The impact of the patient’s initial NACA score on subjective and physiological indicators of workload during pre-hospital emergency care

Frederick Schneider,Christian M. Schulz,Gerhard Schneider,Jan Martin,Ashish K. Khanna

doi:10.1371/journal.pone.0202215

Frederick Schneider, Christian M. Schulz + Show 3 more

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https://doi.org/10.1371/journal.pone.0202215

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Abstract

BackgroundExcessive workload may impair patient safety. However, little is known about emergency care providers’ workload during the treatment of life-threatening cases including cardiopulmonary resuscitation (CPR). Therefore, we tested the hypothesis that subjective and physiological indicators of workload are associated with the patient’s initial NACA score and that workload is particularly high during CPR.MethodsNASA task load index (NASA-tlx) and alarm codes were obtained for 216 sorties of pre-hospital emergency medical care. Furthermore, initial NACA scores of 140 patients were extracted from the physicians’ protocols. The physiological workload indicators mean heart rate (HR) and permutation entropy (PeEn) were calculated for 51 sorties of primary care. General linear mixed models were used to analyze the association of NACA scores with subjective (NASA-tlx) and physiological (mean HR, PeEn) measures of workload.ResultsIn contrast to the physiological variables PeEn (p = 0.10) and HR (p = 0.19), the mental (p<0.001) and temporal demands (p<0.001) as well as the effort (p<0.001) and frustration (p = 0.04) subscale of the NASA-tlx were significantly associated with initial NACA scores. Compared to NACA = I, an initial NACA score of VI (representing CPR) increased workload by a mean of 389.5% (p = 0.001) in the mental and 345.9% (p<0.001) in the temporal demands, effort by a mean of 446,8% (p = 0.002) and frustration by 190.0% (p = 0.03). In line with the increase in NASA-tlx, PeEn increased by 20.6% (p = 0.01) and HR by 6.4% (p = 0.57).ConclusionsPatients’ initial NACA scores are associated with subjective workload. Workload was highest during CPR.

Highlights

The treatment of emergency patients can lead to occupational stress and job strain.[1]
General linear mixed models were used to analyze the association of NACA scores with subjective (NASA-tlx) and physiological measures of workload
In contrast to the physiological variables permutation entropy (PeEn) (p = 0.10) and heart rate (HR) (p = 0.19), the mental (p

Summary

Introduction

The treatment of emergency patients can lead to occupational stress and job strain.[1]. In a review by Leedal and Smith, different methodological approaches to indicators of anesthetists’ subjective and physiological workload in the operating theatre were described.[2] Leedal and Smith emphasized the importance of the NASA task load index (NASA-tlx) as an instrument for subjective workload measurements.[2] The NASA-tlx is a multi-dimensional questionnaire that has originally been designed by Hart and Staveland for the National Aeronautics and Space Agency (NASA) to assess pilots’ workload during flight simulations;[3] it has been used in various medical environments[4,5,6] including anesthesia.[7] Recently, Parsons and co-workers used the NASA-tlx to assess workload during pediatric resuscitation.[8]. Little is known about emergency care providers’ workload during the treatment of life-threatening cases including cardiopulmonary resuscitation (CPR). We tested the hypothesis that subjective and physiological indicators of workload are associated with the patient’s initial NACA score and that workload is high during CPR

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