How can artificial intelligence decrease cognitive and work burden for front line practitioners?

Artificial intelligence (AI) has tremendous potential to improve the cognitive and work burden of clinicians across a range of clinical activities, which could lead to reduced burnout and better clinical care. The recent explosion of generative AI nicely illustrates this potential. Developers and organizations deploying AI have a responsibility to ensure AI is designed and implemented with end-user input, has mechanisms to identify and potentially reduce bias, and that the impact on cognitive and work burden is measured, monitored, and improved. This article focuses specifically on the role AI can play in reducing cognitive and work burden, outlines the critical issues associated with the use of AI, and serves as a call to action for vendors and users to work together to develop functionality that addresses these challenges.

Ten-year work burden after prostate cancer treatment

INTRODUCTION

We aim to characterize the magnitude of the work burden (weeks off from work) associated with prostate cancer (PCa) treatment over a 10-year period after PCa diagnosis and identify those at greatest risk.

MATERIALS AND METHODS

We identified men diagnosed with PCa treated with radical prostatectomy, radiation therapy, or active surveillance/watchful waiting within CaPSURE. Patients self-reported work burden and SF36 general health scores via surveys before and 1,3,5, and 10 years after treatment. Using multivariate repeated measures generalized estimating equation modeling we examined the association between primary treatment with risk of any work weeks lost due to care.

RESULTS

In total, 6693 men were included. The majority were White (81%, 5% Black, and 14% Other) with CAPRA low- (60%) or intermediate-risk (32%) disease and underwent surgery (62%) compared to 29% radiation and 9% active surveillance. Compared to other treatments, surgical patients were more likely to report greater than 7 days off work in the first year, with relatively less time off over time. Black men (RR 0.64, 95% CI 0.54-0.77) and those undergoing radiation (vs. surgery, RR 0.46, 95% CI 0.41-0.51) were less likely to report time off from work over time. Mean baseline GH score (73 [SD 18]) was similar between race and treatment groups, and stable over time.

CONCLUSIONS

The work burden of cancer care continued up to 10 years after treatment and varied across racial groups and primary treatment groups, highlighting the multifactorial nature of this issue and the call to leverage greater resources for those at greatest risk.

A Preliminary Study on the Abnormal Deaths and Work Burden of Chinese Physicians: A Mixed Method Analysis and Implications for Smart Hospital Management

Background: The population of Chinese physicians is frequently threatened by abnormal death, including death by overwork or homicide. This is not only a health problem, but also a social problem that has attracted the attention of both hospitals and the government. Objective: This study aims to analyze the characteristics of abnormal death in physicians in Chinese hospitals from 2007 to 2020 and to investigate the relationship between abnormal death and physician workload, in order to provide information for policy makers and request improvement technologies. Methods: A mixed research method was used. In order to ensure accuracy and completeness, a relatively comprehensive search was conducted using multiple heterogeneous data sources on the abnormal death of physicians in Chinese hospitals from 2007 to 2020. The collected cases were then descriptively analyzed using the work-related overwork death risk concept framework and the deductive grounded theory approach. In addition, the workload of physicians was calculated between 2007 and 2019 based on three important workload indicators. Results: Between 2007 and 2020, 207 abnormal death events of physicians on the Chinese mainland were publicly reported. Among the 207 victims, the majority (~79%) died from overwork or sudden death. The number of victims who were men was 5.5 times higher than that of women, and victims were between the ages of 31-50 years. These physicians mainly belonged to the departments of surgery, anesthesiology, internal medicine, and orthopedics. Further analysis of the direct causes of death in cases of overwork death showed that 51 physicians (31.1%) died from cardiogenic diseases. Additionally, the per capita workload of physicians in China increased drastically by about 42% from 2007 to 2019, far exceeding physician workloads in Europe, Asia, and Australia (number of inpatients per physician in 2017: 72 vs. 55, 50, 45). The analysis revealed that there was a strong correlation between the number of abnormal deaths of physicians in China and the number of inpatients per physician (r = 0.683, P = 0.01). Conclusion: High-intensity working conditions may be positively correlated with the number of abnormal deaths among physicians. Smart hospital technologies have the potential to alleviate this situation.

Surgeons' Preoperative Work Burden Has Increased Before Total Joint Arthroplasty: A Survey of AAHKS Members

BACKGROUND

Implementation of rapid recovery protocols and value-based programs in total joint arthroplasty (TJA) has required changes in preoperative management, such as optimization, education, and coordination. This study aimed to quantify the work burden associated with preoperative TJA care.

METHODS

Two web-based surveys were distributed to surgeon members of the American Association of Hip and Knee Surgeons. The first questionnaire (265 respondents) consisted of questions related to preoperative patient care in TJA and the associated work burden by orthopedic surgeons and their financially dependent health care providers. The second survey (561 respondents) consisted of questions related to relative change in preoperative patient care work burden since 2013.

RESULTS

Greater than 98% of survey respondents reported providing some level of preoperative medical optimization to their patients. The mean amount of reported time spent by the surgeon and/or a qualified health care provider in preoperative activities not included in work captured in current procedural terminology or hospital billing codes was 153 minutes. The mean amount of reported time spent by ancillary clinical staff in preoperative activities was 177 minutes. Most surgeons reported an increase in work burden for total knee (86%) and total hip (87%) arthroplasty since 2013, with a large portion reporting a 20% or greater increase in work (knee 66%, hip 64%).

