Patient Care Hours Research Articles

An Introduction to the ASPAN Position Statement on Social Media and Perianesthesia Practice

IN 2011, UNDER THE LEADERSHIP of President Christine Price (2010 to 2011), the American Society of PeriAnesthesia Nurses (ASPAN) developed a Digital Media Strategic Work Team (SWT). The ASPAN's operational strategic plan included proposals to provide enhanced member experiences and improved customer service using an expanding digital platform for educational opportunities and social networking possibilities. The Digital Media SWT was charged with exploring and recommending available technology for perianesthesia education and evaluating its impact on the overall strategic plan. During the course of query and discovery, the topic of responsible use related to social media and technology was raised. Many health care providers are using the finger-touch convenience of mobile applications for research, data processing, and clinical resourcing at the bedside. Through the Clinical Practice Committee, members have been seeking guidance concerning prudent use of digital technology for both personal and professional use. While the advantages of bedside access to immediate information and resources are undeniable, there remains temptation to cross from the academic to the recreational benefits of the same technology. The use of these applications during clinical care hours for personal use raises alarms with regards to patient and personal safety. This same topic has clearly caught the attention of a wide variety of specialty nursing organizations, many of whose members have struggled with balancing the benefits of electronic networks with the risks. In concert with the members of ASPAN's Standards and Guidelines SWT, this position statement was created, endorsed at the 2013 preconference Board of Directors meeting, and approved by the members of the Representative Assembly in Chicago. American Society of PeriAnesthesia Nurses: A Position Statement on Social Media and Perianesthesia PracticeASPAN's Digital Media and Standards and Guidelines Strategic Work TeamsTHE ASPAN HAS the responsibility for defining the principles of safe, quality nursing practice in the perianesthesia setting. This includes professional conduct that reflects an understanding and respect for the moral, ethical, and legal issues of perianesthesia practice. The ASPAN, therefore, sets forth this position to acknowledge the impact of social media on clinical practice, patient safety, and professional behaviors. BackgroundAn expanding array of devices (including but not limited to smartphones, tablets, readers, netbooks, notebooks, and laptop computers) and the enhanced ease of access to the Internet have dramatically changed the ability of professionals and consumers to communicate, socialize, and find/share information at incredible rates of speed across the continents. Numerous social media sites allow for the ready access and sharing of news, information (personal and professional), images, and other content. Several basic media types currently exist. These more common platforms include virtual group rooms for information sharing, picture and video sharing sites, e-mail and instant messaging, and virtual gaming. In addition to the benefits associated with access to the social media world, there are a number of disadvantages for health care providers. These include the potential for: •Breach of privacy and confidentiality standards, •Violation of professional boundaries, •Abuse and/or misuse of technology both personally and professionally, and •Questionable reliability of information sources from the Internet. PositionThe ASPAN is highly committed as an advocate for a culture of safety and to the principles of the Perianesthesia Standards for Ethical Practice in all perianesthesia practice settings, for the patient, the nurse, and the health care team. This commitment includes the impact of technology on perianesthesia practice. The ASPAN provides the following recommendations when considering the use of social media: 1.The privacy and confidentiality of patients will be maintained at all times. 2.Perianesthesia nurses shall avoid posting or commenting on any negative reflections of colleagues, employers, or clinical situations in a public social media forum. 3.Perianesthesia nurses will protect their personal information in public social media forums. 4.Perianesthesia nurses will know and endorse institutional policies and procedures related to social media. 5.Clinical leadership will provide mechanisms to report any observed breach. 6.Educational curriculum will support education, providing principles of professionalism, privacy, and confidentiality. 7.Consider the reliability of the source when using the Internet for medical information. 8.Perianesthesia nurses will refrain from using digital means of socializing during patient care and work hours. Expected OutcomesThe ASPAN recognizes the added value that digital and social media brings to perianesthesia practice and the consequences that improper use of digital and social media can raise. Creating and maintaining a healthy work environment and relationship to digital and social media are essential priorities for perianesthesia nurses. Approval of StatementThis statement was recommended by a vote of the ASPAN Board of Directors on April 13, 2013, and approved by a vote of the ASPAN Representative Assembly on April 14, 2013, in Chicago, IL. Theresa L. Clifford, MSN, RN, CPAN, is a Clinical Resource Nurse, Mercy Hospital, Portland, ME, and a Former President of American Society of Perianesthesia Nurses from 2009 to 2010

What Would Osler Do?

