Scheduled Work Hours Research Articles

Do emergency medicine residents have access to healthy food options during work hours?

Relatively little data describe how diet and food choices impact trainee well-being despite evidence that diet impacts both physical and mental health. The objective was to describe food options available to emergency medicine (EM) residents when on duty. A survey utilizing closed-ended, binary, rank-order responses was developed by experts in graduate medical education and wellness; it was piloted, revised, and then electronically distributed to 211 EM residency programs over 2 weeks in 2021. The program director (PD) or associate PD was invited to participate. A total of 114 EM programs participated (54%). The primary teaching site included 43 community hospitals, 23 county hospitals, and 48 university hospitals. Resident access to an onsite hospital cafeteria was most common (97%); other onsite options were vending machines (87%), fresh food fridges (34%), national chains (32%), local restaurants (25%), food trucks (30%), and farmer's markets (11%). More than one-third (38%) reported that onsite options did not include healthy food, 26% reported being dissatisfied with onsite food, and 35% rarely or never purchased food onsite. Most programs (89%) do not have a dedicated "meal break" for residents while on duty. Few residency programs include diet or nutrition classes or counseling. When programs sponsor meals during residency events, nutritional value and dietary considerations were ranked less important than cost of food and convenience. Access to healthy food options is not always available during scheduled resident work hours, and dedicated meal breaks are infrequent. These data should inform institutional initiatives to improve the health and well-being of resident physicians.

Does it matter whether others are working hard or hardly working? Effects of descriptive norms on attitudes to time theft at work

AbstractTime theft—time that employees waste or spend not working during their scheduled work hours—poses serious costs to many employers. Although previous research has suggested the importance of social norms for understanding time theft behavior, experimental studies are lacking. This paper presents the results of two preregistered experiments that examined if information about whether most people engage in time theft or not (descriptive norms) has effects on intentions and attitudes to steal time at work. The results confirmed that people are less willing to conduct time theft if they are led to believe that others avoid such behaviors (Experiment 1, N = 170). However, the same norm information did not alter people's moral judgments of coworkers who engage in time theft (Experiment 2, N = 183). The findings tentatively suggest that the less time theft employees see, the less time theft they will commit.

Abstract P4-05-04: Health-Related Quality of Life and Work Impairment Among Individuals Living with HER2+ Breast Cancer with Brain Metastases

