Duty Roster Research Articles

Physician factors associated with increased risk for complaints in primary care emergency services: a case \u2013 control study

BackgroundPatient safety incidents defined as any unintended or unexpected incident that could have or were judged to have led to patient harm, are reported as relatively common. In this study patient complaints have been used as an indicator to uncover the occurrence of patient safety incidents in primary care emergency units (PCEUs) in Norway.MethodsTen PCEUs in major cities and rural parts of Norway participated. These units cover one third of the Norwegian population. A case-control design was applied. The case was the physician that evoked a complaint. The controls were three randomly chosen physicians from the same PCEU as the physician having evoked the complaint. The following variables regarding the physicians were chosen: gender, citizenship at, and years after authorization as physician, and specialty in general practice. The magnitude of patient contact was defined as the workload at the PCEU. The physicians’ characteristics and workload were extracted from the medical records from the fourteen-day period prior to the consultation that elicited the complaint. The rest of the variables were then obtained from the Norwegian physician position register. Logistic regression was used to estimate odds ratio for complaints both unadjusted and adjusted for the independent variables. The data were analyzed using SPSS (Version25) and STATA.ResultsA total of 78 cases and 217 controls were included during 18 months (September 1st 2015 till March 1st 2017). The risk of evoking a complaint was significantly higher for physicians without specialty in general practice, and lower for those with medium low and medium high workload compared to physicians with no duty during the fourteen-day period prior to the index consultation. The limited strength of the study did not make it possible to assess any correlation between workload and the other variables (physician’s gender, seniority and citizenship at time of authorization).ConclusionsContinuous medical training and achieving the specialty in general practice were decisively associated with a reduced risk for complaints in primary care emergency services. Future research should focus on elements promoting quality of care such as continuing education, duty rosters and other structural and organizational factors.

Sustaining a national surgical training programme during the COVID-19 pandemic

The COVID-19 pandemic has disrupted all segments of daily life, with the healthcare sector being at the forefront of this upheaval. Unprecedented efforts have been taken worldwide to curb this ongoing global catastrophe that has already resulted in many fatalities. One of the areas that has received little attention amid this turmoil is the disruption to trainee education, particularly in specialties that involve acquisition of procedural skills. Hand surgery in Singapore is a standalone combined programme that relies heavily on dedicated cross-hospital rotations, an extensive didactic curriculum and supervised hands-on training of increasing complexity. All aspects of this training programme have been affected because of the cancellation of elective surgical procedures, suspension of cross-hospital rotations, redeployment of residents, and an unsustainable duty roster. There is a real concern that trainees will not be able to meet their training requirements and suffer serious issues like burnout and depression. The long-term impact of suspending training indefinitely is a severe disruption of essential medical services. This article examines the impact of a global pandemic on trainee education in a demanding surgical speciality. We have outlined strategies to maintain trainee competencies based on the following considerations: 1) the safety and wellbeing of trainees is paramount; 2) resource utilization must be thoroughly rationalized; 3) technology and innovative learning methods must supplant traditional teaching methods; and 4) the changes implemented must be sustainable. We hope that these lessons will be valuable to other training programs struggling to deliver quality education to their trainees, even as we work together to battle this global catastrophe.

Sustaining a national surgical training programme during the COVID-19 pandemic.

The COVID-19 pandemic has disrupted all segments of daily life, with the healthcare sector being at the forefront of this upheaval. Unprecedented efforts have been taken worldwide to curb this ongoing global catastrophe that has already resulted in many fatalities. One of the areas that has received little attention amid this turmoil is the disruption to trainee education, particularly in specialties that involve acquisition of procedural skills. Hand surgery in Singapore is a standalone combined programme that relies heavily on dedicated cross-hospital rotations, an extensive didactic curriculum and supervised hands-on training of increasing complexity. All aspects of this training programme have been affected because of the cancellation of elective surgical procedures, suspension of cross-hospital rotations, redeployment of residents, and an unsustainable duty roster. There is a real concern that trainees will not be able to meet their training requirements and suffer serious issues like burnout and depression. The long-term impact of suspending training indefinitely is a severe disruption of essential medical services. This article examines the impact of a global pandemic on trainee education in a demanding surgical speciality. We have outlined strategies to maintain trainee competencies based on the following considerations: 1) the safety and wellbeing of trainees is paramount; 2) resource utilization must be thoroughly rationalized; 3) technology and innovative learning methods must supplant traditional teaching methods; and 4) the changes implemented must be sustainable. We hope that these lessons will be valuable to other training programs struggling to deliver quality education to their trainees, even as we work together to battle this global catastrophe.

