A job analysis of mental health nursing in a school for students with intellectual and developmental disabilities

While schools have become settings for the delivery of mental health supports to students, mental health nursing has not yet described its practice in schools. In the absence of this mental health nursing literature, a quantitative self-reporting job analysis methodology was used to describe the tasks of mental health nursing in a specialist school as an observant-participator in a single-case holistic case study. Additional aims were to compare the results with the general school nursing and the disability nursing literatures and interpret these findings for mental health nursing. Categories of tasks from general school nursing were used to deductively interpret the results. Tasks were recorded across all categories of school nursing. The greatest number of tasks were recorded in the professional performance category, followed by planning, then personnel. The least number of tasks were recorded in the health education and promotion category, followed by practice and treatments, assessment and diagnosis, and management. These results differ from tasks in general school nursing but share similarities with intellectual and developmental disability nursing, particularly related to relationships and communication. Practising effectively as a mental health nurse in a specialist school requires capabilities for working with people with disability, particularly communicating and establishing relationships, in addition to clinical mental health skills. Mental health nursing in schools is an area of practice that requires further exploration to capitalise on emerging policy developments to support student mental health.

Human resource implications of expanding latent tuberculosis patient care activities

Introduction

The World Health Organization (WHO) declared increasing services for latent tuberculosis infection (LTBI) a priority to eliminate tuberculosis (TB) by 2035. Yet, there is little information about thehuman resource needs required to implement LTBI treatment scale-up. Our study aimed to estimate the change in healthcare workers (HCW) time spent on different patient care activities, following an intervention to strengthen LTBI services.

Methods

We conducted a time and motion (TAM) study, observing HCW throughout a typical workday before and after the intervention (Evaluation and Strengthening phases, respectively) at 24 health facilities in five countries. The precise time spent on pre-specified categories of work activities was recorded. Time spent on direct patient care was subcategorized as relating to one of three conditions: LTBI, active or suspected TB, and non-TB (i.e., patients with any other medical condition). A linear mixed model (LMM) was fit to estimate the change in HCW time following the intervention.

Results

A total of 140 and 143 HCW participated in the TAMs during the Evaluation and Strengthening phases, respectively. Results from intervention facilities showed an increase of 9% (95% CI: 3%, 15%) in the proportion of HCW time spent on LTBI-related services, but with a corresponding change of -11% (95% CI: -21%, -1%) on active TB services. There was no change in the proportion of time spent on LTBI care in control facilities; this remained low in both phases of the study.

Discussion

Our findings suggest that additional HCW personnel will be required for expansion of LTBI services to ensure that this expansion does not reduce the time available for care of active TB patients.

Toward ensuring care quality and safety across settings: examining time pressure in a nursing home with observational time motion study metrics based on the Omaha system

BACKGROUND

Meaningful data to determine safe and efficient nursing workload are needed. Reasoning a nurse can accomplish a finite number of interventions and location changes per hour, examination of time pressure using time motion study (TMS) methods will provide a comparable indication of safe and efficient workload for an individual nurse.

METHODS

An observer shadowed 11 nurses at a 250-bed nursing home in the Southeastern United States and recorded 160 h of observations using TimeCaT, web-based TMS data recording software. Predefined Omaha System nursing interventions (N = 57) and locations (N = 8) were embedded within TimeCaT. The time-stamped data were downloaded from TimeCaT and analyzed using descriptive and inferential statistics. Five time pressure metrics were derived from previous TMS findings in acute care settings.

RESULTS

Overall, nurses spent 66 s for each intervention, performed 65 interventions per hour, stayed 130 s at each location, changed locations 28 times per hour, and multitasked for 29% of working time. Computed hourly time pressure metrics enabled visualization of variability in time pressure metrics over time, with differences in multitasking by licensure, unit/role, and observation session time.

CONCLUSIONS

Nursing home nurses consistently experienced a high degree of time pressure, especially multitasking for one-third of their working time. To inform staffing decision making and improve the quality of care, resident outcomes, and nurse satisfaction, it is critical to identify ways to mitigate time pressure. Additional research is needed to refine and extend the use of the time pressure metrics.