Abstract Background: Roughly 20% of people diagnosed with breast cancer (BC) will be considered HER2+. HER2+ BC patients are among those at highest risk for developing brain metastases, with up to 50% developing brain metastases. Brain metastases are associated with faster disease progression, shorter survival, and myriad increased impairments. Despite the significant burden faced by HER2+ BC patients living with brain metastases (BMBC), there is little empirical research available regarding the unique experiences of this population. The goals of this exploratory study were to examine the feasibility of recruiting HER2+ BMBC patients to complete an online survey, and to describe their health-related quality of life (HRQOL) and experiences with work impairment. Methods: 62 women with HER2+ metastatic BC were recruited via advocacy partners, Living Beyond Breast Cancer and Metastatic Breast Cancer Alliance, and completed an online survey in January 2022. Participants reported sociodemographics, clinical history, current caregiving support received, physical health (Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical Health 2av1.2), HRQOL (PROMIS-29v2.0 and PROMIS Cognitive Function Short Form 8a) and work impairment (Work Productivity and Activity Impairment Questionnaire–Specific Health Problem (WPAI-SHPv2.0)). Descriptive statistics were calculated for study variables; PROMIS measures were converted to T scores (M=50, SD=10), enabling comparisons to established population benchmarks. Results presented in this study are restricted to the 30 HER2+ participants living with BMBC. Results: Participants were 47% White, 23% Hispanic, 23% Asian, 3% Black/African American, 3% American Indian/Alaska Native; mean age=43y (range: 33-72); 83% held a Bachelor degree or higher; 70% were married or partnered; mean years since BMBC diagnosis=2.7 (range: < 1-20); mean years between diagnosis and onset of metastatic disease=1.8 (range: 0-11). 67% of participants reported receiving constant care from a caregiver; the remaining participants reported receiving an average of 10.2 hours/week of care. 50% of participants reported physical health corresponding to poor levels (>2 SD on PROMIS). The majority of participants reported HRQOL impairments corresponding to moderate to severe levels (>1SD on PROMIS): Anxiety (84%); Physical Function (80%); Pain Interference (77%); Depression (70%); Fatigue (70%); Sleep Disturbance (67%); Cognitive Function (63%); and Ability to Participate in Social Roles and Activities (53%). Mean symptom burden T-scores (range: 60.4-67.7) and mean functional impairment T-scores (range: 36.0-39.9) were poorer relative to several reference groups (i.e., other women with HER2+ MBC, overall BC population benchmarks, general US population benchmarks). At the time of the survey, 73% of participants were not employed due to disability. Among those employed (n=7); 100% reported that BMBC negatively affected their employment in the past week: mean percent of scheduled work hours missed=37% (range: 14-74%); mean percent of reduced productivity while working=39% (range: 0-80%); and mean overall work impairment=60% (range: 39-95%). Conclusions: HER2+ BMBC patients experience substantial emotional, physical, social, and cognitive quality of life impairments, high work absenteeism, reduced productivity, and overall work impairment, suggesting significant unmet needs for this population. Efforts to recruit HER2+ BMBC patients were successful, suggesting high feasibility of future work with a more robust sample. Despite the small sample size, our descriptive results provide a key foundation for future research with HER2+ BMBC patients to formally test hypotheses and evaluate predictor variables impacting patient HRQOL and work impairment. Citation Format: Victoria G. Morris, Alexandra K. Zaleta, Heather Badt. Health-Related Quality of Life and Work Impairment Among Individuals Living with HER2+ Breast Cancer with Brain Metastases [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-05-04.

Adopting a metaverse-based workspace to support research team collaboration: a pilot study from an academic health informatics laboratory.

This study aimed to understand how a metaverse-based (virtual) workspace can be used to support the communication and collaboration in an academic health informatics lab. A survey of lab members (n = 14) was analyzed according to a concurrent triangulation mixed methods design. The qualitative survey data were organized according to the Capability, Opportunity, Motivation, Behavior (COM-B) model and combined to generate personas that represent the overall types of lab members. Additionally, scheduled work hours were analyzed quantitatively to complement the findings of the survey feedback. Four personas, representative of different types of virtual workers, were developed using the survey responses. These personas reflected the wide variety of opinions about virtual work among the participants and helped to categorize the most common feedback. The Work Hours Schedule Sheet analysis showed the low number of possible collaboration opportunities that were utilized compared to the number available. We found that informal communication and co-location were not supported by the virtual workplace as we had originally planned. To solve this issue, we offer 3 design recommendations for those looking to implement their own virtual informatics lab. First, labs should establish common goals and norms for virtual workplace interactions. Second, labs should carefully plan the virtual space layout to maximize communication opportunities. Finally, labs should work with their platform of choice to address technical limitations for their lab members to improve user experience. Future work includes a formal, theory-guided experiment with consideration on ethical and behavioral impact.

Time Theft in the Los Angeles Retail Sector: The Need for New Labor Standards and a Fair Workweek

We argue that employers subject workers to time theft by controlling workers’ time—both on and off the clock. Time theft considers employer control of workers’ time without the promise of pay through unstable scheduling practices as well as beyond their scheduled work hours. We develop a typology of time theft through a discussion of survey and workshop data with retail workers in Los Angeles. We underscore how federal labor law is inadequate to address unstable scheduling and we discuss retail worker organizing and the implications of time theft for labor policy and worker movements.

