Factors That Influence Home Care Case Managers' Work and Workload

Analysis of home care nurses' workload: A time-motion study

This observational-descriptive time and motion study was conducted to determine how heavy home care nurses' workload is and how they allocate their work time to home healthcare. It was carried out in the home health services of the district municipality.The Information form, Nursing Activities Report Form, Cheltenham Patient Classification Scale were used. The time-motion study method was implemented to perform the workload analysis. The nurses allocated 68.02 minutes to direct care, 61.02 minutes to indirect care, 53.26 minutes to their work unit-related activities, and 119.42 minutes to their personal activities.Among all the activities performed during the day, the longest time was allocated to educational activities. Another area that took a long time was the registration procedures. Performing workload analysis with different methods that will measure many concrete and intangible attempts of home care nurses will contribute to workforce planning in home care services, resolving of the unmet home care needs of patients and continuous quality improvement.

Factors associated with the workload of health professionals in hospital at home: a systematic review

BACKGROUND

Understanding the factors related to workload, could help hospital at home (HaH) managers to make decisions on the most appropriate and efficient use of the HaH services. Published studies on this topic are scarce, so we have conducted a systematic review to identify such factors according to published evidence.

METHODS

Due to the heterogeneity of HaH models, HaH was defined as a care that provides a set of medical and nursing care and attention of hospital rank to patients at home, when they no longer require hospital infrastructure but still need active monitoring and complex care. The electronic data base literature search was conducted in MEDLINE (Ovid), EMBASE (Ovid), and Cinahl (EBSCOhost) from inception to December 2021, including grey literature. Search terms related to `hospital at home´, `workload´ and `care time´ were used. There was no restriction on language, type of study or year of publication. Quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist and certainty in the body of evidence was assessed using the GRADE Pro Tool. Results were summarised in a tabulated format.

RESULTS

Eighteen studies with 56,706 patients were included. Workload was measured as time, number of visits or both. The predictive factors of the workload included variables related to patient characteristics and other valid and reliable patient classification systems, as well as characteristics of the institutions where the studies were conducted. The factors associated with higher workloads were: being older, male, living in a rural environment, presenting a higher number of diagnoses, having worse functional status and being unable to assume self-care.

CONCLUSIONS

The identified predictors of workload are mostly associated with home nursing care. The results could be useful and applicable to different organisational models of HaH health systems. More studies that include physicians and proxy measures of workload are needed.