CONCLUSION

To provide quality arthroplasty care with marked reductions in complication rates, lengths of stay, and readmissions, members of the American Association of Hip and Knee Surgeons report a substantial preoperative work burden that is not included in current coding metrics. Policy makers should account for this time in coding models to continue to promote pathway improvements.

Assessment of work-related fatigue in Polish physiotherapists and of its effect on their diagnostic accuracy and physiotherapy planning

Introduction. A physiotherapist's work requires constant focus, concentration and good physical constitution. Nowadays, we can observe an increasing demand for physiotherapist services, as the number of patients and working hours are increasing. As a result, physiotherapists experience growing work-related load and fatigue. The aim of this study was to assess the degree and characteristics of fatigue in physiotherapists, as well as to assess its effect on the accuracy of their functional diagnosis and the therapeutic treatment they propose. Methods. The study population consisted of 18 physiotherapists. To assess subjective fatigue, we used the Japanese questionnaire, and to assess the number of mistakes made, we used two films made by our group that presented a functional examination of patients. Results. The analysis of fatigue in physiotherapists after a day's work showed a significant decrease in activity, decrease in motivation and increase in physical fatigue. The number of mistakes made after a day's work increased. Conclusions. The study showed that the work of physiotherapists negatively affects the levels of activity, motivation and physical strength. Diagnostic accuracy and physiotherapy planning was worse after a day's work. The occupation of a physiotherapists was categorized as psychologically burdening.

Work-Related Accumulated Fatigue among Doctors in Tertiary Hospitals: A Cross-Sectional Survey in Six Provinces of China

Objectives: “Karoshi” (death due to overwork) of doctors occurred frequently and attracted increasing attention in recent years in China. This study aimed to determine the prevalence of work-related accumulated fatigue of doctors and its associated factors in tertiary hospitals of China. Methods: A cross-sectional questionnaire survey was conducted on 1729 full-time doctors employed by 24 tertiary hospitals across eastern developed, central developing, and western underdeveloped regions of China. Accumulated fatigue was categorized into four levels using the “Self-diagnosis Checklist for Assessment of Workers’ Accumulated Fatigue” rated on a scale matrix considering both overwork and fatigue symptoms. Ordinal logistic regression analyses were performed to identify factors associated with work-related accumulated fatigue. Results: About 78.8% of respondents reported a “high level” of work-related accumulated fatigue, including 42.0% at a “very high” level. Male doctors and those aged between 30 and 45 years and who had a professional title were found to have higher levels of accumulative fatigue than others. Low salary and poor working conditions (in the western region) were also significantly associated with high levels of work-related accumulated fatigue (p < 0.05). Conclusion: High levels of work-related accumulated fatigue are prevalent in doctors working in tertiary hospitals in China. Male doctors establishing their early- and mid-careers are the high-risk group. Poor working conditions are associated with work-related accumulated fatigue.

Electronic health record impact on work burden in small, unaffiliated, community-based primary care practices

BACKGROUND

The use of electronic health records (EHR) is widely recommended as a means to improve the quality, safety and efficiency of US healthcare. Relatively little is known, however, about how implementation and use of this technology affects the work of clinicians and support staff who provide primary health care in small, independent practices.

OBJECTIVE

To study the impact of EHR use on clinician and staff work burden in small, community-based primary care practices.

DESIGN

We conducted in-depth field research in seven community-based primary care practices. A team of field researchers spent 9-14 days over a 4-8 week period observing work in each practice, following patients through the practices, conducting interviews with key informants, and collecting documents and photographs. Field research data were coded and analyzed by a multidisciplinary research team, using a grounded theory approach.

PARTICIPANTS

All practice members and selected patients in seven community-based primary care practices in the Northeastern US.

KEY RESULTS

The impact of EHR use on work burden differed for clinicians compared to support staff. EHR use reduced both clerical and clinical staff work burden by improving how they check in and room patients, how they chart their work, and how they communicate with both patients and providers. In contrast, EHR use reduced some clinician work (i.e., prescribing, some lab-related tasks, and communication within the office), while increasing other work (i.e., charting, chronic disease and preventive care tasks, and some lab-related tasks). Thoughtful implementation and strategic workflow redesign can mitigate the disproportionate EHR-related work burden for clinicians, as well as facilitate population-based care.

CONCLUSIONS

The complex needs of the primary care clinician should be understood and considered as the next iteration of EHR systems are developed and implemented.

Balancing Caregiving and Work: Role Conflict and Role Strain Dynamics

Positing role conflict as a bidirectional construct in which work interferes with caregiving (WIC) and caregiving interferes with work (CIW), this study investigated its antecedents (demands and support of caregiving and work) and consequences (role strain). A national sample of 583 women between the ages of 50 and 64 years identified using random-digit-dial procedures completed a telephone survey. Structural equation modeling revealed that caregiving demands were positively associated with CIW and caregiving burden; instrumental caregiving support reduced CIW and caregiving burden. Work demands were positively associated with WIC, CIW, caregiving burden, and work burden. Emotional workplace support reduced WIC, CIW, and work burden. CIW and WIC were positively associated with caregiving burden; only WIC was positively associated with work burden. Findings suggest that demands and supports related to the caregiving role do not influence work-related role strain; work demands and supports influence role strain experienced from both caregiving and work domains.