Challenges and Benefits of ‘Work from Home’ for employees in the Kingdom of Bahrain

COVID-19 ushered in a range of strategic, structural, and operational changes in organisations. Significant among these changes being the work from home (WFH) arrangement. The main aim of this study was to identify the challenges and benefits that the WFH arrangement brought in its wake, for employees in the Kingdom of Bahrain. The similarities and differences in the challenges faced, and benefits reaped by different demographic segments of respondents, namely; male and female, managers and non-managers, and the four generations [Baby-boomers, Gen X, Millennials, and Gen Z] were examined. The study revealed that the major challenges faced by respondents of these segments were receiving work requests from managers and colleagues after scheduled work hours and/or at their convenience, keeping a regular schedule, keeping family members away from workspace- especially during virtual meetings, not having access to the tools or information needed for the job, not having workspace/workstation at home, and communication with colleagues being hard. The major benefits listed were saving commute time, flexible working, work life balance, personal and family care, and more focus. The general preference of majority of the respondents was to continue with WFH arrangement - half the time in the future. The findings of this study threw light on the need for organisations to formulate policies for overcoming the challenges faced by respondents during WFH. This would result in better productivity and contribute to the employees’ well-being.

Physicians' electronic inbox work patterns and factors associated with high inbox work duration.

Electronic health record systems are increasingly used to send messages to physicians, but research on physicians' inbox use patterns is limited. This study's aims were to (1) quantify the time primary care physicians (PCPs) spend managing inboxes; (2) describe daily patterns of inbox use; (3) investigate which types of messages consume the most time; and (4) identify factors associated with inbox work duration. We analyzed 1 month of electronic inbox data for 1275 PCPs in a large medical group and linked these data with physicians' demographic data. PCPs spent an average of 52 minutes on inbox management on workdays, including 19 minutes (37%) outside work hours. Temporal patterns of electronic inbox use differed from other EHR functions such as charting. Patient-initiated messages (28%) and results (29%) accounted for the most inbox work time. PCPs with higher inbox work duration were more likely to be female (P < .001), have more patient encounters (P < .001), have older patients (P < .001), spend proportionally more time on patient messages (P < .001), and spend more time per message (P < .001). Compared with PCPs with the lowest duration of time on inbox work, PCPs with the highest duration had more message views per workday (200 vs 109; P < .001) and spent more time on the inbox outside work hours (30 minutes vs 9.7 minutes; P < .001). Electronic inbox work by PCPs requires roughly an hour per workday, much of which occurs outside scheduled work hours. Interventions to assist PCPs in handling patient-initiated messages and results may help alleviate inbox workload.

Automatic Work-Hours Recorder for Medical Staff (Staff Hours): Mobile App Development.

BackgroundThere are numerous mobile apps for tracking work hours, but only a few of them record work hours automatically instead of relying on manual logging. No apps have been customized for medical staff, whose work schedules are highly complicated as they have both regular hours and on-call duties.ObjectiveThe specific aims of this study were to (1) identify the Staff Hours app users’ GPS-defined work hours, (2) examine the overtime work hours from the app-recorded total work hours and the participants’ self-reported scheduled work hours, and (3) compare these app-recorded total work hours among different occupations.MethodsWe developed an app, Staff Hours, to automatically calculate a user’s work hours via GPS background data. Users can enter their scheduled hours, including regular hours and on-call duties. The app automatically generates overtime reports by comparing the app-recorded total work hours with the user-defined scheduled hours. A total of 183 volunteers (60 females and 123 males; mean age 32.98 years, SD 6.74) were included in this study. Most of the participants (162/183, 88.5%) were medical staff, and their positions were resident physicians (n=89), visiting staff (n=38), medical students (n=10), registered nurses (n=25), and non–health care professionals (non-HCPs; n=21).ResultsThe total work hours (mean 55.69 hours, SD 21.34) of the 183 participants were significantly higher than their scheduled work hours (mean 50.67 hours, SD 21.44; P=.01). Medical staff had significantly longer total work hours (mean 57.01 hours, SD 21.20) than non-HCPs (mean 45.48 hours, SD 20.08; P=.02). Residents (mean 60.38 hours, SD 18.67) had significantly longer work hours than visiting staff (mean 51.42 hours, SD 20.33; P=.03) and non-HCPs (mean 45.48 hours, SD 20.08; P=.004).ConclusionsStaff Hours is the first automatic GPS location–based app designed for medical staff to track work hours and calculate overtime. For medical staff, this app could keep complete and accurate records of work hours in real time, reduce bias, and allow for better complying with labor regulations.

