Activities of the oral health teams in primary health care: a time-motion study.

BACKGROUND: Efficient planning of the oral health workforce in Primary Health Care (PHC) is paramount to ensure equitable community access to services. This requires a meticulous examination of the population's needs, strategic distribution of oral health professionals, and effective human resource management. In this context, the average time spent on care to meet the needs of users/families/communities is the central variable in healthcare professional workforce planning methods. However, many time measures are solely based on professional judgment or experience. OBJECTIVE: Calculate the average time parameters for the activities carried out by the oral health team in primary health care. METHOD: This is a descriptive observational study using the time-motion method carried out in five Primary Health Care Units in the city of São Paulo, SP, Brazil. Direct and continuous observation of oral health team members occurred for 40 h spread over five days of a typical work week. RESULTS: A total of 696.05 h of observation were conducted with 12 Dentists, three Oral Health Assistants, and five Oral Health Technicians. The Dentists' main activity was consultation with an average duration of 24.39 min, which took up 42.36% of their working time, followed by documentation with 12.15%. Oral Health Assistants spent 31.57% of their time on infection control, while Oral Health Technicians spent 22.37% on documentation. CONCLUSION: The study establishes time standards for the activities performed by the dental care team and provides support for the application of workforce planning methods that allow for review and optimization of the work process and public policies.

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.

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.

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.

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.

The Purpose of Time-Motion Studies (TMSs) in Healthcare: A Literature Review.

By utilizing time study methodologies, one can ascertain how long it takes a skilled person to complete a task with a specific level of quality. Time study aids in the selection of different job execution options as well as in the determination of the workforce required for a certain task, and thus assist in increasing manpower efficiency. It also aids in the acquisition of plants and machinery. By elaborating on the definition of "time-motion studies" (TMSs) as it is used in the biomedical literature and presenting justification based on full knowledge of that definition, this work aims to contribute to the standardization of TMSs. In TMSs, which is a type of quantitative data gathering, an outside observer records the motions and time necessary to complete an activity, together with an analysis aimed at increasing productivity. This paper suggests that, according to the researchers, the term is used to designate a range of investigations, the gathering and/or analysis of the length of one or more occurrences. A detailed analysis of all the available literature is done in this paper to get knowledge about TMS and its use in healthcare. Also, a comprehensive overview of many methodologies applied in works that are classed or referred to as TMSs is provided in this paper. Time motion investigations were first introduced in industrial engineering at the beginning of the twentieth century. Since then, they have been extensively employed by biological researchers, and because there is currently interest in parts of clinical workflow, they have attracted attention. However, combining the findings from different studies has proven challenging because there is a lot of variation in how techniques are used and reported. Although efforts have been made to uniformly publish these data and outcomes, there is still confusion about what TMSs are. A shared understanding of time and motion (TAM) research, as well as a proper acknowledgment of the various approaches it comprises, is a critical step toward standardization and validation. In this review paper literature analysis is done to discover what is known as TMSs to achieve the mentioned purpose.

Concussion vs. resignation by submission: Technical-tactical behavior analysis considering injury in mixed martial arts.

This research study verified the technical-tactical actions during the mixed martial arts (MMA) fights to generate serious enough injury to stop the MMA round, determining technical-tactical potential risk factors for injury in official MMA combats, according to Concussion or Resignation per Submission. A total of 990 rounds with concussions and 627 resignations per submission were considered with severe injury (i.e., a fight ended by a doctor or referee). All injuries were diagnosed and managed by attending ringside physicians during the MMA fights and rounds and had a continuous technical-tactical behavior analysis, p ≤ 0.05. The leading cause of concussion was due to head trauma (~90%), with higher dependence on head strikes scored actions. Comparisons between Concussion and Resignation per Submission combats demonstrated differences between distance head strikes actions [13(6,25) vs. 9(4,18) frequencies], clinch head strikes actions [1(0;4) vs. 1(0;3) frequencies], ground head strikes actions [1(0;8) vs. 2(0;10) frequencies] and takedowns actions [0(0;1) vs. 1(0;2) frequencies]. This information may provide significant evidence regarding the doctor stoppage in concussion combats and when it could be called by officials supervising MMA.

