12-hour Shifts Research Articles

Assessment of hand hygiene strategies on skin barrier function during COVID-19 pandemic: A randomized clinical trial.

Coronavirus disease 2019 (COVID-19) has increased the frequency of handwashing. There is scarce evidence regarding the impact of different hand hygiene procedures on skin barrier function in clinical practice. To compare the impact on skin barrier function of different hand hygiene measures in healthcare workers in daily practice. A randomized controlled clinical trial was conducted. Participants were randomized to sanitize their hands with water and soap, alcohol-based hand sanitizers (ABHSs), or disinfectant wipes during their 8-hour working shift. Epidermal barrier functional parameters, such as transepidermal water loss (TEWL), and the microbial load were assessed before and immediately after the working day. Tolerance and acceptability of each product were recorded after work. Sixty-two participants were included and 20, 21, and 21 were randomized to use water and soap, ABHS, and disinfectant wipes, respectively. After the 8-hour shift, TEWL increase was higher with disinfectant wipes than with soaps or ABHS (+5.45 vs +3.87 vs -1.46 g h-1 m-2 , respectively; P=.023). Bacteria and fungi colony-forming unit (CFU) count reductions were lower for the water and soap group than for ABHS and disinfectant wipes. Disinfectant wipes were considered more difficult to use (P=.013) compared with water and soap and ABHS. Daily hand hygiene with ABHS showed the lowest rates of skin barrier disruption and the highest reduction of CFU.

Time and Effort by Labor Nurses to Achieve and Maintain a Continuous Recording of the Fetal Heart Rate via External Monitoring

ObjectiveTo describe the time and effort of labor and delivery (L&D) nurses working to achieve a continuous recording of the fetal heart rate via external fetal monitoring, as well as the types of aids involved in that process. DesignDescriptive study using a cross-sectional survey methodology. Setting/Local ProblemNurses on our L&D units were frequently repositioning laboring women and fetal monitors, and utilizing various aids to achieve continuous monitoring. No evidence to support a best practice for achieving continuous fetal monitoring was identified. ParticipantsL&D nurses practicing in New Jersey. Intervention/MeasurementsAn online survey was used to collect data from labor nurses to identify if they used aids and what types of aids they used in their practice to achieve and maintain a continuous recording of the fetal heart rate via external fetal monitoring, as well as the amount of time that they spent doing so at the bedside. ResultsOf the 134 nurses who participated in the survey, 50% reported spending 1 to 2 hours repositioning an individual, and 48.9% reported spending 1 to 2 hours per 12-hour shift manipulating the ultrasound transducer. Thus, up to one third of the shift was spent working to achieve a continuous recording of the fetal heart rate via external fetal monitoring. More than 99% (n = 133) of participants reported the use of aids. The most popular aids included supplemental monitoring equipment such as extra fetal monitor straps or improvised aids such as washcloths. ConclusionL&D nurses spend at least some time at the bedside manipulating the ultrasound transducer to achieve and maintain a continuous recording of the fetal heart rate via external fetal monitoring. Various aids are used to do so. Understanding the amount of time nurses spend at the bedside and the aids used for this purpose may provide a better understanding of the work of L&D nurses.

Occupational Stress and Perceived Quality of Life Among Clinical Nurses: A Cross-Sectional Study in A Nigerian State

Abstract This study assessed the influence of occupational stress on perceived quality of life among clinical nurses in selected hospitals in Nigeria. A cross sectional descriptive research design was adopted while multiple sampling was used to select the respondents from hospitals in Ogun state. Slovin’s formula (n=N/[1+N (e²)]) was used to determine the sample size of 425. A structured questionnaire was used to obtain information from respondents. The analysis was done with SPSS version 25 while descriptive such as tables and bar charts and inferential statistics were used to present the data. Findings revealed that the mean age of the respondents is 36.37±8.90 years and majority of the respondents were between 30-49 years. Almost half of the respondents (48.0%) reported high occupational stress while 44.2% and 7.8% reported low & fair occupational stress respectively. High workload (83.9%), long hours of night shift (71.1%), lack of resources and equipment (67.8%), frequency night shift (67.5%), emotional load of dealing with aggressive and demanding patients (62.6%), poor salary (61.6%), and prolong standing with no time for break (58.5%) are factors responsible for stress among nurses. The results further showed that 52.2% of the respondents reported good work-related quality of life while 38.8% rated their work-related quality of life as poor. The study also showed that there was significant relationship between occupational stress (Organizational issues (P= 0.035), Occupational hazards (P= 0.024), Interpersonal relationships (p= 0.003) and unmet basic physiological needs (P= 0.005)) and work-related quality of life. Conclusion: This study concluded that occupational stress affects nurses’ work-related quality of life negatively and influence patients’ outcomes. Hence, there is an urgent need for development of health promotion programmes on stress reduction and stress management. Keywords: Influence, Occupational Stress, Quality of life, Clinical Nurses.

