Developing a Technique to Measure Anesthesiologists' Real-Time Workload

Abstract

Workload is a construct used to describe the extent to which an operator has engaged the cognitive and physical resources required for task performance. As task difficulty increases, operators allocate more resources to maintain acceptable performance. The purpose of the present study is to develop a technique to measure workload continuously, with high-resolution in real-time, and in a way that accounts for the contribution of multiple individual task components of the job of administering anesthesia. Workload associated with 51 clinical tasks performed by anesthesiologists was assessed using a written survey instrument, developed for this study. Participants were 241 anesthesia providers. Interval scale values were computed for each of the tasks using direct estimatation procedures. These values were then used to produce workload density maps for actual anesthesia cases by weighting the tasks performed during the case by their workload scale values. Moment-by-moment data on the specific tasks performed by anesthesiologists were obtained in real-time by trained observers during actual anesthetic cases. This type of analysis can be used to evaluate the costs associated with technical anesthesia procedures, increase our understanding of the anesthesiologist's job, and guide rational optimization of procedures, equipment, scheduling, and training.

Defining and measuring the effort needed for inpatient medicine work

“…This project allowed us to consider the effort required for inpatient internal medicine work on a more granular level than has been described previously. Although the difficulty of tasks associated with anesthesia and surgical work has been described, 3,4,7,[18][19][20] our study is a unique contribution to the internal medicine literature. Understanding the difficulty of tasks performed by inpatient physicians is an important step toward better management of workload.…”

“…3,4 In 2 studies, anesthesiologists were asked to rate the effort or intensity associated with the tasks that they performed in the operating room. 4,5 In subsequent studies, this group used a trained observer to record the tasks anesthesiologists performed during a case. 6,7 Work density was calculated by multiplying the duration of each task by the previously developed task intensity score.…”

“…The term mental refers to cognitive effort, whereas psychological refers to emotional effort. We used the same scales with the same anchors as described in the anesthesia literature, 4 but substituted the internal medicine specific tasks. Each item was rated on a 7-point Likert-type scale (1 ¼ almost no stress or effort; 7 ¼ most effort).…”

“…We used the terminology that the study participants used to describe their work (eg, they used the term eyeballing a patient to describe the process of making an initial assessment of the patient's status). This list of 99 items was formatted into a survey to allow study participants to rate each task across 3 domains: physical effort, mental effort, and psychological effort, based on previous studies in anesthesia 4 (see Supporting Information). The term mental refers to cognitive effort, whereas psychological refers to emotional effort.…”

Effects of Intraoperative Reading on Vigilance and Workload during Anesthesia Care in an Academic Medical Center

“…21 Workload density is a technique that permits real-time assessment of procedural workload per unit time whereby the incremental contribution of each task (as it is actually performed) is calculated as an aggregate measure. Workload density was calculated in 5-min intervals by multiplying the amount of time (in seconds) spent on each individual task by its workload factor score (a numerical value for each possible task derived in a previous study in which the relative workload associated with 71 anesthesia tasks was determined using statistical methods 21,22 ). Dividing the summed workload density values throughout maintenance by the total maintenance duration generated a normalized cumulative workload density for the entire maintenance period of each study case.…”