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.

Comparison of time taken to obtain an arterial blood gas result at the bedside using the ProximaTM point of care machine vs. a standard remote arterial blood gas analyser: A randomized controlled trial.

Introduction: The ProximaTM point of care (POC) device enables arterial blood gas (ABG) samples to be analysed without the nurse leaving the patient. The benefits of this for work efficiency have not been evaluated. Methods: We compared the time taken to obtain an ABG result using ProximaTM versus a standard ABG sampling system. Twenty patients were randomized to ABG sampling using ProximaTM, or a standard ABG system. Nurses were observed performing all ABG sampling episodes for a minimum of 24 hours and no more than 72 hours. Results: The mean time taken to obtain a result using ProximaTM was 4:56 (SD = 1:40) minutes compared to 6:31 (SD = 1:53) minutes for the standard ABG technique (p < 0.001). Mean time away from the patient's bedside was 3.07 (SD = 1:17) minutes using the standard system and 0 minutes using ProximaTM (p < 0.001). Conclusions: Reduced time for blood gas sampling and avoidance of time away from patients may have significant patient safety and resource management implications, but the clinical and financial significance were not evaluated.

Clinical comparison of intraoral CMOS and PSP detectors in terms of time efficiency, patient comfort, and subjective image quality.

Purpose: This study compared the effectiveness of complementary metal-oxide semiconductors (CMOS) and photostimulable phosphor (PSP) plates as intraoral imaging systems in terms of time efficacy, patient comfort, and subjective image quality assessment in real clinical settings. Materials and Methods: Fifty-eight patients (25 women and 33 men) were included. Patients were referred for a full-mouth radiological examination including 1 bitewing radiograph (left and right) and 8 periapical radiographs for each side (left maxilla/mandible and right maxilla/mandible). For each patient, 1 side of the dental arch was radiographed using a CMOS detector, whereas the other side was radiographed using a PSP detector, ensuring an equal number of left and right arches imaged by each detector. Clinical application time, comfort/pain, and subjective image quality were assessed for each detector. Continuous variables were summarized as mean±standard deviation. Differences between detectors were evaluated using repeated-measures analysis of variance. P<0.05 was accepted as significant. Results: The mean total time required for all imaging procedures with the CMOS detector was significantly lower than the mean total time required for imaging procedures with PSP (P<0.05). The overall mean patient comfort scores for the CMOS and PSP detectors were 4.57 and 4.48, respectively, without a statistically significant difference (P>0.05). The performance of both observers in subjectively assessing structures was significantly higher when using CMOS images than when using PSP images for all regions (P<0.05). Conclusion: The CMOS detector was found to be superior to the PSP detector in terms of clinical time efficacy and subjective image quality.

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.

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.

Emergency department physicians' distribution of time in the fast paced-workflow-a novel time-motion study of drug-related activities.

Background In the emergency department physicians are forced to distribute their time to ensure that all admitted patients receive appropriate emergency care. Previous studies have raised concerns about medication discrepancies in patient's drug lists at admission to the emergency department. Thus, it is important to study how emergency department physicians distribute their time, to highlight where workflow redesign can be needed.Aim to quantify how emergency department physicians distribute their time between various task categories, with particular focus on drug-related tasks.Method Direct observation, time-motion study of emergency department physicians at Diakonhjemmet Hospital, Oslo, Norway. Physicians' activities were categorized in discrete categories and data were collected with the validated method of Work Observation Method By Activity Timing between October 2018 to January 2019. Bootstrap analysis determined 95% confidence intervals for proportions and interruption rates.Results During the observation time of 91.4 h, 31 emergency department physicians were observed. In total, physicians spent majority of their time gathering information (36.5%), communicating (26.3%), and documenting (24.2%). Further, physicians spent 17.8% (95% CI 16.8%, 19.3%) of their time on drug-related tasks. On average, physicians spent 7.8 min (95% CI 7.2, 8.6) per hour to obtain and document patients' drug lists.Conclusion Emergency department physicians are required to conduct numerous essential tasks and distributes a minor proportion of their time on drug-related tasks. More efficient information flow regarding drugs should be facilitated at transitions of care. The presence of healthcare personnel dedicated to obtaining drug lists in the emergency department should be considered.