Risk factors, time to onset and recurrence of delirium in a mixed medical-surgical ICU population: A secondary analysis using Cox and CHAID decision tree modeling.

A retrospective secondary analysis of 4,200 patients was collected from two academic medical centers. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in all patients. Univariate and multivariate Cox models, logistic regression analysis, and Chi-square Automatic Interaction Detector (CHAID) decision tree modeling were used to explore delirium risk factors. Increased delirium risk was associated with exposed only to artificial light (AL) hazard ratio (HR) 1.84 (95 % CI: 1.66-2.044, P<0.001), physical restraint application 1.11 (95 % CI: 1.001-1.226, P=0.049), and high nursing care requirements (>8 hours per 8-hour shift) 1.18 (95 % CI: 1.048-1.338, P=0.007). Delirium incidence was inversely associated with greater family engagement 0.092 (95 % CI: 0.014-0.596, P=0.012), low staff burnout and anticipated turnover scores 0.093 (95 % CI: 0.014-0.600, P=0.013), non-ICU length-of-stay (LOS)<15 days 0.725 (95 % CI: 0.655-0.804, P<0.001), and ICU LOS ≤15 days 0.509 (95 % CI: 0.456-0.567, P<0.001). CHAID modeling indicated that AL exposure and age <65 years were associated with a high risk of delirium incidence, whereas SOFA score ≤11, APACHE IV score >15 and natural light (NL) exposure were associated with moderate risk, and female sex was associated with low risk. More rapid time to delirium onset correlated with baseline sleep disturbance (P=0.049), high nursing care requirements (P=0.019), and prolonged ICU and non-ICU hospital LOS (P<0.001). Delirium recurrence correlated with age >65 years (HR 2.198; 95 % CI: 1.101-4.388, P=0.026) and high nursing care requirements (HR 1.978, 95 % CI: 1.096-3.569), with CHAID modeling identifying AL exposure (P<0.001) and age >65 years (P=0.032) as predictive variables. Development of ICU delirium correlated with application of physical restraints, high nursing care requirements, prolonged ICU and non-ICU LOS, exposure exclusively to AL (rather than natural), less family engagement, and greater staff burnout and anticipated turnover scores. ICU delirium occurred more rapidly in patients with baseline sleep disturbance, and recurrence correlated with the presence of delirium on ICU admission, exclusive AL exposure, and high nursing care requirements.

24-hour on-duty shifts during the training of neurology residents in Spain: changes in the last decade

The neurology training program in Spain, approved in 2006, emphasizes the importance of residents' on-duty shifts supervised by a neurologist. An evaluation of the Specialty National Commission in 2008 showed an unequal fulfillment of this goal: 60.30% of the training units offered their residents 24-hour shifts with on-duty supervision, and only 43% in their own center. After more than a decade, and a new national training program on design, we would like to know the current situation and possible factors that might be involved. Cross-sectional study through self-administered surveys to neurology training units that had recently graduated residents (n = 77). Responses were collected between October 2021 and February 2022. All units answered the survey. In 2021, 88.30% met the supervision objectives, and 83% offered their trainees 24-hour on-duty shifts with a neurologist in their center. Among related factors, there is a significant direct relationship between this kind of shift, the hospital's size, and the existence of a stroke unit. Residents' guidance during the 24-hour neurology on-duty shifts follows the path set by the training program and the national commission. However, there are still some differences that go beyond purely healthcare aspects. The future national program could establish new guidelines that help us achieve less heterogeneity, in order to offer the same training in the assessment of acute neurological patients.