Refining Vendor-Defined Measures to Accurately Quantify EHR Workload Outside Time Scheduled With Patients

Accurately quantifying clinician time spent on electronic health record (EHR) activities outside the time scheduled with patients is critical for understanding occupational stress associated with ambulatory clinic environments. We make 3 recommendations regarding EHR workload measures that are intended to capture time working in the EHR outside time scheduled with patients, formally defined as work outside of work (WOW): (1) separate all time working in the EHR outside of time scheduled with patients from time working in the EHR during time scheduled with patients, (2) do not exclude any time before or after scheduled time with patients, and (3) encourage the EHR vendor and research communities to develop and standardize validated, vendor-agnostic methods for measuring active EHR use. Attributing all EHR work outside time scheduled with patients to WOW, regardless of when it occurs, will produce an objective and standardized measure better suited for use in efforts to reduce burnout, set policy, and facilitate research.

The effects of weight categories on the time-motion analysis of female high-level judo athletes between the 2016 and 2020 Olympic cycles

This study compared the time of female judo combat phases in international competitions between two Olympic cycles (2016; 2020) according to weight divisions (48 kg = 132; 52 kg = 72; 57 kg = 109; 63 kg = 96; 70 kg = 69; 78 kg = 106; >78 kg = 82; total = 666 combats/cycle). The behaviors of 1,332 high-level female judo combats were randomly observed over two Olympic cycles (2016 = 666; 2020 = 666) from the top 20 athletes in the world ranking by weight division. We performed time-motion analysis according to the combat phase and sequential judo actions (approach, gripping, attack, defense, groundwork, pause, and effort: pause ratio) considering the moment when the combat ended (Regular time = RT; Golden score = GS). The weight division groups were compared between Olympic cycles (2016; 2020), and p < 0.05 was defined as significant. The main results showed that 2020 athletes spent less time in the gripping (p = 0.005), attack (p < 0.001), defense (p < 0.001), groundwork (p<0.001) and pause (p = 0.002) phases than 2016 athletes. However, compared by the end-of-combat, 2020 female athletes spent less time in all combat phases for RT combats (p < 0.001), and more time in the approach phase for GS combats (p < 0.05) than in 2016. The 2016 weight divisions showed a higher diversity in the effort: pause ratio (2.5:1-3.4:1), whereas the 2020 weight divisions had values closer to each other (2.8,1-3:1). Analyzing each weight division separately and by the end-of-combat, the main results showed that (p < 0.05): 48, 63, 70, and 78 kg reduced the time in almost every phase of RT combat (except for: 63 kg = gripping and attack; 70 kg = approach and groundwork; 78 kg = approach); 48 and 57 kg increased the groundwork time in GS combats whereas 78 kg decreased; 52 kg and 78 kg increased the GS approach time. The temporal behavior of the combats changed between the Olympic cycles with different rules. These data must be considered to understand the characteristics of each group and to prescribe specialized training in female judo.

Home Health Nursing Care Time for Patients with Parkinson's Disease

There is an urgent need to provide personalized care more efficiently to patients with Parkinson's disease (PD) who live at home. To understand the impact of patient attributes and features on nursing care time, we assessed the amount of time required to perform home visits to patients with PD and identified patient characteristics related to differences in nursing care time. Twenty patient (median age 78.0 years) visits were video-recorded. Nursing care activities were categorized, while time spent on them was measured to identify differences in care time by patient. Correlations between patient characteristics and care times were calculated. The median time per visit was 49 min and 7 s. Time was mostly spent on daily living assistance (76.0%), followed by medical care assistance (10.0%) and record keeping and administration (14.0%). Results suggested that patient care was characterized by longer time spent on patient comfort, physical therapy, and patient consultation or education. In general, time per visit increased with patients' age. The variation in care implementation time tended to be large in daily living assistance and small in medical care assistance. These data may be useful for providing and managing personalized care for patients. These data can also contribute to making nurse care more specialized.