Intervalos de tempo para processamento de materiais consignados de prótese total de quadril / Processing time of loaner items for total hip replacement / Intervalos de tiempo para el procesamiento de materiales consignados para prótesis total de cadera

Objetivo: Estimar os intervalos de tempo envolvidos no reprocessamento de materiais consignados temporários de prótese total de quadril em um centro de material e esterilização de um hospital privado de São Paulo (SP). Método: Estudo exploratório-descritivo, de campo, com abordagem quantitativa. A amostra foi composta de 41 processamentos de materiais consignados. Os intervalos de tempo foram registrados com auxílio de cronômetro digital, hora inicial e final de cada atividade. O cálculo amostral foi estimado com intervalo de confiança de 95%. Resultados: O tempo total do processamento teve mediana de 10 horas, o tempo efe-tivo total foi de 4,9 horas e o intervalo de tempo entre o fim do reprocessamento e o horário da cirurgia foi de 4,7 horas de antecedência. Houve cancelamento de uma cirurgia em virtude do atraso na entrega do material. Conclusão: Nesta pesquisa foram mensurados os tempos de reprocessamento de materiais consignados, sendo mantido o rigor metodológico em todas as etapas, com estimativas que respeitaram o intervalo de confiança, o que faz deste estudo passível de reprodução. Sugere-se que profissionais de outras instituições realizem tais mensurações, de modo que permitam a construção de indicadores, auxiliando enfermeiros na tomada de decisão.

Objective: To estimate the time intervals necessary to reprocess loaner items for total hip replacement in a sterile processing department of a private hospital in São Paulo (SP). Method: This is an exploratory, descriptive field study with a quantitative approach. The sample consisted of 41 processing cycles for loaner items. Intervals were recorded using a digital stopwatch, including the start and end times of each activity. Sample calculation was estimated with a 95% confidence interval. Results: Median total processing time was 10 hours, total effective time was 4.9 hours, and the interval between the end of reprocessing and the time of surgery was 4.7 hours in advance. One surgery was canceled due to delayed delivery of the item. Conclusions: This study measured the reprocessing times of loaner items, maintaining the methodological rigor at all stages, with estimates that respected the confidence interval, making this investigation reproduci-ble. We suggest that professionals from other facilities perform these measurements to allow the construction of indicators that can help nurses in decision-making.

Objetivo: Estimar los intervalos de tiempo involucrados en el reprocesamiento de materiales consignados temporalmente para reemplazo total de cadera en un Centro de Material y Esterilización de un hospital privado de São Paulo. Método: Estudio de campo exploratorio-descriptivo con enfoque cuantita-tivo. La muestra consistió en 41 procesamientos de materiales consignados. Los intervalos de tiempo se registraron con la ayuda de un cronómetro digital, hora de inicio y finalización de cada actividad. El cálculo del tamaño de la muestra se estimó con un intervalo de confianza del 95%. Resultados: El tiempo total de procesamiento tuvo una mediana de 10 horas; el tiempo efectivo total fue de 4,9 horas y el intervalo de tiempo entre el final del reprocesamiento y el momento de la cirugía fue de 4,7 horas antes. Se canceló una cirugía debido al retraso en la entrega del material. Conclusión: En esta investigación se midieron los tiem-pos de reprocesamiento de los materiales consignados, manteniendo el rigor metodológico en todas las etapas, con estimaciones que respetaron el intervalo de confianza, haciendo este estudio susceptible de reproducción. Se sugiere que profesionales de otras instituciones realicen dichas mediciones, de manera que per-mitan la construcción de indicadores, ayudando a las enfermeras en la toma de decisiones.

Differences in Documented and Actual Medication Administration Time in the Emergency Department: A Prospective, Observational, Time-Motion Study.