Job Burnout and Its Related Factors Among Surgical Technologists

Introduction: Job burnout is a long-term response to job-related emotional and interpersonal stressors. These stressors are associated with individual, interpersonal, and organizational factors. Objective: This study aimed to determine the degree of burnout and its related factors among surgical technologists. Materials and Methods: This analytical cross-sectional study was conducted in hospitals affiliated with the Iran University of Medical Sciences. A total of 125 surgical technologists were recruited by stratified sampling method. The study data were collected using a demographic questionnaire and Maslach Burnout Inventory (MBI) and then analyzed by the independent t-test, 1-way analysis of variance, and multiple linear regression with a simultaneous model. Results: More than half of the participants (52%) were in the age group of fewer than 30 years. The Mean±SD scores of job burnout in terms of intensity and frequency were 47. 88±17.5 and 47. 95±17.42, respectively. The mean job burnout scores of the majority of surgical technologists in dimensions of emotional exhaustion (intensity), depersonalization (intensity and frequency), and reduced personal accomplishment (intensity and frequency) were at a low level, but it was at a moderate level in the dimension of emotional exhaustion (frequency) among more than half of them. Through a multiple regression, the identified predictors of job burnout (frequency) were education level (β=9.377, 95%CI; 1.618-17.136, P&lt;0.05) and work experience (β=-21.091, 95%CI; -38.201- -3.980, P&lt;0.05). Meanwhile, education level (β=8.320, 95%CI; 0.568- 16.073, P&lt;0.05), work experience (β=-30.976, 95%CI; -54.715 - -7.236, P&lt;0.05), and hours of night shifts per month (β=-10.660, 95%CI; -18.205- -3.115, P=0.01) predicted job burnout (intensity). Conclusion: The job burnout of more than half of surgical technologists in the dimension of emotional exhaustion (frequency) was at a moderate level. Novice workers and operating room BScs suffered more from job burnout than those with an Associate degree and experienced workers. In this regard, healthcare and planner providers must pay attention to operating room BScs, especially novice workers.

Encounter patterns and worker absenteeism/presenteeism among healthcare providers in Thailand

• We examined number of encounters made by healthcare providers in inpatient wards. • Wards were stratified by risk of respiratory virus transmission. • A median encounter duration was two minutes. Difference in encounter patterns by ward type was observed. • About one in five work shifts were staffed by HCPs with acute muscle pain and/or respiratory symptoms who continued to work while ill. • The encounter episodes were highest among physicians working working during the 8-hour evening shift in high-risk wards. We examined the characteristics of healthcare providers’ (HCPs) encounters, and the frequency of worker absenteeism/presenteeism, among HCPs in inpatient wards at a tertiary-level public hospital in Bangkok, Thailand. The wards were stratified by risk of respiratory virus transmission: low-risk (Surgery, Rehabilitation, Orthopedic, and Obstetrics and Gynecology) and high-risk (Medicine, Pediatric, Emergency, and Ear, Nose, and Throat) . Observers followed HCPs throughout one self-selected 8-hour work shift to record their interaction with others. An encounter was defined as a 2-way conversation with ≥3 words in the physical presence of ≥1 person at <3 feet distance; or a physical skin-to-skin touch. We administered structured questionnaires to document demographics, health and work history, past practice while ill, and recent and current acute muscle pain and/or respiratory symptoms. We collected data from time and attendance records of participants reporting illness within the past seven days. From July to August 2019, 240 HCPs were enrolled and observed during 395 work shifts; 15,878 total encounters were made with a median duration of two minutes (interquartile range, 1–3). Number of contacts ranged from 25 to 49 encounters/8 h in the low-risk wards and 40 to 66 encounters/8 h in the high-risk wards. Physicians working during the 8-hour evening shift in high-risk wards had the highest estimated number of contacts (66 encounters; 95% confidence interval [CI], 43–89) while nurses working during the 8-hour night shift in the low-risk wards had the lowest number of contacts (25 encounters; 95% CI, 22–28). Forty-two (11%) shifts were staffed by HCPs with acute muscle pain and/or respiratory symptom(s) at the time of interview, and 89 (23%) by HCPs who reported symptom(s) during the past seven days, for which none were absent from work. We observed difference in encounter patterns by ward type. About one in five work shifts were staffed by HCPs with acute muscle pain and/or respiratory symptoms who continued to work while ill. These findings have implications for preventing infectious disease transmission and the policy around sick leave in healthcare settings.

