Time Study Research Articles

The reality of nursing time: how nurses spend their shifts.

Nurse staffing levels are increasingly challenged while pressures on healthcare systems are rising. There is a clear need to optimise efficiency in healthcare delivery in order to deliver safe, effective and quality health care. To understand how nurses working shifts spend their time and explore opportunities to improve efficiency in care delivery. A time-motion study was conducted on three acute care wards in a district general hospital in West Wales; 13 nurses were observed over 14 shifts, each activity undertaken was recorded in real time. In all, 109 hours were observed. Approximately half of nurses' time is spent delivering direct patient care, with medications administration taking the majority of time. A number of recommendations are made involving processes and workforce modelling with the aim of improving efficiency and safety. Further research would be required to assess the impact of their introduction.

Time Motion Study of Tuberculosis Patients Attending a Hospital in an Indian State

Abstract Objectives: To analyse the time taken in availing various services by a patient of cardinal symptoms of Tuberculosis in TB Hospital, Bhopal, India and to determine the satisfaction of patients regarding care. Methods: This is a time–motion observational study of patients who came with symptoms of TB. A sample of 210 was calculated using Cochran’s formula. Results: Amongst the 210 patients studied, the majority were males, i.e. 123 (58.6%). A striking feature was found during this study that reports of sputum were given 2–5 days after collection. Conclusion: This busy hospital dedicated to providing comprehensive healthcare pertaining to TB had multiple patient queues, long clinical visits and short clinical encounters. Although the patients were satisfied with the clinical consultations from the doctors, they found difficulty in availing laboratory and X-ray services.

Multitasking during Medication Management in a Nursing Home: A Time Motion Study.

Multitasking, defined as performing two or more interventions simultaneously, increases the cognitive burden of clinicians. This may, in turn, lead to higher risk of medication and procedural errors. Time motion study (TMS) data for nurses in nursing homes revealed an extensive amount of multitasking while managing medications. Further investigation of multitasked nursing interventions will provide a foundation for optimizing medication management workflows. Using a continuous observational TMS method, this study aimed to describe pairs of multitasked nursing interventions associated with medication management interventions, including preparing and administering medications, assessing medication effects, instructing on medications, and documenting medication administration. An external nurse observer used 57 predefined Omaha System nursing interventions embedded within TimeCaT (version 3.9), TMS data recording software to collect observation data in a single nursing home. A total of 120 hours of time-stamped observation data from nine nurses were downloaded from TimeCaT and analyzed using descriptive and inferential statistics. The majority (74%) of medication management interventions were multitasked, resulting in 2,003 pairs of multitasked interventions. Of the 57 Omaha System nursing interventions, 35 were involved in these multitasking pairs. When nurses multitasked, the average duration of medication preparation was longer (non-multitasked: 81 seconds; multitasked: 162 seconds, p < 0.05), while the average duration of medication administration record documentation was shorter (non-multitasked: 93 seconds; multitasked: 66 seconds, p < 0.05). The findings reveal the complexity of medication management in nursing homes with numerous and diverse multitasking pairs. Findings provide a platform for in-depth study of medication management multitasking in the clinical context, and inform future efforts to create clinical and informatics solutions to optimize medication management workflow. This method may be also applied to examine medication management and multitasking in other clinical settings.

Determinants of received care time among Finnish home care clients and assisted living facility residents: a time-motion study

BackgroundAgeing populations and care workforce shortages across Europe are causing challenges for care services for older people. Therefore, it is paramount that limited care resources are allocated optimally, based on the clients’ care needs. Multiple functioning-related factors have been identified that determine the amount of care time clients receive, while organizational and other factors remain largely unexplored. The aim was to examine how various individual and organizational factors are associated with clients’ received care time in different care settings.MethodsCross-sectional observational study design with data from time and motion study, registers, and surveys was used. In total, 1477 home care clients and 1538 residents from assisted living facilities with 24/7 service participated, from 61 Finnish care units. Linear mixed-effect modeling was used to examine the association between individual and organizational-level variables and received care time.ResultsPhysical functioning was the strongest predictor of received care time in both care settings. In home care, greater pain, more unstable health, and higher team autonomy were associated with increased care time. In assisted living, depressive mood and higher staffing level of the organization were associated with care time. Clients who received informal care also received significantly more care time from nurses in both care settings.ConclusionsPhysical functioning was the main driver of received care time. Interventions that maintain or improve physical functioning can help restrain the growing need of care resources, although it is important to ensure that each client receives care according to their holistic care needs.

