse-to-patient assignments, and researchers have developed a simulation model 8,9 to evaluate such assignments. Although the literature indicates that nurses consider many different factors in deciding nurseto-patient assignments, 1,13 these models merely consider the objective of workload balancing.…”

mentioning

confidence: 99%

Developing and Testing a Computerized Decision Support System for Nurse-to-Patient Assignment

Oostveen

Braaksma

Vermeulen

2014

CIN: Computers, Informatics, Nursing

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Nurse-to-patient assignment is a frequently recurring, time-consuming, and complex process owing to the many considerations involved. Creating well-balanced, high-quality assignments is crucial to ensuring patient safety, quality of care, and job satisfaction for nurses. A computerized decision support system can assist (charge) nurses in the nurse-to-patient assignment process. In this two-phase multimethod study, a computerized decision support system was developed and evaluated. Three nursing wards in a 1000-bed Dutch university hospital participated. In the first phase of this study, considerations relevant to the assignment process--and their relative importance--were investigated in a literature review, focus group sessions with nurses, and a survey among nurses. Using information from the first phase, the computerized decision support system was developed based on an integer linear program. In the second phase, a before-and-after study was conducted to test and evaluate the computerized decision support system both quantitatively (duration of the assignment process) and qualitatively (survey on workload). Thirty-six measurements were performed to test the computerized decision support system. After implementation, a 30% time reduction was achieved in the nurse-to-patient assignments, and nurses (N = 138) experienced a lower workload. Therefore, the implementation of computerized decision support system would increase both the quality and safety of care as well as the nurses' job satisfaction and should be investigated rigorously in the coming years.

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“…nursing activities score (NAS)) represents a patient-level workload (Miranda et al, 2003). Task-level measures identified in this narrative review (n ¼ 9) include direct care time (n ¼ 5), task-related time based on task complexity (NAS) (n ¼ 3), time of tasks including walking time (n ¼ 1), time spent on direct care activities, indirect care activities and non-patient activities (n ¼ 1), and ratio of non-patient activity time to patient activity time (n ¼ 1) (Hurst, 2008;Hurst, 2011;Sundaramoorthi et al, 2010;Twigg and Duffield, 2009;van den Oetelaar et al, 2016;Altafin et al, 2014;Simmons and Kuys, 2011;Debergh et al, 2012;Serafim et al, 2017). All of these metrics use the time spent performing specific tasks in quantification of workload where…”

Section: Objective Measures Of Workloadmentioning

confidence: 99%

Objective measures of workload in healthcare: a narrative review

Fishbein

Nambiar

McKenzie

et al. 2019

IJHCQA

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Purpose Workload is a critical concept in the evaluation of performance and quality in healthcare systems, but its definition relies on the perspective (e.g. individual clinician-level vs unit-level workload) and type of available metrics (e.g. objective vs subjective measures). The purpose of this paper is to provide an overview of objective measures of workload associated with direct care delivery in tertiary healthcare settings, with a focus on measures that can be obtained from electronic records to inform operationalization of workload measurement. Design/methodology/approach Relevant papers published between January 2008 and July 2018 were identified through a search in Pubmed and Compendex databases using the Sample, Phenomenon of Interest, Design, Evaluation, Research Type framework. Identified measures were classified into four levels of workload: task, patient, clinician and unit. Findings Of 30 papers reviewed, 9 used task-level metrics, 14 used patient-level metrics, 7 used clinician-level metrics and 20 used unit-level metrics. Key objective measures of workload include: patient turnover (n=9), volume of patients (n=6), acuity (n=6), nurse-to-patient ratios (n=5) and direct care time (n=5). Several methods for operationalization of these metrics into measurement tools were identified. Originality/value This review highlights the key objective workload measures available in electronic records that can be utilized to develop an operational approach for quantifying workload. Insights gained from this review can inform the design of processes to track workload and mitigate the effects of increased workload on patient outcomes and clinician performance.

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Simulation and patient assignment

Cited by 8 publications

References 1 publication

Respiratory Care Work Assignment Based on Work Rate Instead of Work Load

Respiratory Care Work Assignment Based on Work Rate Instead of Work Load

Developing and Testing a Computerized Decision Support System for Nurse-to-Patient Assignment

Objective measures of workload in healthcare: a narrative review

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