Occupational Fatigue and Associated Factors among Saudi Nurses Working 8-Hour Shifts at Public Hospitals.

IntroductionShift work and demanding work schedules contribute to occupational fatigue, negatively affecting patient safety and nurses’ well-being, consequently placing nurses and patients at risk for injury and adverse health outcomes. For preventing fatigue and minimizing its negative consequences, information about its characteristics and associated factors is required.ObjectivesThis study aimed to assess occupational fatigue “acute fatigue, chronic fatigue, and inter-shift recovery” among Saudi nurses working 8-h shifts. Further, we explored factors associated with fatigue from nurses’ perspectives.MethodsWe conducted a mixed-method study with a convenience sample of Saudi nurses (N = 282) working in four public hospitals in Saudi Arabia. Data were collected using the nurses’ profile form; the occupational fatigue exhaustion recovery (OFER) scale, for relevant quantitative data; and open-ended questions for qualitative data. We used descriptive and inferential statistics for analysing the quantitative data and content analysis of the qualitative data.ResultsThe results showed that Saudi nurses rated themselves moderately fatigued with working 8-h shifts. The inter-shift recovery subscale showed a negative correlation with chronic fatigue and acute fatigue (r = −0.518, r = −0.356, P < 0.001). Sleeping problems, meals per day, and frequency of exercise showed significant relations with chronic fatigue among nurses (p < 0.05). In addition, three categories were derived from the qualitative content analysis. Saudi nurses reported work-related, psychosocial, and individual factors as major contributors to fatigue and recovery.ConclusionOccupational fatigue is a multidimensional issue, and nurses and nurse managers are challenged with reducing its prevalence and negative impact on nurses and patients. Our quantitative and qualitative findings suggest the need for a comprehensive approach to fatigue management and mitigation, including organizational support, creative workforce planning, flexible work schedules, and psychosocial support. Fatigue reduction and prevention policies and educational programs are vital strategies to improve nurses’ well-being and inter-shift recovery.

Study of the physiological effects of shift work using the HRV analysis method

Shift work in industry and services cannot be avoided, but the adverse health effects of shift work are well known. The results of workplace physiological measurements in the Hungarian solid mineral mining oil and gas extraction and processing industry was, carried out under the coordination of the Scientific Committee on Mining Health and Ergonomics of the Hungarian Academy of Sciences, The Committee studiedy the variations of age and life characteristics of the workers, the various working conditions and environment and the heart rate variability (HRV) parameters. Our workplace studies covered 8, 12 and 24-hour shift works alike during morning, afternoon and night shifts with 2, 5 or 7 days per shift. In the evaluation, the significant differences in HRV parameters reflecting different physiological conditions, working conditions and work environment are presented for the morning only (control group) and the shift work groups. Evaluation of the results of the measurements carried out at the workplaces adjusted to the actual work schedule using known methods of mathematical statistics made it possible to investigate the effects of different circumstances and conditions. Based on the reviewed research results regarding the health effects of shift work, IARC/WHO concluded in 2010 that shift work was probably carcinogenic to humans (category 2A) - a recommendation that was changed to night shift work in 2019, based on the research results revealed in the meantime. Our studies call attention to the potential for using the results of new methods developed through innovation and to the justification for their use in occupational health.

155 Piloting a Tabletop Simulation to Prepare Nurses for Ward Coordination

We know staff attrition is a core challenge for the NHS with many nurses leaving the profession in the first 2 years post-qualification The aim of the study was to improve retention and resilience of the nursing workforce by increasing confidence in their ability at clinical coordination.This table-top simulation pilot used a convenience sample of six staff nurses new to the role of clinical coordinator. We drew on clinical governance findings and input from experienced nurse-coordinators to simulate coordinating a shift on a surgical emergency unit. The shift was run in compressed time over 32 minutes followed by a 1.5 hour debrief. During the shift we used ‘injects’ intentionally designed to stimulate learning in: Problem solvingDecision-makingClinical processesSupporting colleagues/workforce resilienceSituational awarenessThe pilot was evaluated through peer observation and focus group. Peer observation provided an objective analysis of session content. A neutral party facilitated the focus group, which gathered data on how the training session had been received by participants and evaluated whether learning outcomes were met by content.Participants were assigned to work in pairs. Briefing was provided for session content and timeline. We used a simulated handover of patients for verisimilitude. The 12-hour shift was compressed into 4-minute segments with a ‘countdown’ timer ticking off each segment as the simulated shift progressed. This added time pressure and demonstrated how decision-making skills can be influenced by external forces. The participants had access to the hospital intranet and documented their actions/decisions on a template. Facilitated discussion took place after the tabletop simulation followed by a lunch break and then the focus group.