1168 Time Spent on Ambulatory Electronic Health Records Outside of Scheduled Work Hours by Gastroenterology Physicians

INTRODUCTION: The introduction of electronic health records (EHR) has been linked to physician burnout. This study aims to quantify the time gastroenterology physicians spend on ambulatory EHR outside of scheduled work hours. METHODS: Data was collected for time spent in ambulatory EHR for the eight-week period 02/03/2019 - 03/30/2019. Cumulative scheduled time was calculated for each physician. Hospital-based clinical encounters and time spent in hospital-based EHR were excluded from analysis. Ratios of ambulatory EHR time to scheduled time were calculated. We also analyzed data on physician FTE status, post-fellowship experience, new patient visit time interval, and correlated these data with the aforementioned ratio. P-values &lt; 0.05 were considered significant. This study was reviewed by our Institutional Review Board, and a waiver was obtained. RESULTS: Data was available for 41 providers; 18 providers were excluded (5 non-physicians, 3 with FTE status &lt; 0.2, 2 pediatric gastroenterologists, 8 without available scheduled time data). Data were analyzed for 23 gastroenterology physicians with 7,373 ambulatory encounters (3465 office visits, 310 office-based procedures, and 3598 ASC) across 4 sites. The average weekly time spent in EHR was 41.30 ± 11.73 hours, and the average weekly scheduled time was 24.48 ± 7.64 hours. Correspondingly, the average ratio of EHR time to scheduled time was determined to be 1.78 ± 0.70. Part-time and full-time physicians were also compared. There was a greater proportion of males in the full-time group rather than the part-time group (90.91% vs. 58.33%, P = 0.076). In addition, there was a trend towards a higher ratio of EHR time to scheduled time for part-time physicians (1.99 ± 0.88 vs. 1.56 ± 0.36), although this was not statistically significant (P = 0.15). The only statistically significant predictor of ratio was FTE status, treated as a continuous variable; the slope of the linear regression model was -3.06 ± 0.83 (P = 0.001) and the corresponding R2 was 0.39. Neither experience, in years after fellowship, nor new patient visit interval, were correlated with ratio. CONCLUSION: Our data show that gastroenterology physicians spend significant time outside of their scheduled time on EHR-related tasks. More studies are needed to better understand the distribution of time across different tasks; targeted countermeasures, such automation and utilization of non-physician staff, may help reduce the burden of EHR time and, correspondingly, the risk for physician burnout.

Understanding healthcare provider absenteeism in Kenya: a qualitative analysis

BackgroundHealthcare worker absenteeism is common in resource limited settings and contributes to poor quality of care in maternal and child health service delivery. There is a dearth of qualitative information on the scope, contributing factors, and impact of absenteeism in Kenyan healthcare facilities.MethodsIn-depth semi-structured interviews were conducted between July 2015 and June 2016 with 20 healthcare providers in public and private healthcare facilities in Central and Western Kenya. Interviews were audio-recorded, transcribed, coded, and analyzed using an iterative thematic approach.ResultsHalf of providers reported that absenteeism occurs in both private and public health facilities. Absenteeism was most commonly characterized by providers arriving late or leaving early during scheduled work hours. The practice was attributed to institutional issues including: infrequent supervision, lack of professional consequences, limited accountability, and low wages. In some cases, healthcare workers were frequently absent because they held multiple positions at different health facilities. Provider absences result in increased patient wait times and may deter patients from seeking healthcare in the future.ConclusionThere is a significant need for policies and programs to reduce provider absenteeism in Kenya. Intervention approaches must be cognizant of the contributors to absenteeism which occur at the institutional level.