INTRODUCTION: Retrospective studies suggest that a rapid initiation of treatment results in a better prognosis for patients in the emergency department. There could be a difference between the actual medication administration time and the documented time in the electronic health record. In this study, the difference between the observed medication administration time and documentation time was investigated. Patient and nurse characteristics were also tested for associations with observed time differences. METHODS: In this prospective study, emergency nurses were followed by observers for a total of 3 months. Patient inclusion was divided over 2 time periods. The difference in the observed medication administration time and the corresponding electronic health record documentation time was measured. The association between patient/nurse characteristics and the difference in medication administration and documentation time was tested with a Spearman correlation or biserial correlation test. RESULTS: In 34 observed patients, the median difference in administration and documentation time was 6.0 minutes (interquartile range 2.0-16.0). In 9 (26.5%) patients, the actual time of medication administration differed more than 15 minutes with the electronic health record documentation time. High temperature, lower saturation, oxygen-dependency, and high Modified Early Warning Score were all correlated with an increasing difference between administration and documentation times. DISCUSSION: A difference between administration and documentation times of medication in the emergency department may be common, especially for more acute patients. This could bias, in part, previously reported time-to-treatment measurements from retrospective research designs, which should be kept in mind when outcomes of retrospective time-to-treatment studies are evaluated.

Improvement in outpatient services using the WeChat calling system in the Shanghai Children's Hospital.

OBJECTIVES: We explored the utility of WeChat applet as part of the Outpatient Department (OPD) to provide patients with timely queuing information and compared it with the traditional calling system. METHODS: Data for the WeChat calling system was extracted for the period of May 2018 to September 2018. Data for the traditional system was extracted for the same period from the year 2017. We compared the effective patient waiting time and nurse idle time i.e. nonproductive time spent on factors outside of employees' control with the two systems. We also analyzed the relationship between the length of waiting time and conflicts between doctors and patients. RESULTS: The mean wait time for the traditional calling system was 126 minutes, while the average idle time for nurses was 96 minutes/day. On the other hand, the mean wait time for the WeChat calling system was 33 minutes, and the average idle time for nurses was 72 minutes/day. The incremental profit (cost of traditional calling system - cost of WeChat calling system) achieved from switching systems was 13,879 yuan/month. Behavioral observations showed that wait time (OR=2.745, 95%CI 1.936~3.892 P<0.0001) was a risk factor for staff-patient conflict. CONCLUSION: The cost of the WeChat calling system was significantly lower than the traditional system. Also, the traditional calling system was time-consuming. Longer waiting time was the main factor affecting OPD quality and caused conflicts between doctors and patients.

Evaluación inicial del Sistema de Referencia y Contrarreferencia ambulatoria en la DIRIS Lima Norte, desde los centros materno infantiles

Desde julio 2018 se implementa el SRCR de consulta ambulatoria en IPRESS de DIRIS Lima-Norte utilizando el aplicativo REFCON; incluye cinco sub-procesos, tres de ellos ocurren en IPRESS de destino. Objetivo : Caracterizar las referencias emitidas en las IPRESS I-4 que tuvieron como IPRESS de destino a los hospitales de la DIRIS Lima Norte, y el tiempo de citas de las mismas. Material y métodos : Estudio cuantitativo observacional de tipo transversal, que incluyó las referencias emitidas en el periodo mayo-octubre 2019, por siete IPRESS I-4. Se analizaron las referencias por IPRESS, sexo, etapa de vida, especialidad y tiempos hasta la cita. Se estimó medidas de tendencia central y dispersión; y chi-cuadrado para el análisis bivariado, usando Stata v.16. Resultados : Hubo 19 951 referencias de siete IPRESS de origen. La población más referida fue de 30-59 años (39,22%) y mujeres (67,04%). Se excluyó del análisis de tiempos 2 714 referencias por información incompleta. El tiempo de aceptación en IPRESS de destino mostró gran variabilidad, solo 23,14% fueron aceptadas en menos de 24 horas. El subproceso de aceptación hasta la cita mostró que la mitad de pacientes demoraron entre 80-85 días en ser atendidos. Solo se reportaron 110 contrarreferencias; de ellas, 48 (43,6%) fueron a Juan Pablo II. Conclusiones : Se evidencia una incipiente implementación, ausencia de normatividad, irregular capacitación de personal y limitación de personal que se traduce en alto porcentaje de rechazos y retrasos en aprobación de referencias. Y tiempos mayores de 80 días desde el registro de la referencia hasta la cita, para el 50% de las mismas, desconociendo el porcentaje de citas atendidas.