Resident Night Float or 24-hour Call Hospital Coverage: Impact on Training, Patient Outcome, and Length of Stay

The impact of neurosurgical resident hospital coverage system, performed via a night float (12-hour shifts overnight) or a 24-hour call, on neurological surgery resident training and patient care is unknown. Retrospective review comparing night float and 24-hour call coverage on trainee surgical experience, elective time, annual program surveys, patient outcomes, and length of stay. The Ohio State Wexner Medical Center Neurosurgery residency program, Columbus, Ohio. The neurosurgical residents from 2016 to 2019. Monthly cases performed by junior residents significantly increased after transitioning to a 24-hour call schedule (18 versus 30, p < 0.001). There were no differences for total cases among program graduates during this time (p = 0.7). Trainee elective time significantly increased after switching to 24-hour call coverage (18 versus 24 months after the transition; p = 0.004). Risk-adjusted mortality and length of stay indices were not different (0.5 versus 0.3, p = 0.1; 0.9 versus 0.9; p = 0.3). Program surveys had minimal change after the transition to 24-hour call. Transitioning from a night float to a 24-hour call coverage system led to improved junior resident case volume and elective time without detrimental effect on patient-related outcomes.

Analysis of time-to-disposition intervals during early and late parts of an emergency department shift.

Time-to-disposition is an important metric for emergency department throughput. We hypothesized that providers view the shift end as a key timepoint and attempt to leave as few dispositions as possible to the oncoming team, thereby making quicker decisions later in the shift. This study evaluates disposition distribution relative to when patients are assigned a provider during the course of a shift. 50,802 cases were analyzed over the one-year study interval. 31,869 patients were seen in the early half of a shift (hours 1-4) and 18,933 were seen in the later half (hours 5+). We ran a linear mixed model that adjusted for age, gender, emergency severity index score, time of day, weekend arrivals, quarter of arrival and shift type. Median time-to-disposition for the early group was 3.25h (IQR 1.90-5.04), and 2.62h (IQR 1.51-4.31) for the late group. From our mixed model, we conclude that in the later parts of the shift, providers take on average 15.1% less time to make a disposition decision than in the earlier parts of the shift. Patients seen during the latter half of a shift were more likely to have a shorter time-to-disposition than similar patients seen in the first half of a shift. This may be influenced by many factors, such as providers spending the early hours of a shift seeing new patients which generate new tasks and delay dispositions, and viewing the end of shift as a landmark with a goal to maximize dispositions prior to sign-out.

Comparison of 12-Hour Biweekly Versus 6-Hour Weekly Shifts on Fatigue in Student Nurses.

Some challenges affecting student nurse learning include student fatigue, clinical recovery time, and hindered clinical experiences due to students experiencing long clinical shifts. The aim of this study was to evaluate the differences between 12-hour biweekly and 6-hour weekly shifts on student nurse fatigue. A descriptive research design was used with second-year nursing students (N=80) upon completion of their clinical rotations of four distinct cohorts during 2019-2020. All students in these cohorts were invited to complete the Occupational Fatigue Exhaustion Recovery (OFER15) online survey, developed and validated to assess the full spectrum of fatigue. There were no statistically significant differences in acute fatigue, chronic fatigue, or the inter-shift recovery subscale for the 6-hour and 12-hour clinical groups. Student nurses, like registered nurses, would likely prefer to choose between a 6-hour and 12-hour clinical shift depending on their individual circumstances. In the parameters of this study, there was no statistical significance in shift length and student nurse fatigue. Student nurse fatigue levels can affect learning inside and outside of nursing clinical experiences. In this study, no statistical significances were found between 6-hour and 12-hour clinical experiences in second-year nursing students. Offering both the 6-hour and 12-hour clinical experiences provides flexibility for students, clinical sites, and the school of nursing.