Prizrak pedokratii v teatre marionetok: o shkolnom samoupravlenii i granitsakh detskoy agentnosti v pervye gody sovetskoy vlasti

In Soviet Russia, the 1920s are known as a period of an unprecedented growth of the autonomy of children in various aspects of social life. One example is the decision of the Narkompros to introduce student self-government in the UnifiedLaborSchool in 1918. When raised to a national scale, the initial radical idea rapidly degraded over the following decade into a much more moderate pedagogical position that was implemented in a set of unimpressive everyday practices, predominantly meetings and duty rosters. By analyzing published and archival sources that contain evidence and opinions presented by pedagogues, teachers and students, this article traces the evolution of the idea and practices of student self-government in early Soviet Russia. The analysis of arguments in favour of expanding or limiting the agency of children in the context of self-government shows that teachers perceived the introduction of the self-government as an attack on their authority; a broad consensus existed among teachers on the necessity to control children’s agency, primarily in terms of their decision-making. A contradiction between the declared independence of children and the requisite teacher’s control was resolved by an appeal to pedagogical mastery that made it possible to render invisible the teacher’s manipulative behaviors.

Work related fatigue and sleepiness at work among intern house officers of four hospitals in Sri Lanka

Introduction: Intern house officers (IHOs) are expected to work long duration shifts with frequent on-calls. Lack of adequate sleep due to prolonged duty hours leads to increase in medical errors. United States and European countries have imposed guidelines to restrict duty hours of IHOs, however no such restrictions are implemented in Sri Lanka. Objectives: The aim of this study was to evaluate fatigability and sleepiness at work among IHOs of four main hospitals in Sri Lanka. Method: IHOs of Colombo South Teaching Hospital, National Hospital Sri Lanka, Lady Ridgway Children’s Hospital and De Soysa Maternity Hospital were recruited. Duty rosters were analysed for the length of duty shifts and night on-calls. Questionnaires were used to record fatiguability, sleepiness at work, medical errors, risk at work and daytime sleepiness. Results: Out of 94 IHOs, 73% worked more than 100 hours and 32% worked more than 125 hours a week. Notably, 38% did three night on-calls per week and 31% did more than three. Subjective fatigue level at work was reported as “most of the time” and “always” by more than 80% of IHOs, 32% had severe day time sleepiness. Fatigue risk assessment score indicated that 97% IHOs were in the high-risk group. Female IHOs were found to be more fatigued. One third of doctors reported medical errors due to fatigue and sleepiness which was significantly high in medicine rotation. Conclusions: IHOs were found to be over working. Majority were fatigued and sleepy at work. Self reported medical errors during internship were found to be high.

Health Related Reforms as a Predictor of Change of Behavior Among Inmates. A Study of Correctional Facilities in Kenya

This study focused on health related reforms on change of behavior of inmates in correctional facilities in Kenya. The study was based on the following objective; to examine how health related reforms influences change of behavior of inmates in correctional facilities in Kenya. The study tested one alternate hypothesis on whether the relationship among the study variable was significant. The target population was 10,111 individuals spread as 2,953 prison officers and 7,158 inmates. From this population a sample was drawn using a formula totaling to 385 individuals who were picked for the study. The sample was spread accordingly as 112 prison officers and 273 inmates. Purposive sampling was used to select officers’ in-charge and their deputies. Twelve prison officers on duty were picked randomly from duty roster using prime numbers for focus group discussion from each prison. A separate list of long term prisoners was compiled from the records of capital offence and other offences who have served jail term of over ten years or have been in remand for ten years and then the sample size was picked in proportionate to the population in each prison institution from the list. Primary data was gathered by a semi-structured questionnaire, an interview schedule and focus group discussion from the target population. Secondary data was gathered through analyzing relevant documents. The study incorporated quantitative and qualitative approaches to process, analyze, and interpret the data. The SPSS was applied to run analyses for percentages, frequency distributions, and measures of central tendency, where applicable. Descriptive statistics were computed for variable using frequencies, percentages, mean and standard deviation. Statistical tools used for inferential statistic were person’ s product moment correlation(r), simple regression, multiple regression and step wise regression (R 2). T-tests were used to test hypothesis in the study the results revealed that r=0.429,t=5.189, at p=0.000<0.05. H 1 was confirmed and concluded that health reforms had a statistically significant influence on change of behavior of inmates in correctional facilities in Kenya. Findings of the study are expected to assist government policy makers regarding formulation and implementation of the prison reforms. The serving inmates may benefit from the improved prison environment which will be aligned with market preference and whose content may benefit the community. Keys terms : Health related reforms, change of behavior, inmates, correctional facilities DOI : 10.7176/JLPG/91-13 Publication date: November 30 th 2019