Evaluation of pharmacist time dedicated to vancomycin dosing in adult patients using a 24-hour AUC nomogram or trough monitoring approach: A time motion study

DISCLAIMER

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

Evidence-based guideline recommendations for vancomycin dosing recently shifted from a trough-based strategy to an area under the curve (AUC) approach. While several AUC dosing methods exist, the optimal approach has not been determined. Literature characterizing time requirements for various vancomycin dosing strategies remains limited.

METHODS

A time and motion study was conducted to measure the time spent by clinical pharmacists dosing vancomycin using an AUC nomogram. Pharmacists who dosed and monitored vancomycin for adult patients on the general medical ward (GMW) or intensive care unit (ICU) of a large academic medical center consented to study participation. Vulnerable patients and vancomycin orders for surgical infection prophylaxis were excluded. The primary outcome was the median amount of time clinical pharmacists dedicated to vancomycin-related clinical activities during an 8-hour weekday shift. Secondary outcomes included the proportion of patients prescribed vancomycin at the beginning of each shift and factors contributing to greater than average time spent on vancomycin-related responsibilities.

RESULTS

Seven clinical pharmacists collected data on 178 vancomycin orders. The estimated amount of time a clinical pharmacist spent on daily vancomycin responsibilities averaged 10.45 minutes (interquartile range [IQR], 6.94-15.8 minutes). The overall median time requirement per vancomycin assessment was 3.45 minutes (IQR, 1.95-6.7 minutes). The only factor independently associated with prolonged dosing time was follow-up dosing from a previous day.

CONCLUSION

The study elucidated time requirements associated with an AUC nomogram-based vancomycin dosing approach. This data could be used to compare time requirements associated with other existing vancomycin dosing strategies, which may help healthcare systems determine the optimal AUC dosing method for their specific practice model.

Identifying how GPs spend their time and the obstacles they face: a mixed-methods study

Background

Although problems that impair task completion — known as operational failures — are an important focus of concern in primary care, they have remained little studied.

Aim

To quantify the time GPs spend on different activities during clinical sessions; to identify the number of operational failures they encounter; and to characterise the nature of operational failures and their impact for GPs.

Design and setting

Mixed-method triangulation study with 61 GPs in 28 NHS general practices in England from December 2018 to December 2019.

Method

Time–motion methods, ethnographic observations, and interviews were used.

Results

Time–motion data on 7679 GP tasks during 238 hours of practice in 61 clinical sessions suggested that operational failures were responsible for around 5.0% (95% confidence interval [CI] = 4.5% to 5.4%) of all tasks undertaken by GPs and accounted for 3.9% (95% CI = 3.2% to 4.5%) of clinical time. However, qualitative data showed that time–motion methods, which depend on pre-programmed categories, substantially underestimated operational failures. Qualitative data also enabled further characterisation of operational failures, extending beyond those measured directly in the time–motion data (for example, interruptions, deficits in equipment/supplies, and technology) to include problems linked to GPs’ coordination role and weaknesses in work systems and processes. The impacts of operational failures were highly consequential for GPs’ experiences of work.

Conclusion

GPs experience frequent operational failures, disrupting patient care, impairing experiences of work, and imposing burden in an already pressurised system. This better understanding of the nature and impact of operational failures allows for identification of targets for improvement and indicates the need for coordinated action to support GPs.

The Relationship Between Ankle Proprioception and Functional Mobility in People With Parkinson's Disease: A Cross-Sectional Study

Previous research has found ankle proprioception to be impaired in people with Parkinson's disease (PD). However, the relationship between ankle proprioception and functional mobility in people with PD has not been fully investigated. The purpose of this study was to examine whether ankle proprioception is related to the functional mobility of people with PD. Forty-two participants with mild to moderate PD volunteered. Ankle proprioceptive acuity was measured in standing, by using active movement extent discrimination assessment (AMEDA). Functional mobility measures included the timed-up-and-go test (TUG), 30 s sit-to-stand test (30s-STS) and 10-meter walking test (10MWT). Step length and step cadence were recorded during the 10MWT. No significant correlation was found between ankle proprioceptive discrimination scores and any mobility performance measure in people with PD (−0.20<r<0.04, all p > 0.05). However, ankle proprioception scores were significantly correlated with step length (r = 0.38, p < 0.05) and step cadence (r = −0.30, p < 0.05), and were significantly and negatively correlated with the stage of modified Hoehn and Yahr (rho = −0.53, p < 0.01). The lack of relationship between ankle proprioceptive acuity and functional mobility in PD suggests that people with PD may be more limited by reduced sensorimotor integration or may rely more on other sensory input, rather than ankle proprioception, to achieve functional mobility, a finding consistent with sensory reweighting theory. In addition, poorer ankle proprioceptive acuity was associated with decreased step length and increased step cadence, suggesting that the shuffling gait observed in PD may be related to impaired ankle proprioception, which has important clinical implications for gait retraining in people with PD. Given that ankle proprioception was significantly and negatively correlated with the stage of modified Hoehn and Yahr, it may warrant being used as an objective biomarker to monitor the progression of PD.