A cross-sectional national study of burnout and psychosocial work environment in vascular surgery in Denmark

ObjectiveLittle is known about burnout among European vascular surgeons (VSs). In this study, the prevalence of burnout and its associated risk factors were investigated among all VSs and vascular surgeons in training (VSTs) in Denmark. MethodsAn anonymous electronic survey was distributed to all clinical active VSs and VSTs on January 1, 2020. Validated assessment tools were used to measure burnout and aspects of the psychosocial work environment. ResultsA total of 104 VSs and VSTs were invited to participate, and 82% (n = 85) completed the survey. The majority of the respondents were male (60%; n = 50) and VSs (67%; n = 61). Of the respondents, 82% (n = 70) reported either light (54%; n = 46), moderate (22%; n = 19), or severe (6%; n = 5) personal burnout. More than 50% (n = 47) reported work-related burnout, light (39%; n = 33), moderate (9%; n = 8), and severe (7%; n = 6), respectively, whereas 35% (n = 30) reported patient-related burnout, light (31%; n = 26), moderate (2%; n = 2), and severe (2%; n = 2), respectively. Respondents with more than four 24-hour on-call shifts per month had significantly higher work-related burnout scores, whereas respondents with home-living children and those aged 45 to 59 years showed significantly higher personal and patient-related burnout, respectively. There were strong associations between personal and work-related burnout and the psychosocial work environment, especially work organization and interpersonal relations, but not job demands. The prevalence of burnout was unevenly distributed across departments, with the most affected department having a burnout occurrence twice the least affected department. ConclusionsBased on a national survey conducted among all clinical active VSs and VSTs in Denmark, more than 80% (n = 70) suffered from burnout, of whom 28% (n = 24) suffered from moderate to severe personal burnout. The strong association with the psychosocial work environment, and the significant differences between departments, suggest that burnout is modifiable through changes in the work environment.

Is subjectively perceived treatment urgency of patients in emergency departments associated with self-reported health literacy and the willingness to use the GP as coordinator of treatment? Results from the multicentre, cross-sectional, observational study PiNo Bund

ObjectivesAim of this study was to analyse if subjectively perceived treatment urgency of patients in emergency departments is associated with self-reported health literacy and the willingness to use the general...

Application of Discrete Event Simulation in Estimating Productivity of Shotcrete Method in Divider Wall Construction

Discrete-event simulation (DES) techniques are widely used in modeling complex environments where interaction between time-dependent resources and system processes occur in sequences, such as manufacturing ecosystems or production lifecycles, providing an alternative to traditional work measurement. In this study, labor productivity of using shotcrete process in constructing wall dividers for a simple construction project is estimated using a discrete-event simulation (DES) software incorporating project data on process durations, setup time, and machine mean time to failure (MTTF) as model inputs. The simulated productivity rate of using shotcrete to construct a 1000-sq.m. wall in replications of 200, 500, and 1000 is 1.59 man-hours/sq.m., compared to computed rate of 1.33 man-hours/sq.m. using the Program Evaluation and Review Technique (PERT). The total waiting time with respect to the simulation time considering setup, process-in-waiting, and downtime is 48.9% for a single 8-hour shift per workday arrangement. It is shown that by doing multiple 8-hour shifts the resource utilization of the shotcrete equipment can be improved by an average of 43.8% per additional shift bringing the total waiting time to 9.21% for a continuous 8-hour shifts in a single workday. The methodology aims to provide a better baseline estimate of productivity as it takes in to account historical data as well as waiting time arising from resource limitations.

Peripheral Nerve Blocks Associated With Shorter Length of Stay Without Increasing Readmission Rate for Ankle Open Reduction Internal Fixation in the Outpatient Setting: A Propensity-Matched Analysis