Educational Programmes as Key Variable Towards Change of Behavior Among Inmates in Correctional Facilities in Kenya

This study focused on influence of educational programmes on change of behavior of inmates in correctional facilities in Kenya. The study was based on the following objective; to examine how educational programmes reforms influences change of behavior of inmates in correctional facilities in Kenya. The study tested an alternate hypothesis on whether the relationship among the study variable was significant. The target population was 10,111 individuals spread as 2,953 prison officers and 7,158 inmates. From this population a sample was drawn using a formula totaling to 385 individuals who were picked for the study. The sample was spread accordingly as 112 prison officers and 273 inmates. Purposive sampling was used to select officers’ in-charge and their deputies. Twelve prison officers on duty were picked randomly from duty roster using prime numbers for focus group discussion from each prison. A separate list of long term prisoners was compiled from the records of capital offence and other offences who have served jail term of over ten years or have been in remand for ten years and then the sample size was picked in proportionate to the population in each prison institution from the list. Primary data was gathered by a semi-structured questionnaire, an interview schedule and focus group discussion from the target population. Secondary data was gathered through analyzing relevant documents. The study incorporated quantitative and qualitative approaches to process, analyze, and interpret the data. The SPSS was applied to run analyses for percentages, frequency distributions, and measures of central tendency. Descriptive statistics were computed for variable using frequencies, percentages, mean and standard deviation. Statistical tools used for inferential statistic were person’ s product moment correlation(r), simple regression, multiple regression and step wise regression (R 2). T –tests were used to test hypothesis in the study the results revealed that r=0.425,t=7.129, at p=0.000 <0.05,H 1 was confirmed and concluded that educational programmes reforms, had a statistically significant influence on change of behavior of inmates in correctional facilities in Kenya. Findings of the study are expected to be crucial to government policy makers regarding formulation and implementation of the prison reforms. The serving inmates may benefit from the improved prison environment which will be aligned with market preference and whose content may benefit the community. Keywords: Educational programmes, change of behavior, inmates, correctional facilities. DOI : 10.7176/PPAR/9-11-05 Publication date: November 30 th 2019

A HYBRID ANT COLONY OPTIMIZATION ALGORITHM FOR SOLVING A HIGHLY CONSTRAINED NURSE ROSTERING PROBLEM

Distribution of work shifts and off days to nurses in a duty roster is a crucial task. In hospital wards, much effort is spent trying to produce workable and quality rosters for their nurses. However, there are cases, such as mandatory working days per week and balanced distribution of shift types that could not be achieved in the manually generated rosters, which are still being practiced. Hence, this study focused on solving those issues arising in nurse rostering problems (NRPs) strategizing on a hybrid of Ant Colony Optimization (ACO) algorithm with a hill climbing technique. The hybridization with the hill climbing is aiming at fine-tuning the initial solution or roster generated by the ACO algorithm to achieve better rosters. The hybrid model is developed with the goal of satisfying the hard constraints, while minimizing the violation of soft constraints in such a way that fulfill hospital’s rules and nurses’ preferences. The real data used for this highly constrained NRPs was obtained from a large Malaysian hospital. Specifically, three main phases were involved in developing the hybrid model, which are generating an initial roster, updating the roster through the ACO algorithm, and implementing the hill climbing to further search for a refined solution. The results show that at a larger value of pheromone, the chance of obtaining a good solution was found with only small penalty values. This study has proven that the hybrid ACO is able to solve NRPs with good potential solutions that fulfilled all the four important criteria, which are coverage, quality, flexibility, and cost. Subsequently, the hybridmodel is also beneficial to the hospital’s management whereby nurses can be scheduled with balanced distribution of shifts, which fulfil their preferences as well.