SUMMARY Starting in July 2018 the ORCR was implemented in the IPRESS-DIRIS Lima Norte using the REFCON instrument that includes five processes, three of which occur in the IPRESS of destiny. Objective : To characterize the references of IPRESS I-4 whose destiny were DIRIS Lima Norte and time to appointment of the encounters. Methods : A cross- sectional study was carried-out from May to October 2019 including seven IPRESS I-4. References by age, sex and specialty were analyzed as well as time to appointment. Statistics for means and proportions were calculated using Stata v.16. Results : A total of 19,951 references from seven IPRESS were included in the analysis. The most common age group was 30-59 years (39.22%): women accounted for 67.04%. We excluded from the final analysis 2,714 references for not having information on time to appointment. Only 23.14% of referrals were accepted in less than 24 hours. Half of patients had to wait between 80-85 days to have an appointment. Only 110 counter-references were reported, 43.6% went to Juan Pablo II. Conclusions : We observed a clearly inefficient system with long delays in making appointments and high rate of referral rejections, these findings are the result of lack of regulation, lack of manpower and poor training of the existing personnel.

The Influence of Carrying Anterior Load on the Sagittal and Frontal Plane Kinematics of Lower Extremities during Stair Ascending.

BACKGROUND: Anterior load carriage is a one of the commonly performed activities in some industries. Stair climbing while carrying anterior load significantly alters different biomechanical mechanisms that can potentially affect the musculoskeletal function of the lower extremities. OBJECTIVE: The study aims to assess the effect of carrying an anterior load (20% of body weight) on lower extremity kinematics during the kinematical phases of stairs ascent (weight acceptance, pull up, forward continuance, and swing phase). MATERIAL AND METHODS: In this experimental study, data were collected through the use of a custom made wooden staircase and OPtiTrack motion capture system was composed of 12 infrared cameras and a per modeled reflective marker set. Sixteen female college students volunteered to conduct two tasks of ascending stairs with and without an anterior load of approximately 20% of their body weight. The collected frontal and sagittal plane lower extremity joint angles were calculated using MATLAB software (version R2015a). Statistical comparison between the two study tasks was made using IBM SPSS Statistics software (version 25.0; SPSS Inc., Chicago, IL, USA). RESULTS: Based on the results, there is significant difference (p-value < 0.05) between the two study tasks during ascending stair phases in all three sagittal plan lower extremity joint angles. CONCLUSION: Anterior load carried during stair ascent causes participants to depend more on the hip joint (higher flexion angles) compared to stair ascent without loads, which may increase the risk of falls and injuries, and the importance of muscle-strengthening activities and highlight the use of appropriate technique during load carriage.

Use of Lean Methodologies in Outpatient Urology Clinic.

INTRODUCTION: Our objective was to apply lean methodologies to identify and improve processes in the urology clinic. METHODS: A total of 85 appointments in provider and procedure clinics were observed and analyzed using time studies, spaghetti diagrams and process mapping tools. The team determined wait times and rework as areas for quality improvement. Rework is defined as the technician or provider having to see the patient multiple, separate times during a visit. We implemented assigning 1 technician to 1 provider, prepping patient charts in advance, and daily huddles. The team performed a PDSA (Plan, Do, Study, Act) cycle and observed 53 more appointments. RESULTS: Through these interventions the clinic saw improvements in all areas of concern. In the provider clinic, the initial wait times decreased by 63%. Rework decreased by 48%. The overall number of technician rework decreased by 17% and overall provider rework decreased by 50% saving a median of 6 minutes per visit. The procedure clinic saw improvements including up to a 43% decrease in the initial wait time, the chance of all rework decreasing by 55% and the technician rework decreased by 36%, saving 16 minutes per visit. CONCLUSIONS: These interventions proved beneficial in reducing waste and operating a more effective and efficient clinic.