What Would Osler Do?

Trends in a changing vascular practice environment for members of the Society for Vascular Surgery

To survey the Society for Vascular Surgery (SVS) membership with regard to practice trends related to work effort, employment status, practice ownership, endovascular cases, and anticipated changes in practice in the near future. A survey questionnaire was developed to gather information about member demographics and practice, hours worked, full-time (FT) or part-time status, employment status, practice ownership, competition for referrals, proportion of endovascular vs open procedures, and anticipated changes in practice in the next 3 years. We used SurveyMonkey and distributed the survey to all active vascular surgeon (VS) members of the SVS. The response rate was 207 of 2230 (10.7%). Two thirds were in private practice, and 21% were in solo practice. Twenty-four percent were employed by hospitals/health systems. Those VS under the age of 50 years were more likely to exclusively practice vascular surgery compared with VS over the age of 50 years (P= .0003). Sixty-eight of the physicians (32.7%) were between 50 and 59 years old, 186 (90.3%) were men, 192 (92.8%) worked FT (>36 hours of patient care per week), and almost two thirds worked >60 hours per week. Those in physician-owned practices worked >40 hours of patient care per week more often than did FT employed VS (P= .012). Younger VS (age<50 years) more frequently reported >50% of their workload being endovascular compared with older VS (age ≥50 years; P< .001). Eighty percent of FT VS planned to continue their current practice over the next 3 years. Of the 43.6% indicating loss of referrals, 82% pointed to cardiologists as the competition. The current workforce is predominately male and works FT; one-third is between the ages of 50 and 59 years. Younger VS (age<50 years) are more likely to exclusively practice VS and have a higher caseload of endovascular procedures. Those in physician-owned practices are more likely to put in >40 hours of patient care per week than are FT employed VS. Longitudinal surveys of SVS members are imperative to help tailor educational, training, and practice management offerings, guide governmental activities, advocate for issues important to members, improve branding initiatives, and sponsor workforce analyses.

Protecting Patients From an Unsafe System

To understand the etiology and resolution of unanticipated events in the operating room (OR). The majority of surgical adverse events occur intraoperatively. The OR represents a complex, high-risk system. The influence of different human, team, and organizational/environmental factors on safety and performance is unknown. We video-recorded and transcribed 10 high-acuity operations, representing 43.7 hours of patient care. Deviations, defined as delays and/or episodes of decreased patient safety, were identified by majority consensus of a multidisciplinary team. Factors that contributed to each event and/or mitigated its impact were determined and attributed to the patient, providers, or environment/organization. Thirty-three deviations (10 delays, 17 safety compromises, 6 both) occurred--with a mean of 1 every 79.4 minutes. These deviations were multifactorial (mean 3.1 factors). Problems with communication and organizational structure appeared repeatedly at the root of both types of deviations. Delays tended to be resolved with vigilance, communication, coordination, and cooperation, while mediation of safety compromises was most frequently accomplished with vigilance, leadership, communication, and/or coordination. The organization/environment was not found to play a direct role in compensation. Unanticipated events are common in the OR. Deviations result from poor organizational/environmental design and suboptimal team dynamics, with caregivers compensating to avoid patient harm. Although recognized in other high-risk domains, such human resilience has not yet been described in surgery and has major implications for the design of safety interventions.