Experience of surgeon in training in COVID Era

I was privileged enough to be in a surgical residency program in an advanced tertiary care hospital under best mentor one can wish for. Early morning ward rounds, daily progress notes, case presentations, and weekend academic seminars were the usual daily routines. Assisting in operation theater, watching seniors doing meticulous surgery, and learning the tips and tricks were my favorite parts of daily routine. There is a saying that “surgeon is a physician who can operate,” but we usually ignored this aspect of surgery. My mentor emphasized the importance of medical and physiological basis of surgery almost on a daily basis.[1] It never felt so important until today. The global coronavirus 2019 (COVID-19) pandemic thwacked nearly every aspect of personal and professional life since the first case was reported in New Delhi on March 2, 2020. In a matter of few days, things changed drastically. Cases were rapidly increasing despite the countrywide lockdown. Being a chirurgien, we were neither trained nor prepared for this unprecedented time. However, emphasis on medical aspects of teaching in surgical patients suddenly became necessary lessons in these times as we were always involved in COVID care directly or indirectly. Inpatient volume reduced as hospitals prepared for the surge of COVID-19 cases and potential reallocation of residents into COVID ward and fever clinic duty. As the number of elective cases dropped, surgical resident duty rosters were modified in a manner to mitigate resident exposure and risk, while also allowing for backup options in case any resident falls ill or comes under quarantine. Surgical cases were restricted to a single resident to preserve personal protection equipment (PPE). Ward rounds include only the necessary personnel in person, and communication is largely moving to electronic forms and daily progress notes are being sent to senior consultants for whetting. Surgical training is a combination of didactic conferences and experiences, as well as hands-on surgical education. When in-person didactics are canceled and surgical volume is significantly reduced, how does a surgical trainee is supposed to fill the deficit? Fortunately, The Association of Colorectal Surgeon of India swiftly and appropriately responded in these unprecedented times by conducting more frequent webinars, video-based education, and virtual simulation for surgical residents. Initially, we were not accustomed to it, but soon, we realized it as an opportunity to embrace technological advances in internet learning and simulation. It does not only help to overcome the deficit in surgical training, but it also helps to fill the gap in academic institutional differences. Despite taking all precautions, I along with one of my resident colleagues came COVID-19 positive in the 3rd week of May 2020. From working as a resident to be admitted as a patient, it was a journey to the other side. My symptoms were mild and resolved soon. Down the road, situations such as COVID-19 will evoke us to reanalyze routines and traditions. What are the new practices that are being innovated during the COVID-19 pandemic can be adopted more broadly to enhance academic and clinical experiences. How new technology and other innovations will serve as a tool for medical care and clinical learning in the future? Likewise, promoting noncontact digital payment methods are now helping us to reduce spread of infection.[2] Surgical education is based upon the strong tradition of passing the beacon of knowledge from one generation to the next. Despite experiencing considerable loss of routines and traditions, educational and hands-on opportunities, loss of social structure, and many witnessing the frequent loss of life, we will continue with unyielding belief on core medical principles, professionalism, altruism, and quality with safety. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Six weeks' notice of the on-call roster: fact or fantasy? An audit study.

Work-life balance is directly linked to morale, job satisfaction and staff retention - all of which are linked to high quality patient care. Receiving the duty roster in advance is the first step towards achieving any work-life balance, but anecdotally doctors frequently receive very little notice of this. This audit assessed NHS trusts' compliance with the Code of Practice, with specific reference to advance notification of duty rosters. The duty roster should be made available 6 weeks before commencement of post. The initial audit comprised a survey sent to all London surgical CT1s starting in October 2016. The interventions introduced following this were creation of a shared spreadsheet containing roster coordinator contact details, reminder emails sent to roster coordinators and distribution of results to NHS Improvement. A repeat survey was sent to all London surgical CT1s and CT2s starting in October 2017. In the initial audit 48/88 (55%) responded, of whom 4/48 (8%) received their duty roster in accordance with the standard and 9/48 (19%) did not receive the roster at all before starting. A total of 40/48 (83%) of trainees had to make specific contact with their future NHS trust in order to obtain their roster. In this initial audit 12/48 (25%) of trainees were satisfied or very satisfied with the amount of notice given. In the reaudit 133/178 (75%) responded, of whom 23/133 (17%) had received their roster in accordance with the standard and 25/133 (19%) did not receive the roster at all before starting. A total of 97/133 (73%) of trainees had to make specific contact with their future NHS trust in order to obtain their roster. In the reaudit 56/133 (42%) of trainees were satisfied or very satisfied with the amount of notice given. This closed loop audit led to a doubling in the proportion of trainees receiving their rosters in accordance with the standard, and this was associated with an increase in trainee satisfaction levels. However, adherence to the standard remained low in both phases of the audit, and a significant proportion of trainees continue to commence jobs without any knowledge of their on-call roster. A range of measures is proposed to address this.