Peripheral nerve blocks (PNB) have become an important modality for pain management in ankle fracture surgery. Previous studies have reported their efficacy, but concerns with rebound pain and readmissions have been cited as possible deterrents. The purpose of this study was to evaluate the effects of PNB on hospital length of stay (LOS), narcotic intake, visual analog scale (VAS) for pain, and associated complications in patients undergoing outpatient ankle open reduction internal fixation (ORIF). Adult patients undergoing ankle ORIF were matched 2:1 (no block:block) using propensity-score matching. Preoperative patient characteristics and postoperative outcomes were compared between cohorts. VAS and total narcotic intake were evaluated for each of the first 3 postoperative 8-hour shifts. Narcotic medication was converted to morphine milligram equivalents (MME). Thirty-two patients who received PNB were matched to 64 patients who did not. The PNB group had lower VAS and MME during each of the 8-hour shifts after surgery: 0 to 8 hours (VAS 1.8 vs 6.3; MME 10.6 vs 77.9; p < .001), 8 to 16 hours (VAS 1.2 vs 5.9; MME 9.2 vs 28.2; p < .001), 16 to 24 hours (VAS 3.7 vs 6.2; MME 13.2 vs 24.2; p = .006 and 0.019). PNB had a shorter LOS (average 16.7 hours vs 26.8 hours; p < .001). There were no differences in rates of ED presentations after discharge, hospital readmissions, or complications between cohorts. Peripheral nerve blocks after ankle ORIF are associated with shorter hospital LOS, lower VAS, and reduced narcotic intake without increasing rates of ED visits, hospital readmissions, or complications.

Statistical Design of Overnight Trials for the Evaluation of the Number of Operating Rooms That Can Be Disinfected by an Ultraviolet Light Disinfection Robotic System.

Background and objectiveThe number of ultraviolet light disinfection robot systems that are needed for a facility’s surgical suite(s) and/or procedure suite(s) depends in part on how many rooms need to be disinfected overnight by each robot and how long this will take. The answer needs to be determined separately for each surgical and procedure suite because those variables vary both among facilities and among operating rooms or procedure rooms within facilities. In this study, we consider statistical designs to assess how many rooms a facility can reliably (≥90% chance) disinfect overnight using an ultraviolet light disinfection robot system.MethodsWe used 133,927 observed disinfection times from 700 rooms as a population from which repeated samples were drawn with replacement in Monte-Carlo simulations. We used eight-hour and 10-hour shift lengths being multiples of 40 hours for full-time hourly employees.ResultsOne possible strategy that we examined was to estimate total disinfection times by estimating the mean for each room and then summing up the means. However, that did not correctly answer the question of how many rooms can reliably be available for the next day’s first case. Summing up a percentile (e.g., 90%) instead also was inaccurate, because the proper percentile depended on the number of rooms.A suitable strategy is a brief trial (e.g., nine nights or 19 nights) with the endpoint being the daily number of rooms disinfected. Empirically, the smallest count of rooms disinfected among nine nights or the second smallest count among 19 nights are 10th percentiles (i.e., ≈90% probability that at least that number of rooms can be disinfected in the future). The drawback is that while this approach gives the probability of a night with fewer rooms disinfected, it does not give information as to how many fewer rooms may either skip ultraviolet decontamination or start late the next workday because disinfection was not completed. Our simulations showed that there is a substantial probability (≥95%) of at most two rooms fewer or one room greater than the 10th percentile with a nine-night trial and one room fewer or greater with a 19-night trial.ConclusionsBecause probability distributions of disinfection times are heterogeneous both among rooms and among treatments for the same room, each facility should plan to perform its own trial of nine nights or 19 nights. This will provide results that are within two rooms or one room of the correct answer in the long term. This information can be used when planning purchasing decisions, leasing, and technician staffing decisions.

Sleep, sleepiness and need for recovery of industrial employees after a change from an 8- to a 12-hour shift system.

Employees often prefer 12-hour work shifts but they can increase sleepiness and injury risk. We assessed whether sleep, sleepiness, satisfaction and need for recovery changed after changing from an 8-hour to a 12-hour shift system. The participants were 178 employees of the paper, pulp and chemical industries. Using a quasi-experimental controlled intervention design, 83 employees, who changed from an 8-hour shift schedule to a 12-hour shift schedule were compared to those who remained in the 8-hour shift schedule (n=95). Participants filled in a survey on sleep, sleepiness, satisfaction and need for recovery at baseline and 9–12 months after the shift schedule change. We used generalized estimation equation models adjusted for age, sex, shift work experience in years and baseline shift system. Sleep length was longer in the 12-hour shift schedule before the first morning shift and between morning shifts. Sleepiness during morning shifts was less frequent and satisfaction with the shift system was more prevalent in the 12-hour shift schedule. Also, perceived negative associations of the current shift system with work-life balance were less common in the 12-hour shift schedule. The differences found between the shift systems were minor and the results did not indicate significant disadvantages of the 12-hour fast forward-rotating shift system.

12-hour shifts: balancing choice, safety and well-being

12-hour shifts: balancing choice, safety and well-being