Understanding Nursing Workflow for Inpatient Education Delivery: Time and Motion Study

Background

Diabetes self-management education and support improves diabetes-related outcomes, but many persons living with diabetes do not receive this. Adults with diabetes have high hospitalization rates, so hospital stays may present an opportunity for diabetes education. Nurses, supported by patient care technicians, are typically responsible for delivering patient education but often do not have time. Using technology to support education delivery in the hospital is one potentially important solution.

Objective

The aim of this study was to evaluate nurse and patient care technician workflow to identify opportunities for providing education. The results informed implementation of a diabetes education program on a tablet computer in the hospital setting within existing nursing workflow with existing staff.

Methods

We conducted a time and motion study of nurses and patient care technicians on three medical-surgical units of a large urban tertiary care hospital. Five trained observers conducted observations in 2-hour blocks. During each observation, a single observer observed a single nurse or patient care technician and recorded the tasks, locations, and their durations using a Web-based time and motion data collection tool. Percentage of time spent on a task and in a location and mean duration of task and location sessions were calculated. In addition, the number of tasks and locations per hour, number of patient rooms visited per hour, and mean time between visits to a given patient room were determined.

Results

Nurses spent approximately one-third of their time in direct patient care and much of their time (60%) on the unit but not in a patient room. Compared with nurses, patient care technicians spent a significantly greater percentage of time in direct patient care (42%; P=.001). Nurses averaged 16.2 tasks per hour, while patient care technicians averaged 18.2. The mean length of a direct patient care session was 3:42 minutes for nurses and 3:02 minutes for patient care technicians. For nurses, 56% of task durations were 2 minutes or less, and 38% were one minute or less. For patient care technicians, 62% were 2 minutes or less, and 44% were 1 minute or less. Nurses visited 5.3 and patient care technicians 9.4 patient rooms per hour. The mean time between visits to a given room was 37:15 minutes for nurses and 33:28 minutes for patient care technicians.

Conclusions

The workflow of nurses and patient care technicians, constantly in and out of patient rooms, suggests an opportunity for delivering a tablet to the patient bedside. The average time between visits to a given room is consistent with bringing the tablet to a patient in one visit and retrieving it at the next. However, the relatively short duration of direct patient care sessions could potentially limit the ability of nurses and patient care technicians to spend much time with each patient on instruction in the technology platform or the content.

Time use of advanced practice nurses in hospitals: A cross-sectional study

AIMS

To examine the use of time by advanced practice nurses and time use differences according to type of healthcare organization, work experience, and supervisor.

DESIGN

A cross-sectional, observational study.

METHODS

Non-participant observations were executed in Belgium (October 2015-January 2016). Time use was categorized in domains (patient/family, team, healthcare organization) and roles (clinical expert, educator/coach, change agent/innovator, researcher, leader, collaborator, and ethical decision-making facilitator). Proportional working time in domains and roles was calculated. Chi-squared tests identified differences in time use according to type of healthcare organization, number of years of work experience, and type of hierarchical/functional supervisor.

RESULTS

Participants mainly devoted time to the patient/family domain (30.78%) and the clinical expert role (34.19%). The role of leader and ethical decision-making facilitator covered, respectively, 4.84% and 0.07% of participants' time. Time distribution in domains and roles differed between participants in university and peripheral hospitals.