A time-motion study on impact of spatial separation for empiric airborne precautions in emergency department length of stay.

To evaluate the impact of spatial separation on patient flow in the emergency department. This was a retrospective, time-and-motion analysis conducted from 15 to 22 August, 2022 at the emergency department of a tertiary hospital in Kuala Lumpur, Malaysia. During this duration, spatial separation was implemented in critical and semi-critical zones to separate patients with symptoms of respiratory infections into respiratory area, and patients without into non-respiratory area. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Patients triaged to critical and semi-critical zones were included in this study. Timestamps of patient processes in emergency department until patient departure were documented. The emergency department length-of-stay was longer in respiratory area compared to non-respiratory area; 527 min (381-698) versus 390 min (285-595) in critical zone and 477 min (312-739) versus 393 min (264-595) in semi-critical zone. In critical zone, time intervals of critical flow processes and compliance to hospital benchmarks were similar in both areas. More patients in respiratory area were managed within the arrival-to-contact ≤30 min benchmark and more patients in non-respiratory area had emergency department length-of-stay ≤8 h. The implementation of spatial separation in infection control should address decision-to-departure delays to minimise emergency department length of stay. The study evaluated the impact of spatial separation on patient flow in the emergency department. Emergency department length-of-stay was significantly prolonged in the respiratory area. Hospital administrators and policymakers can optimise infection control protocols measures in emergency departments, balancing infection control measures with efficient patient care delivery. STROBE guidelines. None. The study obtained ethics approval from the institution's Medical Ethics Committee (MREC ID NO: 20221113-11727). The author has checked and make sure our submission has conformed to the Journal's statistical guideline. There is a statistician on the author team (Noor Azhar).

Electronic oral health surveillance system for Egyptian preschoolers using District Health Information System (DHIS2): design description and time motion study

BackgroundEarly childhood caries (ECC) is a major global health issue affecting millions of children. Mitigating this problem requires up-to-date information from reliable surveillance systems. This enables evidence-based decision-making to devise oral health policies. The World Health Organization (WHO) advocates the adoption of mobile technologies in oral disease surveillance because of their efficiency and ease of application. The study describes developing an electronic, oral health surveillance system (EOHSS) for preschoolers in Egypt, using the District Health Information System (DHIS2) open-source platform along with its Android App, and assesses its feasibility in data acquisition.MethodsThe DHIS2 Server was configured for the DHIS2 Tracker Android Capture App to allow individual-level data entry. The EOHSS indicators were selected in line with the WHO Action Plan 2030. Two modalities for the EOHSS were developed based on clinical data capture: face-to-face and tele/asynchronous. Eight dentists in the pilot team collected 214 events using modality-specific electronic devices. The pilot’s team's feedback was obtained regarding the EOHSS's feasibility in collecting data, and a time-motion study was conducted to assess workflow over two weeks. Independent t-test and Statistical Process Control techniques were used for data analysis.ResultsThe pilot team reported positive feedback on the structure of the EOHSS. Workflow adaptations were made to prioritize surveillance tasks by collecting data from caregivers before acquiring clinical data from children to improve work efficiency. A shorter data capture time was required during face-to-face modality (4.2 ± 0.7 min) compared to telemodality (5.1 ± 0.9 min), p < 0.001). The acquisition of clinical data accounted for 16.9% and 21.1% of the time needed for both modalities, respectively. The time required by the face-to-face modality showed random variation, and the tele-modality tasks showed a reduced time trend to perform tasks.ConclusionsThe DHIS2 provides a feasible solution for developing electronic, oral health surveillance systems. The one-minute difference in data capture time in telemodality compared to face-to-face indicates that despite being slightly more time-consuming, telemodality still shows promise for remote oral health assessments that is particularly valuable in areas with limited access to dental professionals, potentially expanding the reach of oral health screening programs.