Factors associated with subjective well‐being in cancer workers in Queensland

This study aims to describe factors associated with subjective well-being (SWB) in cancer workers in Queensland and compares results to normative data for the Australian population. This study was based on a cross-sectional survey of 544 cancer workers in Queensland with a response rate of 54%. SWB was measured using the Personal Wellbeing Index for Adults. Multiple regression analyses were performed to identify explanatory variables, which were independently associated with SWB. Results were compared with normative Australian data. The overall mean SWB for study participants was 74.63, which was comparable to the mean of 75.02 for the Australian population (P = 0.47). Female cancer workers had significantly lower levels of SWB compared to the normative data of female Australians (74.44 compared to 75.7, P = 0.03). Multiple regression analyses showed that higher levels of SWB were associated with having 11-30 h of direct patient care hours per week, being married, no child or elder care commitments, good physical health, low levels of both psychological distress and burnout, and high levels of work engagement. Cancer workers' overall levels of SWB were similar to the national mean scores. Amount of time in direct patient care was linked with SWB, with an optimal time between 11 and 30 h per week associated with high SWB. The majority of the factors significantly associated with SWB were of a personal nature such as marital status and physical and mental health. These data provide a valuable baseline for future research in this area, especially in the area of interventions to promote SWB of workers.

Family-friendly working conditions as an advantage in the competition for the next generation of doctors.

Despite a constant number of medical students and graduations, the exodus from the curative medicine has led to a shortage of physicians. The reasons for this - in addition to work intensification which is frequently coupled with long and often unpaid working hours, excessive bureaucracy and increasing economising - can be also found in the changing expectations and roles of young men and women who have a stronger desire for leisure and time for their families. The growing proportion of female doctors reinforces this tendency, as they are more likely to work part-time or to work limited hours or not be available at all to the workplace when pregnant or with young children. Having children usually falls into the period of professional development, so part-time employment or cessation of employment leads to longer training periods or on occasion to a complete withdrawal from a woman’s career. The under-representation of women in executive positions may also be down to the fact that when there is the double burden of work and family, career is often put on hold regardless of potential earlier plans and desires. This is likely to be the most common at university hospitals where, in addition to an already labour intensive workload beyond normal working hours in patient care, additional engagement is expected in research and teaching. And a career predominantly means postdoctoral degrees and appointments via research. The outlined development has caused calls for “family-friendly hospitals,” with better conditions for reconciling family and working life and with more and more regular leisure time. That aside, such working conditions would also represent an advantage in the competition for the next generation of doctors. Medical Practitioner Associations have raised this issue repeatedly in various campaigns and at events in the recent past. The handbook Familienfreundlicher Arbeitsplatz fur Arztinnen und Arzte – Lebensqualitat in der Berufsausubung ” published by A Buhren, A E Schoeller (Federal Medical Association 2010), this issue is looked at in more detail. The regulations on CPD attempt to recognise the desire for greater flexibility, especially for doctors of either gender with families, by recognising part-time work and CPD units with breaks, while bearing in mind the limitations caused by the need for quality.

Limiting PGY 1 Residents to 16 Hours of Duty: Review and Report of a Workshop

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted limits on duty hours. Residents were restricted to working 80 hours/week and limited to 24 hours of continuous patient care. Effective July 2011, an additional restriction will be instituted for PGY 1 residents limiting continuous duty to 16 hours maximum. Prospective evaluation of the impact of the upcoming work shift limitations for PGY 1 residents. Review of literature and discussions among program directors, program coordinators, and residents on the effects of prior limitations of duty hours, as a point of reference, to manage the changes of duty hours for PGY 1 residents during a workshop at the Association of Program Directors in Surgery Annual Meeting. Work-hour restrictions necessitate a change from the traditional 24-hour on-duty call schedule for PGY 1 residents. The benefits to patients of being treated by less tired doctors working in shifts may be offset by communication failures from poor handoffs, rendering the system prone to adverse events/near misses. With additional work-hour restrictions, it is imperative to anticipate problems and deal with them effectively. Continued reevaluation of the handoff system and efforts made to decrease the number of preventable adverse events that typically occur during periods of cross coverage should be undertaken. Labor costs to carry out these new restrictions are predictably high but can be made budget neutral if improvement in patient care leads to reduction in the costs of corrective actions. Residency programs have adapted to the 2003 work-hour restrictions without apparent ill effect. We must study the effects of the July 2011 requirements prospectively as the traditional frontline physicians (PGY 1 residents) will no longer be available for 24-hour duty shifts.