CONCLUSION

Activities were executed in all domains and roles, except for the ethical decision-making facilitator role. Further research could uncover barriers and facilitators for role execution, especially about leadership and ethical decision-making.

IMPACT

Advanced practice nurses, supervisors and policymakers could act to optimize advanced practice nurses' scope of practice.

A Real-Time Automated Patient Screening System for Clinical Trials Eligibility in an Emergency Department: Design and Evaluation

Background

One critical hurdle for clinical trial recruitment is the lack of an efficient method for identifying subjects who meet the eligibility criteria. Given the large volume of data documented in electronic health records (EHRs), it is labor-intensive for the staff to screen relevant information, particularly within the time frame needed. To facilitate subject identification, we developed a natural language processing (NLP) and machine learning–based system, Automated Clinical Trial Eligibility Screener (ACTES), which analyzes structured data and unstructured narratives automatically to determine patients’ suitability for clinical trial enrollment. In this study, we integrated the ACTES into clinical practice to support real-time patient screening.

Objective

This study aimed to evaluate ACTES’s impact on the institutional workflow, prospectively and comprehensively. We hypothesized that compared with the manual screening process, using EHR-based automated screening would improve efficiency of patient identification, streamline patient recruitment workflow, and increase enrollment in clinical trials.

Methods

The ACTES was fully integrated into the clinical research coordinators’ (CRC) workflow in the pediatric emergency department (ED) at Cincinnati Children’s Hospital Medical Center. The system continuously analyzed EHR information for current ED patients and recommended potential candidates for clinical trials. Relevant patient eligibility information was presented in real time on a dashboard available to CRCs to facilitate their recruitment. To assess the system’s effectiveness, we performed a multidimensional, prospective evaluation for a 12-month period, including a time-and-motion study, quantitative assessments of enrollment, and postevaluation usability surveys collected from the CRCs.

Results

Compared with manual screening, the use of ACTES reduced the patient screening time by 34% (P<.001). The saved time was redirected to other activities such as study-related administrative tasks (P=.03) and work-related conversations (P=.006) that streamlined teamwork among the CRCs. The quantitative assessments showed that automated screening improved the numbers of subjects screened, approached, and enrolled by 14.7%, 11.1%, and 11.1%, respectively, suggesting the potential of ACTES in streamlining recruitment workflow. Finally, the ACTES achieved a system usability scale of 80.0 in the postevaluation surveys, suggesting that it was a good computerized solution.

Conclusions

By leveraging NLP and machine learning technologies, the ACTES demonstrated good capacity for improving efficiency of patient identification. The quantitative assessments demonstrated the potential of ACTES in streamlining recruitment workflow and improving patient enrollment. The postevaluation surveys suggested that the system was a good computerized solution with satisfactory usability.

Ending MMA Combat, Specific Grappling Techniques According to the Type of the Outcome

This study compared grappling motor actions of male mixed martial arts (MMA) athletes considering outcome types from Ultimate Fighting Championship ( UFC) bouts. A validated protocol of technical-tactical analysis was utilized as in previous studies addressing MMA performance analysis, and Kruskall Wallis and U Mann-Whitney tests were applied to compare effects of types of outcome decisions (Split vs. Unanimous Decision vs. Knockout-KO/Technical-knockout-TKO vs. Submission). Unanimous Decision showed higher frequencies of takedowns attempted/round than KO/TKO and Submission outcomes (p ≤ 0.05; 1.9 ± 1.9 vs. 1.3 ± 1.4 vs. 1.0 ± 1.1 attempts). Bouts with Split Decision demonstrated higher takedowns/round than bouts ended by Submission (p = 0.048; 0.4 ± 0.7 vs. 0.2 ± 0.6 attempts). TKO/KO showed lower values of sweeps/round (p = 0.008, 0.0 ± 0.0 vs. 0.1 ± 0.3 attempts) and takedowns attempted/round (p = 0.014, 1.3 ± 1.4 vs. 2.0 ± 1.6 attempts) than bouts ending by Split Decision. The Submission outcome showed a higher frequency of submissions attempted/round than KO/TKO and Unanimous Decision (p ≤ 0.041, 0.3 ± 0.7 vs 0.2 ± 0.5 vs 0.2 ± 0.5). These results show a large specificity in the type of grappling attack/situation according to the strategy to end the combat. These results also show that the grappling strategy and tactics are variable depending on the strengths and weaknesses of the athletes, and can be used by coaches and athletes to develop specific training programs.

