195 Workload Measure is Responsive to Staffing Changes in a High-Volume Emergency Department

Abstract

With the growing burdens of patient volume and boarding in the emergency department (ED), the ability to measure changes aimed at improving physician wellness is needed. The NASA Task Load index (NASA-TLX) is a tool that measures perceived work burden that has been previously validated in other fields. Given planned staffing changes at high volume times, we aimed to determine whether the NASA-TLX could be used to identify a change in perceived workload after the addition of an extra resident physician for the swing and night shifts. This was a before and after observational study evaluating the impact of perceived shift workload after the addition of an extra resident during swing shift in a single, urban academic ED. Perceived workload was assessed using the NASA-TLX via an online survey completed after the conclusion of a physician’s shift. Shift times and days were controlled for when sending out surveys. Data was evaluated using Wilcoxon Rank Sum with 95% confidence intervals. Multiple linear regression was performed utilizing patients seen per shift, shift time, and whether the shift was before or after the addition of an extra resident. Significance of the added variable was assessed utilizing an F-test comparing the nested models. The survey results were collected from 1/2019 to 11/2019, with a break of about 2 months after the intervention was implemented resulting in 144 surveys completed, 73 prior to the intervention. Females made up 43% of the surveys with a 37%, 40%, and 23% distribution amongst the day, swing and night shifts, respectively. Significant decreases were found in NASA-TLX scores for both the swing and night shifts, both with a mean difference in scores of 185 (Swing: 95% CI 55 - 315, p<0.01, Night: 95% CI 5 - 390, p<0.05). No significant difference was found for the day shift with mean difference 30 (95% CI -100 to 165, p>0.5). A significant linear regression model was found (F 5.3, p<0.01) with an R2 0.13. When adjusting for shift type and patient volume, the addition of an extra resident offers a statistically significant improvement (F 9.2, p<0.01) in the explanation of the variance of NASA-TLX scores. NASA-TLX appears a responsive measure to staffing changes during busy shift times, but there remains a large variance in scores overall. Despite its validation in other fields, validation of the NASA-TLX in describing the burden of work in ED shifts would be a useful measure when evaluating departmental changes with respect to physician wellness and workload.