Using data envelopment analysis to perform benchmarking in intensive care units

BACKGROUND

Studies using Data Envelopment Analysis to benchmark Intensive Care Units (ICUs) are scarce. Previous studies have focused on comparing efficiency using only performance metrics, without accounting for resources. Hence, we aimed to perform a benchmarking analysis of ICUs using data envelopment analysis.

METHODS

We performed a retrospective analysis on observational data of patients admitted to ICUs in Brazil (ORCHESTRA Study). The outputs in our data envelopment analysis model were the performance metrics: Standardized Mortality Ratio (SMR) and Standardized Resource Use (SRU); whereas the inputs consisted of three groups of variables that represented staffing patterns, structure, and strain, thus resulting in three models. We compared efficient and non-efficient units for each model. In addition, we compared our results to the efficiency matrix method and presented targets to each non-efficient unit.

RESULTS

We performed benchmarking in 93 ICUs and 129,680 patients. The median age was 64 years old, and mortality was 12%. Median SMR was 1.00 [interquartile range (IQR): 0.79-1.21] and SRU was 1.15 [IQR: 0.95-1.56]. Efficient units presented lower median physicians per bed ratio (1.44 [IQR: 1.18-1.88] vs. 1.7 [IQR: 1.36-2.00]) and nursing workload (168 hours [IQR: 168-291] vs 396 hours [IQR: 336-672]) but higher nurses per bed ratio (2.02 [1.16-2.48] vs. 1.71 [1.43-2.36]) compared to non-efficient units. Units from for-profit hospitals and specialized ICUs presented the best efficiency scores. Our results were mostly in line with the efficiency matrix method: the efficiency units in our models were mostly in the "most efficient" quadrant.

CONCLUSION

Data envelopment analysis provides managers the information needed to identify not only the outcomes to be achieved but what are the levels of resources needed to provide efficient care. Different perspectives can be achieved depending on the chosen variables. Its use jointly with the efficiency matrix can provide deeper understanding of ICU performance and efficiency.

Performance management methods and practices among nurses in primary health care settings: a systematic scoping review protocol

BACKGROUND

Nurses make up the largest constituent of the health workforce. The success of health care interventions depends on nurses' ability and willingness to provide quality health care services. A well-implemented performance management (PM) system can be a valuable asset in ensuring that nurses are motivated, promoted, trained and rewarded appropriately. Despite the significant benefits of effective PM such as improved motivation, job satisfaction and morale, PM systems are highly contested. Therefore, it is important to examine evidence on PM methods and practices in order to understand its consequences among nursing professionals in primary health care (PHC) settings.

METHODS

The search strategy of this systematic scoping review will involve various electronic databases which include Academic Search Complete, PsycARTICLES. PsycINFO, Cumulative Index to Nursing and Applied Health Literature, Medline and Cochrane Library from the EbsocHost Database Platform. Electronic databases such as PubMed and Google Scholar, Union catalogue of theses and dissertations via SABINET online and WorldCat dissertations will be incorporated. A grey literature search will be conducted on websites such as the World Health Organization and government websites to find relevant policies and guidelines. The period for the search is from 1978 to 2018. This time period was chosen to coincide with the Declaration of Alma-Ata on PHC adopted in 1978. All references will be exported to Endnote library. Two independent reviewers will begin screening for eligible titles, abstracts and full articles. During title and abstract screening, duplicates will be removed. The Mixed Method Appraisal Tool will determine the quality of included studies. Thematic analysis will be used to analyse the included articles.

DISCUSSION

Evidence of preferences on PM methods and practices will generate insight on the use of PM systems in PHC and how this can be used for the purpose of improving nurses' performance and in turn, the provision of quality health care. We hope to expose knowledge gaps and inform future research.

Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians

IMPORTANCE

Current electronic health record (EHR) user interfaces are suboptimally designed and may be associated with excess cognitive workload and poor performance.

OBJECTIVE

To assess the association between the usability of an EHR system for the management of abnormal test results and physicians' cognitive workload and performance levels.

DESIGN, SETTING, AND PARTICIPANTS

This quality improvement study was conducted in a simulated EHR environment. From April 1, 2016, to December 23, 2016, residents and fellows from a large academic institution were enrolled and allocated to use either a baseline EHR (n = 20) or an enhanced EHR (n = 18). Data analyses were conducted from January 9, 2017, to March 30, 2018.

INTERVENTIONS

The EHR with enhanced usability segregated in a dedicated folder previously identified critical test results for patients who did not appear for a scheduled follow-up evaluation and provided policy-based decision support instructions for next steps. The baseline EHR displayed all patients with abnormal or critical test results in a general folder and provided no decision support instructions for next steps.

MAIN OUTCOMES AND MEASURES

Cognitive workload was quantified subjectively using NASA-Task Load Index and physiologically using blink rates. Performance was quantified according to the percentage of appropriately managed abnormal test results.

RESULTS

Of the 38 participants, 25 (66%) were female. The 20 participants allocated to the baseline EHR compared with the 18 allocated to the enhanced EHR demonstrated statistically significantly higher cognitive workload as quantified by blink rate (mean [SD] blinks per minute, 16 [9] vs 24 [7]; blink rate, -8 [95% CI, -13 to -2]; P = .01). The baseline group showed statistically significantly poorer performance compared with the enhanced group who appropriately managed 16% more abnormal test results (mean [SD] performance, 68% [19%] vs 98% [18%]; performance rate, -30% [95% CI, -40% to -20%]; P < .001).

CONCLUSIONS AND RELEVANCE

Relatively basic usability enhancements to the EHR system appear to be associated with better physician cognitive workload and performance; this finding suggests that next-generation systems should strip away non-value-added EHR interactions, which may help physicians eliminate the need to develop their own suboptimal workflows.

Emerging Ergonomics Issues and Opportunities in Mining

Ergonomics is the scientific discipline that investigates the interactions between humans and systems to optimize both human and system performance for worker safety, health, and productivity. Ergonomics is frequently involved either in the design of emerging technologies or in strategies to alleviate unanticipated human performance problems with emerging technologies. This manuscript explores several such emerging issues and opportunities in the context of the mining sector. In mining, the equipment, tools, and procedures have changed considerably and continue to change. Body-worn technology provides a number of opportunities to advance the safety and health of miners, while teleoperation and autonomous mining equipment stand to benefit significantly from ergonomics applications in other sectors. This manuscript focuses on those issues and opportunities that can impact the safety and health of miners in the near term.

Impact of Pre-Pharmacy Work Experience on Development of Professional Identity in Student Pharmacists

Objective. To determine the benefit of pharmacy work experience on the development of student pharmacists' professional identity. Methods. Students in all four professional years were surveyed using a validated Professional Self-identity Questionnaire (PSIQ). They were also asked about pharmacy experience prior to matriculation and their performance on Drug Information tests given midway through the P1 year and at the beginning of the P3 year. PSIQ responses and test results were compared based on pharmacy experience. Results. The PSIQ was completed by 293 student pharmacists, for a 67% response rate, with 76% of respondents reporting pharmacy experience prior to matriculation. Statistically higher scores on responses to 6 of the 9 PSIQ Likert-type items were observed from students in the first professional year for those with pharmacy experience; however, only one item in the second year showed differences with none in the third and fourth years. No impact of experience was observed on Top 100 or Top 300 grades. Conclusion. Pre-matriculation pharmacy experience may increase development of professional identity early in the student experience but may have little impact on academic readiness. Schools and colleges of pharmacy hoping to recruit students with an early sense of professional identity should consider adding such experience to their admissions requirements.