Gender-Dependent Changes in Time Production Following Quadrato Motor Training in Dyslexic and Normal Readers

Time estimation is an important component of the ability to organize and plan sequences of actions as well as cognitive functions, both of which are known to be altered in dyslexia. While attention deficits are accompanied by short Time Productions (TPs), expert meditators have been reported to produce longer durations, and this seems to be related to their increased attentional resources. In the current study, we examined the effects of a month of Quadrato Motor Training (QMT), which is a structured sensorimotor training program that involves sequencing of motor responses based on verbal commands, on TP using a pre-post design. QMT has previously been found to enhance attention and EEG oscillatory activity, especially within the alpha range. For the current study, 29 adult Hebrew readers were recruited, of whom 10 dyslexic participants performed the QMT. The normal readers were randomly assigned to QMT (n = 9) or Verbal Training (VT, identical cognitive training with no overt motor component, and only verbal response, n = 10). Our results demonstrate that in contrast to the controls, longer TP in females was found following 1 month of intensive QMT in the dyslexic group, while the opposite trend occurred in control females. We suggest that this longer TP in the female dyslexics is related to their enhanced attention resulting from QMT. The current findings suggest that the combination of motor and mindful training, embedded in QMT, has a differential effect depending on gender and whether one is dyslexic or not. These results have implications for educational and contemplative neuroscience, emphasizing the connection between specifically-structured motor training, time estimation and attention.

Process improvement for a complex dual medical procedure

Pancreatic extracorporeal shock wave lithotripsy followed by endoscopic retrograde cholangiopancreatography is accepted worldwide as a treatment for a large, symptomatic, obstructing pancreatic stones. However, timely completion of the combined process requires coordination of equipment and personnel from two different complex procedures.

We used Lean management tools in a week-long event to redesign the process around the patient. Using idea-generated Plan Do Study Act cycles to refine the process, from scheduling to postprocedure recovery, equipment and personnel were aligned to allow these two procedures to occur in immediate succession.

The redesigned process resulted in all patients receiving both procedures without delay. This eliminated over 8 hours of wait time. Standard work and a newly created complex scheduler improved flow. We reduced the number of anaesthetics for patients without prolonging the procedure length.

A time and motion study of junior doctor work patterns on the weekend: a potential contributor to the weekend effect?

BACKGROUND

Patients admitted to hospital on weekends have a greater risk of mortality compared to patients admitted on weekdays. Junior medical officers (JMO) make up the majority of medical staff on weekends. No previous study has quantified JMO work patterns on weekends.

AIM

To describe and quantify JMO work patterns on weekends and compare them with patterns previously observed during the week.

METHODS

Observational time and motion study of JMO working weekends using the Work Observation Method by Activity Timing (WOMBAT; Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia) software. Descriptive statistics were used to determine the proportion of total observed time spent in tasks.

RESULTS

Weekend JMO predominately spent time in indirect care (32.0%), direct care (23.0%) and professional communication (22.1%). JMO spent 20.9% of time multitasking and were interrupted, on average, every 9 min. Weekend JMO spent significantly more time in direct care compared with weekdays (13.0%; P < 0.001) and nights (14.3%; P < 0.001). Weekend JMO spent significantly less time on breaks (8.5%), with less than 1 h in an 11-h shift, compared with JMO during weekdays (16.4%; P = 0.004) and nights (27.6%; P = <0.001). Weekend JMO were interrupted at a higher rate (6.6/h) than on weekdays (rate ratio (RR) 2.9, 95% confidence intervals (CI) 2.6, 3.3) or nights (RR 5.1, 95% CI 4.2, 6.1). Multitasking on weekends (20.9%) was comparable to weekdays (18.9%; P = 0.19) but significantly higher than nights (6.4%; P = <0.001).