Hospital physicians can't get no long-term satisfaction - an indicator for fairness in preference fulfillment on duty schedules.

Physicians are a scarce resource in hospitals. In order to minimize physician attrition, schedulers incorporate individual physician preferences when creating the physicians' duty roster. The manual creation of a roster is very time-consuming and often produces suboptimal results. Many schedulers therefore use model-based software to assist in planning. The planning horizon for duty schedules is usually a single month. Many models optimize the plan for the current planning horizon, without taking into account data on preference fulfillment and work load distribution from previous months. It is therefore possible that, when looking at a longer time horizon, some physicians are disadvantaged in terms of preference fulfillment more often than their peers, simply because this generates better results for the individual months. This may be perceived as unfair by the disadvantaged physicians. In order to eliminate this imbalance, we introduce a satisfaction indicator for preference fulfillment in physician scheduling. This indicator is computed for each physician on each monthly plan and is then used to inform decisions regarding preference fulfillment on the current and future plans. As a result, a more equal distribution of preference fulfillment among physicians is achieved. We run a computational study with three different update strategies for our satisfaction indicator. Our study uses 24 months of data from a German university hospital and derives additional generated data from it. Results indicate that our satisfaction indicator, combined with the right update strategy, can achieve an equal distribution of satisfaction over all physicians within a peer group, as well as stable satisfaction levels for each individual physician over a longer time horizon. As our main contribution, we identify that our satisfaction indicator is more effective in creating equal distribution of long-term satisfaction the higher the rate of conflicting preferences is.

Duty rostering for physicians at a department of orthopedics and trauma surgery

This paper presents a case study of duty rostering for physicians at a department of orthopedics and trauma surgery. We provide a detailed description of the rostering problem faced and present an integer programming model that has been used in practice for creating duty rosters at the department for more than a year. Using real world data, we compare the model output to a manually generated roster as used previously by the department and analyze the quality of the rosters generated by the model over a longer time span. Moreover, we demonstrate how unforeseen events such as absences of scheduled physicians are handled.

Hospital Physicians Cannt Get No Long-Term Satisfaction An Indicator for Fairness in Preference Fulfillment on Duty Schedules

Physicians are a scarce resource in hospitals. In order to minimize physician attrition, schedulers incorporate individual physician preferences when creating the physicians’ duty roster. The manual creation of a roster is very time-consuming and often produces suboptimal results. Many schedulers therefore use model-based software to assist in planning. The planning horizon for duty schedules is usually a single month. Many models optimize the plan for the current planning horizon, without taking into account data on preference fulfillment and workload distribution from previous months. It is therefore possible that, when looking at a longer time horizon, some physicians are disadvantaged in terms of preference fulfillment more often than their peers, simply because this generates better results for the individual months. This may be perceived as unfair by the disadvantaged physicians. In order to eliminate this imbalance, we introduce a satisfaction indicator for preference fulfillment in physician scheduling. This indicator is computed for each physician on each monthly plan and is then used to inform decisions regarding preference fulfillment on the current and future plans. As a result, a more equal distribution of preference fulfillment among physicians is achieved. We run a computational study with three different update strategies for our satisfaction indicator. Our study uses 24 months of data from a German university hospital and derives additional generated data from it. Results indicate that our satisfaction indicator, combined with the right update strategy, can achieve an equal distribution of satisfaction over all physicians, as well as stable satisfaction levels for each individual physician over a longer time horizon. As our main contribution, we identify that our satisfaction indicator is more effective in creating equal distribution of long-term satisfaction the higher the rate of conflicting preferences is.