The practice of neurology, 2000–2010

To present an analysis of American Academy of Neurology (AAN) membership demographics and practice trends over the past decade. Data from the 2009 AAN Census and 2010 Practice Profile Form (PPF) surveys were compared to results from 2004 and 2000 surveys. The Census was sent to all AAN members, and the PPF was sent to a random sample of US practicing neurologists. Since 2000, AAN membership increased by 31%, and the number of US neurologist-members increased by 14%. Mean age of US neurologists increased from 48.6 to 53.3 years, and 23.9% of neurologists are women. There was a 15% increase in the proportion of neurologists relative to the US population, from 3.41 neurologists per 100,000 population in 2000 to 3.92 neurologists in 2009. In 2009, 24.1% of US neurologists were in solo practice, 27.8% were in a neurology group, and 35.6% were in multispecialty/university settings, with little change in practice arrangements over time. The top 5 practice interest areas were unchanged since 2004 as were the number of hours devoted to patient care (42.3) or total work hours per week (57.1). Little change was observed in performed procedures, except increased use of botulinum toxin and nerve blocks and a decline in lumbar punctures. Neurologists rely more on physician assistants to see follow-up and new patients independently (p < 0.001). Despite advances in neurologic diagnosis and therapy, there has been little change in practice characteristics of US neurologists.

The AAN

Four years ago, the Board of Directors of the American Academy of Neurology revisited the mission, vision, and core values of the organization. In other organizations, these efforts result in marketing statements that have little relationship to the actual enterprise. The documents are placed on a shelf to collect dust until the next strategic planning retreat. However, the mission, core values, and in particular the vision identified by the Board of Directors has focused and driven the efforts of the Academy. That vision is “to be indispensable to its members,” frequently quoted when decisions are made at either the board or committee level. To be indispensable, the Academy must know its membership and provide the initiatives and services of benefit to the membership. In this issue of Neurology ®, Adornato et al.1 review 2 recent surveys of Academy membership. There has been little change in the practice settings of neurologists in the past 10 years, with similar proportions of solo private practices, neurology groups, and multispecialty/university settings. Similarly, the hours devoted to patient care and total hours per week have changed little over the same period. As context, there has been a 14% increase in the neurology membership of the Academy and a …

Emergency Department Crowding Is Associated With Decreased Quality of Care for Children

We sought to determine which of several simple indicators of emergency department crowding are most predictive of quality of care in 2 pediatric disease models: acute asthma and pain associated with long-bone fractures. We performed a retrospective, cross-sectional study of patients 2 to 21 years old seen for acute asthma and patients 0 to 21 years old seen for acute, isolated long-bone fractures from November 1, 2007, to October 31, 2008, at a single, academic children's hospital emergency department. The main outcome measures were quality measures based on 3 asthma care-related processes-asthma score, β-agonist, and corticosteroid-and 2 fracture-related processes-analgesic and opioid analgesic. Good quality care was defined as receipt of an indicated process within 1 hour of arrival. Poor quality care was defined as nonreceipt or delayed receipt of an indicated process. Nine crowding measures were assigned based on conditions at each patient's arrival. We calculated the adjusted risk of receiving good quality care for each quality measure at 5 percentiles of crowding for each crowding measure. The asthma population included 927 patients, and the fracture population included 1229 patients. Among the 5 quality measures, we found rates of good quality care ranging from 23% to 64%. In adjusted models, we found an inverse association between crowding and quality. The 2 crowding measures with a consistently inverse association with the 5 quality measures across both populations were total patient-care hours and number arriving in prior 6 hours. Across the 10 models combining 1 of 2 key crowding variables with 1 of 5 quality measures, patients in the 2 populations were 0.40 (95% confidence interval, 0.27-0.55) to 0.78 (confidence interval, 0.71-0.85) times as likely to receive the indicated care process within 1 hour when each crowding measure was at the 75th than at the 25th percentile. Two measures of ED crowding are consistently associated with lower-quality asthma- and fracture-specific care in the ED for pediatric patients.