The associations of occupational hazards and injuries with work environments and overtime for nurses in China.

Occupational hazards (OHs) and occupational injuries (OIs) may contribute to nurses needing sick time and to a high financial burden for hospitals. There is little published literature about nurse-reported OHs/OIs and their relationships with work environments and working overtime in China. This study was designed to describe Chinese hospital registered nurses' OHs/OIs and to explore the associations between work environments, working overtime, and nurse-reported OHs/OIs. This cross-sectional study was conducted in Guangdong province in China in 2014. The sample included 1,517 nurses from 111 medical/surgical units in 23 hospitals. The Practice Environment Scale of the Nursing Work Index was used to measure work environment. Overtime was calculated by subtracting scheduled work hours from actual work hours. Six items were used to measure nurse-reported OHs/OIs. Descriptive statistics, Chi-square tests, and two-level logistic regression models were used to analyze the data. The percentages of nurses reporting OHs/OIs occurred in the year before the survey ranged from 47% to 80%. Nurses who worked in good (vs. poor) unit work environments were less likely to experience OHs/OIs (Odds ratio [OR] = 0.65-0.68, p < .05). Nurses who worked overtime (OR = 1.19-1.33, p < .05) and in Level 3 (largest) hospitals (OR = 1.45-1.80, p < .05) were more likely to experience OHs/OIs. We found that OHs/OIs were prevalent among hospital nurses in China. Better work environment and less nurse overtime were associated with fewer nurse OHs/OIs.

Working overtime in community mental health: Associations with clinician burnout and perceived quality of care.

Funding cuts have increased job demands and threatened clinicians' ability to provide high-quality, person-centered care. One response to increased job demands is for clinicians to work more than their official scheduled work hours (i.e., overtime). We sought to examine the frequency of working overtime and its relationships with job characteristics, work-related outcomes, and quality of care in community health clinicians. One hundred eighty-two clinicians completed demographic and job characteristics questions and measures of burnout, job satisfaction, turnover intention, work-life conflict, and perceived quality of care. Clinicians also reported the importance of reducing stress and their confidence in reducing their stress. Clinicians who reported working overtime were compared to clinicians that did not on demographic and job characteristics and work-related outcomes. Ninety-four clinicians (52%) reported working overtime in a typical week. Controlling for exempt status and group differences in time spent supervising others, those working overtime reported significantly increased burnout and work-life conflict and significantly lower job satisfaction and quality of care than those not working overtime. Clinicians working overtime also reported significantly greater importance in reducing stress but less confidence in their ability to reduce stress than those not working overtime. There were no significant group differences for turnover intention. Working overtime is associated with negative consequences for clinician-related work outcomes and perceived quality of care. Policies and interventions aimed at reducing overtime and work-related stress and burnout may be warranted in order to improve quality of care. (PsycINFO Database Record