Nursing Workload in Relation to Nosocomial Infection in Public Hospital Intensive Care Unit, Malaysia

Nosocomial infections (NIs) is an infection acquired in the hospital and becomes evident 48 hours after admission to the hospital.It continues to be a major problem affecting patient safety and quality of care in Intensive Care Unit (ICU).One of the most pertinent factors leading to NIs is nursing workload. The aim of the study is to determine nursing workload on NIs rate in the ICU, Hospital Serdang. A retrospective cross sectional study was used. Data were collected from NIs surveillance,staff nurses’ duty roster and patient census by using a performa.The result in this study shows,19 %( n=88)cases of NIs were detected in 12 %( n=57) of patient. There was significant moderate positive relationship between the number of infection and the total number of nurses working overtime (r= 0.66,n=88, p = 0.001) and the number of infection and the total number of new staffs (r= 0.51, n=88, p = 0.001). There was significant weak positive relationship between the number of infection and the total number of nurses taking medical leave or emergency leave (r= 0.33, n=88, p = 0.001). This study provide a baseline to improve nursing staffing in ICU. Future planning of ICU staffing should be comprehensive so that patients are not disadvantaged.

Bespoke automation of medical workforce rostering using Google’s free cloud applications

BackgroundProviding safe and consistent care requires optimal deployment of medical staff. Ensuring this happens is a significant administrative burden due to complex working patterns. Electronic rostering platforms can help to...

Mechanical restraint and characteristics of patient, staff and shifts in a psychiatric ward

Background: The use of coercion is a balance between depriving the patients’ autonomy and dignity and preventing endangerment of the body or health of self or others. It is of importance to obtain more knowledge about mechanisms leading to mechanical restraint in the attempt of reducing it.Objective: To analyse for associations between incidence of mechanical restraint (MR) and staffing level, staff demographics, patient characteristics, type of shift (day/evening/night) and change of shifts.Method: A naturalistic descriptive method was used to study cases of MR in a psychiatric ward. Data for each case of MR was obtained from an electronic reporting system. Care workers from each shift were identified using duty rosters. Analyses included binary logistic regression analyses.Results: In 82% of the 114 cases of MR, the patient was diagnosed with personality disorders. In the multiple regression analysis, a significant association was found between the use of MR and the presence of male care workers on the ward (OR:1.44, 95% CI: 1.01–2.05; p = .04). Moreover, MR was associated with evening shifts, compared with day and night shifts (OR =1,29, 95% CI: 1.14–2.57, p = .01). Besides, months from January to December was associated with a decrease in MRs (OR: 0.88, 95% CI: 0.83–0.94; p = 7.3 E-6). No significant associations were found between MR and staffing level or experience.Conclusions: MR was associated with evening shifts, higher number of male care workers on duty and a decrease from January to December.

Duty Rosters and Workloads of Obstetricians in Germany: Results of a Germany-wide Survey.

Compiling a daily hospital roster which complies with existing laws and tariff regulations and meets the requirements for ongoing professional training while also taking the legal regulations on the health of employees into account makes planning the duty roster a challenge. The aim of this study was to obtain a realistic picture of existing duty roster systems and of the current workloads of obstetricians in Germany. This online survey was sent to 2770 physicians training to become obstetricians or specializing in specific areas of obstetric care. The survey consisted of an anonymized 95-item questionnaire which collected data on different types of duty roster systems and the workload of obstetricians in Germany for the period from 17.02.2015 to 16.05.2015. Out of a total of 2770 physicians who were contacted, 437 (16%) completed the questionnaire. Across all forms of care, the care provided outside normal working hours usually (75%) consisted of a combination of regular working times and on-call duty or even consisted entirely of standby duty. Level I perinatal centers were most likely 20% (n = 88) to have a shift system in place. Working a shift system was significantly more common in care facilities which had previously carried out a job analysis. The number of physicians in hospitals who are present during the night shift was higher in facilities with higher numbers of births and in facilities which offered higher levels of care. In addition to regularly working overtime and the fact that often not all the hours worked were recorded, it was notable that the systems used to compile duty rosters often did not comply with legal regulations or with collectively agreed working hours nor were they compatible with the staff planning requirements. The results of this study show that the conditions of work, the working times, and the organization of working times in obstetric departments are in need of improvement. Recording the actual times worked together with an analysis of the activities performed during working times and while on standby would increase the level of transparency for employers and employees.