Protecting patients from an unsafe system

Introduction Surgical teams must deal regularly with unanticipated events in the operating room (OR). We sought to understand the etiology and resolution of these events using a qualitative assessment. Methods To increase the likelihood of capturing an event, we video-recorded and transcribed 8 complex, high-acuity operations, representing 36 hours of patient care. Deviations, defined as episodes of decreased patient safety and/or delays, were identified by majority consensus of a multidisciplinary team. Factors that contributed to each event and/or mitigated its impact were determined and attributed to the system, team or individual provider. Results 24 deviations (14 safety-compromising, 5 delays, 5 both) occurred, at a rate of approximately once every 1.5 hours. All except one were compensated such that patient harm was averted. These deviations were often multifactorial (mean 2.2 factors each). As shown in the Table, problems with communication, coordination, and organizational structure (e.g. inopportunely timed hand-offs) appeared repeatedly at the root of both types of deviations. Mediation of safety compromises was most frequently accomplished with leadership and/or vigilance, while delays tended to be resolved with improved teamwork.Frequency of Appearance of the Most Common Contributing and Compensating FactorsContributing Factors% of DeviationsMitigating Factors% of DeviationsIndividual Provider(Lack of) Knowledge/Training25Monitoring/Vigilance63(Lack of) Leadership17Knowledge/Training17Decision-Making17Leadership38Team(Mis)Communication33Communication50(Mis)Coordination46Coordination33Cooperation33SystemEquipment (Failure)17--Organizational Structure29 Conclusions Unanticipated events are common in the OR. Contrary to popular belief, these events do not reflect human fallibility mitigated by a well-designed system. Rather, deviations result from poor system design and sub-optimal team dynamics, with caregivers then compensating to avoid patient harm. Such resilience has been recognized in other high-risk work environments. These results underscore the need for system redesign and improved team training to improve patient safety.

Work engagement in cancer workers in Queensland: The flip side of burnout

The study aimed to investigate factors associated with work engagement and burnout in cancer workers in Queensland. A cross-sectional survey of 579 cancer workers in Queensland was undertaken. Burnout was measured using the Oldenberg Burnout Inventory (OLBI) and work engagement was measured using the Utrecht Work and Well-being Survey. Multiple regression analyses were performed to identify explanatory variables that were independently associated with burnout and work engagement. The survey response rate was 57%. Total levels of burnout and work engagement in the sample were 31.1% and 34.5%, respectively. Multiple regression analyses showed that shift work, 6-9 years experience, working >20 hours/week, administrative professional stream and being single were associated with higher levels of burnout. There was a positive association between work engagement and nonshift workers, <5 years experience, medical and allied health workers, and workers >45 years of age. In this study, gender, income, hours of direct patient care, location of the centre in regional centres or within the private setting did not have an independent effect on the levels of burnout or work engagement. There was a negative association between burnout and work engagement (P < 0.001). Approximately one-third of the workers sampled reported burnout. Conversely, one-third reported being highly engaged in their work. Further research is required to study the effectiveness of interventions to improve personal resources and prevent burnout. Understanding the factors associated with work engagement is equally important in designing organisational programs to enhance employee engagement.

