The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Susan Gole, Robert L. Chatburn, James K. Stoller; Respiratory Institute, Cleveland Clinic, Cleveland, OH

BACKGROUND: We previously reported a new management parameter, work rate, (Respir Care 2008;53(11):1532), defined as work load due per hour based on cumulative standard treatment times. We found that work rates were unachievable with available staffing for 75% of scheduled due times despite presumed achievable average work load assignments (Respir Care 2009;54(11):1552). The purpose of this study was to determine the best ways to balance our assignment practices based on the work rate parameter. METHODS: We convened a focus group of key employees and used Root Cause Analysis to generate ideas and a plan to balance assignments based on scheduled work rate. We determined that starting scheduled treatments one hour earlier on day shift would help. Scheduled work load comprised small volume nebulizers, metered dose inhalers, bilevel positive airway pressure and mechanical ventilators. Unscheduled workload was all the other modalities. We surveyed the clinical staff to determine willingness to do this. We also evaluated basing assignments on scheduled work load rather than undifferentiated total workload. We collected 12 months of data using a custom Crystal Reports program ( to query a MediLinks database (MediServe, Phoenix AZ) to determine the ratio of scheduled to unscheduled workload. RESULTS: The survey response rate was 65% (15/24) with 88% of the staff willing to adopt an earlier start time. Results of the MediLinks data analysis indicated that on average, scheduled work load comprises 55% of the total work load. However, this metric had high variability per assignment area (range 0 – 0.99). Thus, a standard assignment of 300 minutes/8 hr shift should average 164 minutes of scheduled work load and 136 minutes of unscheduled work load but ideally should be based on actual daily area data. CONCLUSIONS: Our preliminary studies to date suggest that: (1) basing assignments on average work load leads to periodically excessive work rate, resulting in missed treatments and staff dissatisfaction; (2) given current technology and culture, we have only limited ability to reduce peaks in work rate, but staggering treatment times is effective; (3) fair assignments based on average work load should differentiate scheduled vs. unscheduled treatments. Sponsored Research - None