Scheduling of advanced practice providers at Level 1 trauma centers

Myers, Robert A.; Parikh, Pratik; Ekeh, Akpofure Peter; Denlinger, Elizabeth; McCarthy, Mary C.

doi:10.1097/ta.0000000000000250

Cited by 5 publications

(2 citation statements)

References 10 publications

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“…Thirteen RNs in the trauma unit participated voluntarily in 48 h of direct observation and 47 responded voluntarily to an online survey. The RNs were observed from all hours of the day and all 7 days of the week in an attempt to capture the non-stationary nature of interruptions, which are linked to temporal tasks (such as medication and rounding) and also the cyclical workload typical of trauma services (increased admissions during evenings and on weekends) 35. The RNs were enrolled upon obtaining informed consent via a printed copy of the observation protocol and a private opportunity to verbally opt in or out of the study.…”

Section: Methodsmentioning

confidence: 99%

Differentiating between detrimental and beneficial interruptions: a mixed-methods study

et al. 2015

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A mixed-methods approach can help distinguish between detrimental and beneficial interruptions. While interruptions breaking the delivery of steady treatment and attention to the patient are detrimental, those returning the RN's focus to the patient, as well as those supporting patient-clinician and clinician-clinician communications are beneficial. This insight may be helpful to healthcare delivery teams tasked with improving interruption-laden processes.

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Section: Methodsmentioning

confidence: 99%

Differentiating between detrimental and beneficial interruptions: a mixed-methods study

et al. 2015

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“…There have also been simulation studies of staffing to match patient volumes, particularly in trauma and emergency department setting (26-29). However, to our knowledge, there have not been other quantitative studies of the impact of staffing models on physician outcomes and on continuity of care.…”

Section: Discussionmentioning

confidence: 99%

Simulation of a Novel Schedule for Intensivist Staffing to Improve Continuity of Patient Care and Reduce Physician Burnout

Geva¹,

Landrigan²,

Velden

et al. 2017

Critical Care Medicine

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Objective Despite widespread adoption of in-house call for ICU attendings, there is a paucity of research on optimal scheduling of intensivists to provide continuous on-site coverage. Overnight call duties have traditionally been added onto 7 days of continuous daytime clinical service. We designed an alternative ICU staffing model to increase continuity of attending physician care for patients while also decreasing interruptions to attendings’ non-clinical weeks. Design Computer-based simulation of a one-year schedule. Setting A simulated ICU divided into 2 daytime teams each covered by a different attending and both covered by 1 overnight on-call attending. Subjects Simulated patients were randomly admitted on different service days to assess continuity of care. Interventions A Shared Service schedule was compared to a standard 7 Days On schedule. For the 7 Days On schedule, an attending covered a team for 7 consecutive days and off-service attendings cross-covered each night. For the Shared Schedule, 4 attendings shared the majority of daytime and nighttime service for 2 teams over 2 weeks, with recovery periods built into the scheduled service time. Measurements and Main Results Continuity of care as measured by the Continuity of Attending Physician Index (CAPI) increased by 9% with the Shared Schedule. Annually, the Shared Service Schedule was predicted to increase free weekends by 3.4 full weekends and 1.3 weekends with either Saturday or Sunday off. Full weeks without clinical obligations increased by 4 weeks. Mean time between clinical obligations increased by 5.8 days. Conclusions A Shared Service schedule is predicted to improve continuity of care while increasing free weekends and continuity of uninterrupted non-clinical weeks for attendings. Computer-based simulation allows assessment of benefits and tradeoffs of the alternative schedule without disturbing existing clinical systems.

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Nurses’ work with interruptions: an objective model for testing interventions

Myers

Parikh

2017

Health Care Manag Sci

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Interruptions experienced by nurses may lead to errors as their focus and attention to multiple patient needs are disrupted. As quantitative models to understand the dynamics of interruptions are lacking, the objective of this study is a model of a nurse's work with interruptions, generating insights into the onset of interruptions and evaluating suggested interventions. We observed nurses in a US Level I trauma center for 47.3 h, including 259 interruptions (9.1% of total time) across 580 nursing activities. A stochastic, non-stationary, model of a nurse's work was developed considering source and activity-dependent interruptions, with parameters clustered across similar periods of day. Two interventions emulating 'do not disturb' strategies were evaluated, along with a more focused intervention from suggestions that nurses' phone calls be 'triaged'. Modeled outcomes included the increase in interruptions in other activities due to deferment and changes to the beneficial/detrimental interruption (B/D) ratio. Across-the-board sequestering of nurses by deferring interruptions during medication increased the B/D ratio 17% (1.35 vs. 1.58), but resulted in an unforeseen 73% (1.04/h vs. 1.80/h) increase in interruptions during direct care. In contrast, the focused intervention (deferring only those interruptions arriving via cell phone during medication and direct care), netted a 31% improvement in the B/D ratio (1.29 vs. 1.69) and with moderated (< 0.13/h) impact on interruptions during other activities. Modeling the dynamics of the onset of interruptions reveals the potentially negative impact of across-the-board interventions, and the advantage of focused interventions anticipating unmet needs before they present as interruptions.

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Scheduling of advanced practice providers at Level 1 trauma centers

Abstract: Care management study, level IV.

Cited by 5 publications

References 10 publications

Differentiating between detrimental and beneficial interruptions: a mixed-methods study

Differentiating between detrimental and beneficial interruptions: a mixed-methods study

Simulation of a Novel Schedule for Intensivist Staffing to Improve Continuity of Patient Care and Reduce Physician Burnout

Nurses’ work with interruptions: an objective model for testing interventions

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