Productivity in Audiology and Speech-Language Pathology

Productivity in Audiology and Speech-Language Pathology

Do new cohorts of family physicians work less compared to their older predecessors? The evidence from Canada

Although demographics, cohort, and contextual factors are expected to influence physician supply at the intensive margin, much of the literature has examined the demographics and very limited cohort analysis is undertaken. This paper employs a cross-classified fixed-effects methodology to examine the importance of age, period and cohort, and contextual factors in explaining the declining work hours of Canadian family physicians. We define cohorts with five-year intervals according to year of graduation from medical school. Contrary to the previous literature, we find no evidence of reduced hours of work provided by the new cohorts of physicians. Compared to the 1995–99 cohort, older male cohorts perform similar total hours of work per week except those who graduated in the 1960’s while older female cohorts consistently perform fewer total work hours in the range of 3–10 h per week. Consistent with the literature, it is found that female and older physicians provide fewer hours of work compared to the male and younger counterparts, respectively. Although there has been a decline in total hours of work for all physicians in the range of 2–3 h per week in each period, we find a large decline in direct patient care hours (about 4–6 h) and a marginal increase in indirect patient care (about 2–4 h) over the period. Having children less than 6 years and children aged 6–15 years in the physician’s family reduce the work hours of female family physicians by about 7 h and 3 h, respectively. A number of other contextual factors influence work hours of physicians in the expected direction.

Physicians Offer Rx for Health Reform Act

Physicians Offer Rx for Health Reform Act

Medical oncologists and quality of life of women treated for breast cancer.

6051 Background: Quality of life (QOL) of breast cancer patients receiving chemotherapy varies widely. More information is needed as to how the organization of care influences the experience of breast cancer patients. We examined the extent to which medical oncologists (oncs) influence breast cancer patient QOL near the time of chemotherapy. Methods: 3133 women with nonmetastatic breast cancer diagnosed from 6/05-2/07 in Detroit and Los Angeles were identified through SEER registries and surveyed after diagnosis (n = 2268, response rate 72.4%). For women who received systemic chemotherapy (n = 1,116), treating oncs were identified and surveyed (n = 207, RR 65%). Patient survey, SEER and onc data were then merged (480 patients and 145 oncs). The 5 subscales of the FACT-B – social well being (SWB), functional (FWB), physical (PWB), emotional (EWB), and breast cancer specific (BCS) - were dependent variables. Independent variables included patients factors (demographics, stage, surgery type, chemotherapy status (completed vs. ongoing), comorbidities) and onc factors (practice size, use of support personnel, university affiliation, weekly patient care hours, breast cancer case volume, frequency of visits during chemotherapy, and education/support resources). We compared the mean FACT-B scores across oncs. For each FACT-B subscale, we used random effects models to evaluate the variation at the onc level, sequentially controlling for patient and onc factors. Results: The mean (SD) FACT-B score for the sample was 95.1 (1.0) (best possible score = 144), with a range across 145 oncs between 44 and 135. The variation in FACT-B scores explained by onc characteristics was modest (7.9%). Similar effects were found for SWB (9.3%), FWB (8.2%), and BCS (7.2%). The variation explained by oncs for EWB (6.6%) and PWB (3.2%) was weaker. No specific onc variables were significantly associated with the FACT-B or subscales. Conclusions: There is modest variation in QOL among breast cancer patients receiving chemotherapy that is attributable to oncs. Oncs contribute most to SWB and FWB. Further understanding of the mechanisms by which oncology practices improve patient QOL is warranted. No significant financial relationships to disclose.

Got Volunteers? Association of Hospice Use of Volunteers With Bereaved Family Members' Overall Rating of the Quality of End-of-Life Care

Volunteers are a key component of hospice, and they are required by Medicare conditions of participation in the United States. Yet, little is known about the impact of volunteers in hospice. The goal of this study was to characterize whether bereaved family members in hospice programs with increased use of volunteer hours per patient day report higher overall satisfaction with hospice services. A secondary analysis of the 2006 Family Evaluation of Hospice Care data repository with hospice organization data regarding the number of volunteer hours in direct patient care and the total number of patient days served. A multivariate model examined the association of institutional rate of bereaved family members stating end-of-life care was excellent with that of hospices' rate of volunteer hours per patient day, controlling for other organizational characteristics. Three hundred five hospice programs (67% freestanding and 20.7% for profit) submitted 57,353 surveys in 2006 (54.2% female decedents and 47.4% with cancer). Hospice programs reported on average 0.71 hours per patient week (25th percentile: 0.245 hours per patient week; 75th percentile: 0.91 volunteer hours per patient week; and 99 th percentile: 3.3 hours per patient week). Those hospice programs in the highest quartile of volunteer usage had higher overall satisfaction compared with those in the lowest-quartile usage of volunteers (75.8% reported excellent overall quality of care compared with 67.8% reporting excellent in the lowest quartile. After adjustment for hospice program characteristics, hospice programs in the highest quartile had highest overall rating of the quality of care (coefficient=0.06, 95% confidence interval=0.04, 0.09). In this cross-sectional study, hospice programs with higher use of volunteers per patient day were associated with bereaved family member reports that the hospice program quality of care was excellent.