CONCLUSION

On weekends, JMO had few breaks, were interrupted frequently and engaged in high levels of multitasking. This pattern of JMO work could be a potential contributing factor to the weekend effect in terms of JMO abilities to respond safely and adequately to care demands.

A ward-based time study of paper and electronic documentation for recording vital sign observations

OBJECTIVE

To investigate time differences in recording observations and an early warning score using traditional paper charts and a novel e-Obs system in clinical practice.

METHODS

Researchers observed the process of recording observations and early warning scores across 3 wards in 2 university teaching hospitals immediately before and after introduction of the e-Obs system. The process of recording observations included both measurement and documentation of vital signs. Interruptions were timed and subtracted from the measured process duration. Multilevel modeling was used to compensate for potential confounding factors.

RESULTS

In all, 577 nurse events were observed (281 paper, 296 e-Obs). The geometric mean time to take a complete set of vital signs was 215 s (95% confidence interval [CI], 177 s-262 s) on paper, and 150 s (95% CI, 130 s-172 s) electronically. The treatment effect ratio was 0.70 (95% CI, 0.57-0.85, P  < .001). The treatment effect ratio in ward 1 was 0.37 (95% CI, 0.26-0.53), in ward 2 was 0.98 (95% CI, 0.70-1.38), and in ward 3 was 0.93 (95% CI, 0.66-1.33).

DISCUSSION

Introduction of an e-Obs system was associated with a statistically significant reduction in overall time to measure and document vital signs electronically compared to paper documentation. The reductions in time varied among wards and were of clinical significance on only 1 of 3 wards studied.

CONCLUSION

Our results suggest that introduction of an e-Obs system could lower nursing workload as well as increase documentation quality.

eWasted time: Redundant work during hospital admission and discharge

Potential unintended consequences of health information technology include fragmentation of workflow and redundant work. We could not identify any prior direct observation studies that quantified redundant work related to health information technology in the clinical setting. Our objective was to quantify redundant work during admission and discharge to our general internal medicine service at an academic medical center. We performed a time and motion study at Sunnybrook Health Sciences Centre in Toronto, Canada. We observed 13 clinicians performing an admission or a discharge, and the type and length of each task was recorded using an Apple iPad tablet. We identified redundant tasks related to health information technology and calculated the time spent completing these tasks. We found that 22 percent of clinician time was spent on redundant tasks. Our finding highlights the importance of workflow and software integration when implementing health information technology.

A comparison of time-motion and technical-tactical variables between age groups of female judo matches

The aim of the study was to verify differences between age groups of female judo matches in time-motion and technical-tactical analysis. The sample was composed of pre-cadet (13-14 years, n = 148), cadet (15-16 years, n = 228), junior (17-19 years, n = 104) and senior (>20 years, n = 237) groups. The time-motion indicators consisted of total combat time, standing combat time, displacement without contact, gripping time, total time of techniques, groundwork combat time and pause time, per match and by each combat/pause cycle. Technical and tactical variables were also collected. The one-way analysis of variance and a post hoc test were conducted, P ≤ 0.05. Cadets, with a median of 7 (2, 12), had a number of combat/pause cycles different from junior, with 3 (1, 8.5). Regarding time-motion per match and per cycle, senior had longer total combat time, standing combat time and gripping time than other groups. Senior presented lower frequency of leg techniques than pre-cadet, cadet and junior. Time-motion and technical-tactical variables effects in female judo athletes emphasise the difference between seniors and other groups.

Relationship between attack and pause in world Taekwondo championship contests: effects of gender and weight category

BACKGROUND

The aim of this study was to compare between weight and gender categories the attack and pause times during the 2007 Taekwondo World Championship.

METHODS

A total of 88 rounds (47 male and 41 female contests) were analyzed.

RESULTS

There was no difference in attack/balancing times ratio between genders (0.13 ± 0.06 vs 0.13 ± 0.06, P > 0.05). The attack number was significantly higher in round 3 than in round 1 for all categories and genders. The balancing time was lower during the round 3 than round 1 for low-weight male and high-weight female categories. The delta of change from round 1 to 3 (round 3 - round 1) for attack time and attack/balancing times ratio were lower in male than female.

