The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

VALIDATING WORK-RATE: A NEW PARAMETER FOR DISTRIBUTING RESPIRATORY THERAPY WORKLOAD

Susan Gole1, Mike Rado2, Robert L. Chatburn1; 1Respiratory Therapy, Cleveland Clinic, Cleveland, OH; 2Management Engineering, Cleveland Clinic, Cleveland, OH

We previously reported a pilot study of a new management parameter, work-rate (workload due per hour based on cumulative standard treatment times) to equalize distribution of workload and the timeliness of delivered treatments (Respir Care 2008;53(11):1532). The purpose of this study was to collect baseline data for a quarter of 2009. Our hypotheses were that (1) work-rate is unevenly distributed over a 3 shift day and (2) despite a reasonable average workload, work-rate may attain unachievable values. METHODS: Data were defined as non-ICU scheduled treatments and were collected using a custom Crystal Reports program (sapglobal.com) to query a MediLinks database (MediServe, Phoenix AZ). The database is used to record billing and charting information. Workload data consisted of scheduled treatments for small volume nebulizers (standard time = 9 min), metered dose inhalers (6 min), positive expiratory pressure (10 min), bronchopulmonary hygiene (10 min), continuous positive airway pressure (8 min), bilevel positive airway pressure (8 min), and nasotracheal suctioning (8 min). Workload was calculated as cumulative standard treatment times aggregated by hour of the day when treatments were due. Workload due times were base on ordered frequency. Policy requires therapies to be completed 30 minutes before or after due times (i.e., 1 hour window around due time). Average work-rates (workload/hour) were compared for due times during the day (08:00, 12:00, 14:00, 16:00, 20:00, 24:00, 02:00, 04:00) using one way ANOVA. P values < 0.05 were considered significant. RESULTS: Data were collected from 3/7/9 to 4/23/9. Average work-rates varied greatly (Figure) during the 24 hour day (P < 0.001). Scheduled staff averaged 7.5, 6.5, and 3.0 therapists for day, evening, and night shifts respectively. Our staff efficiency standard is 64% and assigned workload averaged 5 hours/shift. Required staffing was 34.5, 10.8, 1.6, 13.8, 21.4, 5.5, 1.0, 5.3 therapists at 08:00, 12:00, 14:00, 16:00, 20:00, 24:00, 02:00, 04:00 respectively, assuming standard treatment times were adhered to for all treatments. CONCLUSIONS: Work rates were unachievable with available staffing for 75% of scheduled due times despite presumed achievable average workload assignments. This study suggests that assignment practices common to the profession are based on questionable assumptions. Further quality improvement efforts are required to plan and implement a better work assignment system. Sponsored Research - None

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