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Introduction: Nicknamed “Superstorm Sandy,” it is regarded as one of the deadliest, most destructive, and costly hurricanes of the 2012 Atlantic Hurricane Season. The storm struck the New York City on October 29th, 2012, “97 people died… thousands were displaced from their homes, and 2 major hospitals required perilous evacuations even as the hurricane-force winds engulfed the metropolitan region.”(2) Methods: One of the support centers was Lenox Hill Hospital (LHH), a 652-bed tertiary-care center, with 3 separate intensive care units each having 12 dedicated beds and additional 17 monitored step-down beds per unit. There are 8 full time intensivists and 6 fellows available 24 hours per day, 7 days a week. Emergency preparations at LHH began Thursday before the storm. Emergency Command Centers were activated; generators and other emergency equipment were tested. The hospital decanted to increase capacity with a pre-storm census of 397. Emergency teams were assigned, plans for medications and supplies were implemented, and transfer protocols activated. (1) LHH generally has a reserve of 26 invasive and 14 non-invasive ventilators. In preparation for Sandy, an additional 10 invasive and 5 non-invasive ventilators were rented increasing the reserve by 37.5%. Results: LHH received a total of 102 evacuees from surrounding hospitals, with the bulk, 83 patients coming from New York University (NYU) Langone Medical Center which was emergently shut down early Monday morning on October 29th. 62% of the NYU patients were admitted between 3 and 6 am, equaling 1 patient every 3 to 4 minutes. At that time all patients were admitted to LHH physician teams with limited patient information due to an inaccessible NYU electronic medical record system.(1) Due to the high volume of incoming patients and continued lack of functional facilities at NYU, a satellite office for credentialing was established. In the upcoming days, 315 NYU physicians and licensed independent practitioners were given Disaster Emergency privileges at LHH, over 700 NYU nurses were credentialed and oriented to LHH, and 160 NYU residents and fellows were added by the Office of Graduate Medical Education.(1) Conclusions: Intensive Care triage was performed in the Emergency Department upon arrival of evacuated patients by LHH Intensivist run teams and the units remained under LHH care personnel. Scheduled work hours were increased to allow availability of a fellow onsite at all times for critically ill patient management with a supervising intensivist. To accommodate the large flow of patients 1 chief and 2 supervising respiratory therapists took 48 hour call shifts alternately. Direct communication with the NYU healthcare staff was maintained and upon discharge from telemetry, transfer summaries were provided for each patient. The LHH pulmonary team fully incorporated their NYU counterparts. Two attendings and two fellows where emergently credentialed by the Medicine Board and seamlessly integrated into the bronchoscopy suite schedule. By prioritizing cases and rescheduling elective procedures, all cases were accommodated with ancillary support and cytological evaluation as needed. The Pulmonary consult services functioned independently; however, LHH pulmonary coverage was available for immediate assistance if the NYU staff was off site. After the storm, occupancy at LHH persisted from 99 to 107% with an average daily census of 493 to 550 patients. LHH transitioned to a 7 day a week operation performing operative elective procedures on Saturdays and Sundays.(1) BIBLIOGRAPHY: 1. Anthony Antonacci & Dennis Connors. “Executive Committee.” Presented on November 28, 2012. Microsoft PowerPoint File. 2. David Abramson & Irwin Redlener. “Hurricane Sandy: Lessons Learned, Again.” Disaster Medicine and Public Health Preparedness vol. 6; no. 4: 328–9. 3. Irwin Redlener & Michael J. Reilly. “Lessons from Sandy - Preparing Health Systems for Future Disasters.” New England Journal of Medicine 13 December 2012: 2269–71

Small-Scale Timber Harvesting: Mule Logging in Hyrcanian Forest

Animal-powered logging is a labour-intensive operation. Mule logging is still performed in the Hyrcanian forest ecoregion in Iran as a small-scale harvesting method. Mule logging in Namkhaneh district of Kheyrud Forest within this ecoregion was studied to develop hauling regression models and estimate haulage costs. A continuous time study was conducted of hauling of sawn-lumber, pulpwood and fuelwood, to assess mule logging productivity and cost for sawn-lumber and pulpwood as well as fuelwood hauling. Hauling distance was found to be the most important cost factor in wood extraction by mule. The hourly production rates of hauling with mule were 0.84, 0.52 and 0.42 m3 for sawn-lumber, pulpwood and fuelwood, respectively. The cost of the mule hauling system USD 13 per productive mule hours. Hourly costs of mule hauling of sawn-lumber, pulpwood and fuelwood logging were 15.5, 25, and 30.6 USD/m3. Increasing hauling distances caused a linear increase in haulage cost. There appears to be an opportunity to reduce cost of log production by increasing scheduled work hours, wider utilization of mules and reducing labour cost.

Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparison

Background: There are currently no field data about the effect of implementing European Working Time Directive (EWTD)-compliant rotas in a medical setting. Surveys of doctors’ subjective opinions on shift work have not provided reliable objective data with which to evaluate its efficacy.Aim: We therefore studied the effects on patient's safety and doctors’ work-sleep patterns of implementing an EWTD-compliant 48 h work week in a single-blind intervention study carried out over a 12-week period at the University Hospitals Coventry & Warwickshire NHS Trust. We hypothesized that medical error rates would be reduced following the new rota.Methods: Nineteen junior doctors, nine studied while working an intervention schedule of <48 h per week and 10 studied while working traditional weeks of <56 h scheduled hours in medical wards. Work hours and sleep duration were recorded daily. Rate of medical errors (per 1000 patient-days), identified using an established active surveillance methodology, were compared for the Intervention and Traditional wards. Two senior physicians blinded to rota independently rated all suspected errors.Results: Average scheduled work hours were significantly lower on the intervention schedule [43.2 (SD 7.7) (range 26.0–60.0) vs. 52.4 (11.2) (30.0–77.0) h/week; P < 0.001], and there was a non-significant trend for increased total sleep time per day [7.26 (0.36) vs. 6.75 (0.40) h; P = 0.095]. During a total of 4782 patient-days involving 481 admissions, 32.7% fewer total medical errors occurred during the intervention than during the traditional rota (27.6 vs. 41.0 per 1000 patient-days, P = 0.006), including 82.6% fewer intercepted potential adverse events (1.2 vs. 6.9 per 1000 patient-days, P = 0.002) and 31.4% fewer non-intercepted potential adverse events (16.6 vs. 24.2 per 1000 patient-days, P = 0.067). Doctors reported worse educational opportunities on the intervention rota.Conclusions: Whilst concerns remain regarding reduced educational opportunities, our study supports the hypothesis that a 48 h work week coupled with targeted efforts to improve sleep hygiene improves patient safety.

A Pilot Study of the Safety Implications of Australian Nurses' Sleep and Work Hours

The frequency and severity of adverse events in Australian healthcare is under increasing scrutiny. A recent state government report identified 31 events involving “death or serious [patient] harm” and 452 “very high risk” incidents. Australia‐wide, a previous study identified 2,324 adverse medical events (AME) in a single year, with more than half considered preventable. Despite the recognized link between fatigue and error in other industries, to date, few studies of medical errors have assessed the fatigue of the healthcare professionals involved. Nurses work extended and unpredictable hours with a lack of regular breaks and are therefore likely to experience elevated fatigue. Currently, there is very little available information on Australian nurses' sleep or fatigue levels, nor is there any information about whether this affects their performance. This study therefore aims to examine work hours, sleep, fatigue and error occurrence in Australian nurses. Using logbooks, 23 full‐time nurses in a metropolitan hospital completed daily recordings for one month (644 days, 377 shifts) of their scheduled and actual work hours, sleep length and quality, sleepiness, and fatigue levels. Frequency and type of nursing errors, near errors, and observed errors (made by others) were recorded. Nurses reported struggling to remain awake during 36% of shifts. Moderate to high levels of stress, physical exhaustion, and mental exhaustion were reported on 23%, 40%, and 36% of shifts, respectively. Extreme drowsiness while driving or cycling home was reported on 45 occasions (11.5%), with three reports of near accidents. Overall, 20 errors, 13 near errors, and 22 observed errors were reported. The perceived potential consequences for the majority of errors were minor; however, 11 errors were associated with moderate and four with potentially severe consequences. Nurses reported that they had trouble falling asleep on 26.8% of days, had frequent arousals on 34.0% of days, and that work‐related concerns were either partially or fully responsible for their sleep disruption on 12.5% of occasions. Fourteen out of the 23 nurses reported using a sleep aid. The most commonly reported sleep aids were prescription medications (62.7%), followed by alcohol (26.9%). Total sleep duration was significantly shorter on workdays than days off (p<0.01). In comparison to other workdays, sleep was significantly shorter on days when an error (p<0.05) or a near error (p<0.01) was recorded. In contrast, sleep was higher on workdays when someone else's error was recorded (p=0.08). Logistic regression analysis indicated that sleep duration was a significant predictor of error occurrence (χ2=6.739, p=0.009, eβ=0.727). The findings of this pilot study suggest that Australian nurses experience sleepiness and related physical symptoms at work and during their trip home. Further, a measurable number of errors occur of various types and severity. Less sleep may lead to the increased likelihood of making an error, and importantly, the decreased likelihood of catching someone else's error. These pilot results suggest that further investigation into the effects of sleep loss in nursing may be necessary for patient safety from an individual nurse perspective and from a healthcare team perspective.