Quality and safety of handover in intensive care

Introduction Handover is an inevitable and essential aspect of caring for critically ill patients and information handed over should be accurate, succinct, and sufficient to allow the seamless continuation of care between teams. Objectives To assess staff involvement, time taken for the handover, key components addressed, availability of a standard format and factors causing disturbances to an effective handover were the key components studied to determine the quality and safety. Methodology Study population were doctors and nursing offices working in the general and specialised ICUs of the National Hospital of Sri Lanka, De Soysa maternity hospital and the Castle street hospital for women. Study period was July to September 2013. Sample size was 120. Data was collected using a self-administered questionnaire based on the guidelines on clinical handover by the Australian Medical Association. Data was analysed as simple percentages and review of absolute numbers using bar and pie charts for each ICU. Results The doctor’s presence in the nurse’s handover and nurse’s presence in doctor’s handover was less than 70% in all the ICUs. There was no fixed time for handover in 92% of ICU shifts and nearly 90% of times it happened after the conclusion of the shift and the average time taken was 30mins. Compliance with the recommended content of handover was more than 60% in almost all the ICUs. There was no structured format for handover in any of the ICUs. Telephone calls were the most common distracting factor identified. Conclusion / Recommendations Handover can be made more effective and safe with implementation of a printed handover sheet for use as well as an overlapping shift pattern in duty rosters, dedicated time and a place for handover.

Supervision of learners with intellectual disabilities in a special school: In loco parentis of teachers as a wellness perspective

This chapter addresses a study that was conducted at a special school for learners with intellectual disabilities in the Bojanala region of South Africa’s North West Province. After all, the learners are the heartbeat of the school; in their absence, the school, its buildings and facilities, and even the teachers would be rendered pointless. The aim of this study was to explore ways in which learners are supervised and cared for, considering their mild, moderate and (in a few cases) severe intellectual disabilities. This longitudinal study took place over a period of three years and was embedded in a community engagement project conducted at a particular special school in said region. Due to the nature of a project, action research was selected as the approach most likely to yield useful results over an extended period of time. Additionally, Hettler’s Wellness Theory (1980) was used as the theoretical framework by which to investigate how this school’s teachers and other personnel adhered to the in loco parentis principle - i.e. teachers’ legal imperative to assume some of parental functions and responsibilities, including protecting learners’ physical and psychological wellbeing. As such, the school management team (SMT) and teachers made up the study’s participants. Data were collected by means of questionnaires, interviews and observations. In their encounters with the school management team, the researchers realised that it is particularly crucial to ensure learner safety at special schools. Initial findings also revealed that most of the teachers employed at the school had not received training on teaching at a special school. Furthermore, teachers indicated that they were aware of their specific roles, stating that they only needed to be reminded of what they needed to do in order to ensure learner safety at all times. They pointed out that they simply followed the duty roster with regard to learner safety. This entails teaching learners about dangerous objects like garden utensils and how to remove them from the school premises in addition to adhering to the school safety policy. The teachers further revealed that 24-hour security personnel were employed by the school and that the school premises were bordered by a fence. Meanwhile, the SMT indicated that, although the school did have a safety policy, threats to learner safety persisted. For example, learners were not provided with protective equipment while working in the workshops. The SMT listed the potential consequences of this unsafe school environment as physical injuries, bullying, kidnapping, arson, harassment, and teen pregnancies. Since the study was transformative in nature and action research was relevant, there was a need for intervention. Thus, the findings of the study were shared with the SMT. Furthermore, it was clear from conversations with teachers that they needed intervention, including in-service training. The intervention process was discussed with the school management team and all staff members. It was patently obvious that the majority of the teachers and some of the management team did not have specialised training in special needs or inclusive education and that they were not aware of the needs of learners with intellectual disabilities. The SMT thus highlighted the need for training for all staff members in how to adhere to the in loco parentis principle.

Simulated annealing approach to nurse rostering benchmark and real-world instances

The nurse rostering problem, which addresses the task of assigning a given set of activities to nurses without violating any complex rules, has been studied extensively in the last 40 years. However, in a lot of hospitals the schedules are still created manually, as most of the research has not produced methods and software suitable for a practical application. This paper introduces a novel, flexible problem model, which can be categorized as ASBN|RVNTO|PLG. Two solution methods are implemented, including a MIP model to compute good bounds for the test instances and a heuristic method using the simulated annealing algorithm for practical use. Both methods are tested on the available benchmark instances and on the real-world data. The mathematical model and solution methods are integrated into a state-of-the-art duty rostering software, which is primarily used in Germany and Austria.