CONCLUSIONS

Female seems to intensify more the combat in the last round than male, and this seems be related to the weight division.

Can real time location system technology (RTLS) provide useful estimates of time use by nursing personnel?

Accurate, precise, unbiased, reliable, and cost-effective estimates of nursing time use are needed to insure safe staffing levels. Direct observation of nurses is costly, and conventional surrogate measures have limitations. To test the potential of electronic capture of time and motion through real time location systems (RTLS), a pilot study was conducted to assess efficacy (method agreement) of RTLS time use; inter-rater reliability of RTLS time-use estimates; and associated costs. Method agreement was high (mean absolute difference = 28 seconds); inter-rater reliability was high (ICC = 0.81-0.95; mean absolute difference = 2 seconds); and costs for obtaining RTLS time-use estimates on a single nursing unit exceeded $25,000. Continued experimentation with RTLS to obtain time-use estimates for nursing staff is warranted.

Spatial warping by oriented line detectors can counteract neural delays

The slow speed of neural transmission necessitates that cortical visual information from dynamic scenes will lag reality. The “perceiving the present” (PTP) hypothesis suggests that the visual system can mitigate the effect of such delays by spatially warping scenes to look as they will in ~100 ms from now (Changizi, 2001). We here show that the Hering illusion, in which straight lines appear bowed, can be induced by a background of optic flow, consistent with the PTP hypothesis. However, importantly, the bowing direction is the same whether the flow is inward or outward. This suggests that if the warping is meant to counteract latencies, it is accomplished by a simple strategy that is insensitive to motion direction, and that works only under typical (forward-moving) circumstances. We also find that the illusion strengthens with longer pulses of optic flow, demonstrating motion integration over ~80 ms. The illusion is identical whether optic flow precedes or follows the flashing of bars, exposing the spatial warping to be equally postdictive and predictive, i.e., peri-dictive. Additionally, the illusion is diminished by cues which suggest the bars are independent of the background movement. Collectively, our findings are consistent with a role for networks of visual orientation-tuned neurons (e.g., simple cells in primary visual cortex) in spatial warping. We conclude that under the common condition of forward ego-motion, spatial warping counteracts the disadvantage of neural latencies. It is not possible to prove that this is the purpose of spatial warping, but our findings at minimum place constraints on the PTP hypothesis, demonstrating that any spatial warping for the purpose of counteracting neural delays is not a precise, on-the-fly computation, but instead a heuristic achieved by a simple mechanism that succeeds under normal circumstances.

Do physicians spend more time with non-English-speaking patients?

OBJECTIVE

To determine whether physicians at a general internal medicine clinic spend more time with non-English-speaking patients.

DESIGN

A time-motion study comparing physician time spent with non-English-speaking patients and time spent with English-speaking patients during 5 months of observation. We also tested physicians' perceptions of their time use with a questionnaire.

SETTING

Primary care internal medicine clinic at a county hospital.

PATIENTS/PARTICIPANTS

One hundred sixty-six established clinic patients, of whom 57 were non-English speaking and 109 were English speaking, and 15 attending physicians and 8 third-year resident physicians.

MEASUREMENTS AND MAIN RESULTS

Outcome measures included total patient time in clinic, wait for first nurse or physician contact, time in contact with the nurse or physician, physician time spent on the visit, and physician perceptions of time use with non-English-speaking patients. After adjustment for demographic and comorbidity variables, non-English-speaking and English-speaking patients did not differ on any time-motion variables, including physician time spent on the visit (26.0 vs 25.8 minutes). A significant number of clinic physicians believed that they spent more time during a visit with non-English-speaking patients (85.7%) and needed more time to address important issues during a visit (90. 4%), (both p <.01). Physicians did not perceive differences in the amount they accomplished during a visit with non-English-speaking patients.

CONCLUSIONS

There were no differences in the time these physicians spent providing care to non-English-speaking patients and English-speaking patients. An important limitation of this study is that we were unable to measure quality of care provided or patients' satisfaction with their care. Physicians may believe that they are spending more time with non-English-speaking patients because of the challenges of language and cultural barriers.