Utilization and Cost of Log Production from Animal Logging Operations

Forest harvesting with animals is a labor-intensive operation. It is expensive to use machines on smaller woodlots, which require frequent moves if mechanically logged. So, small logging systems using animals may be more cost effective. In this study, work sampling was used for five animal logging operations in Alabama to measure productive and non-productive time elements to determine utilization with respect to operators, functions (felling and processing of trees, skidding, loading, and forwarding of logs), animals, and machines. Cost of log production was calculated from the figures reported by owners and the crew members. Average utilization of crew was 58 percent, animals (horses and mules) were utilized only 22 percent and the machines were utilized from 5 to 74 percent of scheduled time. Average cost of log production per m3 was $11.28. There appears to be an opportunity to reduce cost of log production by coordinating functions, increasing scheduled work hours, utilization of machines and animals, and reducing labor cost.

Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures

Knowledge of the physiological effects of extended (24 hours or more) work shifts in postgraduate medical training is limited. We aimed to quantify work hours, sleep, and attentional failures among first-year residents (postgraduate year 1) during a traditional rotation schedule that included extended work shifts and during an intervention schedule that limited scheduled work hours to 16 or fewer consecutive hours. Twenty interns were studied during two three-week rotations in intensive care units, each during both the traditional and the intervention schedule. Subjects completed daily sleep logs that were validated with regular weekly episodes (72 to 96 hours) of continuous polysomnography (r=0.94) and work logs that were validated by means of direct observation by study staff (r=0.98). Seventeen of 20 interns worked more than 80 hours per week during the traditional schedule (mean, 84.9; range, 74.2 to 92.1). All interns worked less than 80 hours per week during the intervention schedule (mean, 65.4; range, 57.6 to 76.3). On average, interns worked 19.5 hours per week less (P<0.001), slept 5.8 hours per week more (P<0.001), slept more in the 24 hours preceding each working hour (P<0.001), and had less than half the rate of attentional failures while working during on-call nights (P=0.02) on the intervention schedule as compared with the traditional schedule. Eliminating interns' extended work shifts in an intensive care unit significantly increased sleep and decreased attentional failures during night work hours.

An evaluation of preemployment drug testing.

As part of a blind longitudinal study, 5,465 job applicants were tested for use of illicit drugs, and the relationships between these drug-test results and absenteeism, turnover, injuries, and accidents on the job were evaluated. After an average 1.3 years of employment, employees who had tested positive for illicit drugs had an absenteeism rate 59.3% higher than employees who had tested negative (6.63% vs. 4.16% of scheduled work hours, respectively). Employees who had tested positive also had a 47% higher rate of involuntary turnover than employees who had tested negative (15.41% vs. 10.51%, respectively). No significant associations were detected between drug-test results and measures of injury and accident occurrence. The practical implications of these results, in terms of economic utility and prediction errors, are discussed.