County-Level Estimates of Need for Mental Health Professionals in the United States

County-Level Estimates of Need for Mental Health Professionals in the United States

The Association between Emergency Department Crowding and Analgesia Administration in Acute Abdominal Pain Patients

The authors assessed the effect of emergency department (ED) crowding on the nontreatment and delay in treatment for analgesia in patients who had acute abdominal pain. This was a secondary analysis of prospectively enrolled nonpregnant adult patients presenting to an urban teaching ED with abdominal pain during a 9-month period. Each patient had four validated crowding measures assigned at triage. Main outcomes were the administration of and delays in time to analgesia. A delay was defined as waiting more than 1 hour for analgesia. Relative risk (RR) regression was used to test the effects of crowding on outcomes. A total of 976 abdominal pain patients (mean [+/-standard deviation] age = 41 [+/-16.6] years; 65% female, 62% black) were enrolled, of whom 649 (67%) received any analgesia. Of those treated, 457 (70%) experienced a delay in analgesia from triage, and 320 (49%) experienced a delay in analgesia after room placement. After adjusting for possible confounders of the ED administration of analgesia (age, sex, race, triage class, severe pain, final diagnosis of either abdominal pain not otherwise specified or gastroenteritis), increasing delays in time to analgesia from triage were independently associated with all four crowding measures, comparing the lowest to the highest quartile of crowding (total patient-care hours RR = 1.54, 95% confidence interval [CI] = 1.32 to 1.80; occupancy rate RR = 1.64, 95% CI = 1.42 to 1.91; inpatient number RR = 1.57, 95% CI = 1.36 to 1.81; and waiting room number RR = 1.53, 95% CI = 1.31 to 1.77). Crowding measures were not associated with the failure to treat with analgesia. Emergency department crowding is associated with delays in analgesic treatment from the time of triage in patients presenting with acute abdominal pain.

The feminisation of Canadian medicine and its impact upon doctor productivity

We examined the differences in work patterns between female and male doctors in Canada to gain insight into the effect of an increased number of female doctors on overall doctor productivity. Data on the practice profiles of female and male doctors across Canada were extracted from the 2007 National Physician Survey. A doctor productivity measure, 'work hours per week per population' (WHPWPP), was created, based on the number of weekly doctor hours spent providing direct patient care per 100,000 citizens. The predicted WHPWPP was calculated for a hypothetical time-point when the female and male doctor populations reach equilibrium. The differences in current and predicted WHPWPP were then analysed. Female medical students currently (2007) outnumber male medical students (at 57.8% of the medical student population). The percentage of practising doctors who are women is highest in the fields of paediatrics, obstetrics and gynaecology, psychiatry and family practice. Female doctors work an average of 47.5 hours per week (giving 30.0 hours of direct patient care), compared with 53.8 hours worked by male doctors (35.0 hours of direct patient care) (P < 0.01, chi(2) test). Female doctors tend to work less on call hours per week and see fewer patients while on-call. Female doctors are also more likely to take parental leave or a leave of absence (P < 0.01, chi(2) test). The difference in current and predicted WHPWPP was found to be 2.6%, equivalent to 1853 fewer full-time female doctors or 1588 fewer full-time male doctors. Gender appears to have a significant influence on the practice patterns of doctors in Canada. If the gender-specific work patterns described in the present study persist, an overall decrease in doctor productivity is to be anticipated.