The time motion study of an out-patient department in a tertiary care hospital in Tamil Nadu

The time motion study of an out-patient department in a tertiary care hospital in Tamil Nadu

A Scalable and Extensible Logical Data Model of Electronic Health Record Audit Logs for Temporal Data Mining (RNteract): Model Conceptualization and Formulation.

Increased workload, including workload related to electronic health record (EHR) documentation, is reported as a main contributor to nurse burnout and adversely affects patient safety and nurse satisfaction. Traditional methods for workload analysis are either administrative measures (such as the nurse-patient ratio) that do not represent actual nursing care or are subjective and limited to snapshots of care (eg, time-motion studies). Observing care and testing workflow changes in real time can be obstructive to clinical care. An examination of EHR interactions using EHR audit logs could provide a scalable, unobtrusive way to quantify the nursing workload, at least to the extent that nursing work is represented in EHR documentation. EHR audit logs are extremely complex; however, simple analytical methods cannot discover complex temporal patterns, requiring use of state-of-the-art temporal data-mining approaches. To effectively use these approaches, it is necessary to structure the raw audit logs into a consistent and scalable logical data model that can be consumed by machine learning (ML) algorithms. We aimed to conceptualize a logical data model for nurse-EHR interactions that would support the future development of temporal ML models based on EHR audit log data. We conducted a preliminary review of EHR audit logs to understand the types of nursing-specific data captured. Using concepts derived from the literature and our previous experience studying temporal patterns in biomedical data, we formulated a logical data model that can describe nurse-EHR interactions, the nurse-intrinsic and situational characteristics that may influence those interactions, and outcomes of relevance to the nursing workload in a scalable and extensible manner. We describe the data structure and concepts from EHR audit log data associated with nursing workload as a logical data model named RNteract. We conceptually demonstrate how using this logical data model could support temporal unsupervised ML and state-of-the-art artificial intelligence (AI) methods for predictive modeling. The RNteract logical data model appears capable of supporting a variety of AI-based systems and should be generalizable to any type of EHR system or health care setting. Quantitatively identifying and analyzing temporal patterns of nurse-EHR interactions is foundational for developing interventions that support the nursing documentation workload and address nurse burnout.

Timber Harvesting Economics in Early Commercial Thinning and Group Selection Prescriptions

Forest management decisions that consider both short- and long-term objectives are becoming more challenging and costly, due to market uncertainty, labor shortages, and the evolving forest industry. Under such unpredictable circumstances, a better understanding of the production economics of various silvicultural prescriptions is crucial in implementing sound forest management activities. The objectives of this study were to: a) estimate stump to landing productivity and cost for Early Commercial Thinning (ECT) and Group Selection (GS) prescriptions; and b) compare the harvest system cost ($/PMH) using machine rate and PATH (Planning and Analysis in Timber Harvesting) methods. Detailed time-motion studies were conducted in the spruce-fir forest of Northern Maine, USA, during the summer of 2019. The results, as expected, indicated the harvesting costs were 23% higher for ECT (21.08 $/m3) compared to GS (16.32 $/m3). The average productivity of the harvester and forwarder were reduced by 15 and 37%, respectively, for ECT compared to GS. The estimated harvesting system cost ($/PMH) was 4% higher as indicated by PATH compared to machine rate method. Higher operational productivity in GS can be attributed to the larger volume of logs, and shorter travel loaded distance than ECT. These findings can help forest managers make more informed decisions while implementing appropriate silvicultural prescriptions under varying conditions based on management objectives and market conditions.

Evaluation of Productivity and Cost Analysis on a Combined Logging System

The efficient planning and control of timber harvesting operations is crucial to growth productivity and reducing costs, and different systems or methods are applied to obtain elevated performance. In particular, cable yarding is a highly appreciated and very efficient wood extraction method in areas that are difficult to access with ground-based extraction machines. Combined logging systems are not diffuse and not often implemented. For this reason, the use and the application of innovative methods are limited. However, some combinations have recently been observed in forest operations. This study, conducted in a deciduous stand in Bulgaria, paid attention to the combination of a tractor-mounted tower yarder (Valentini V400) with a clambunk skidder (Timberjack 1010D), aiming to examine the viability and develop the operational efficiency of the two-stage extraction system and to define the time, log volume extracted per unit by the yarder and the clambunk, and the yarding and skidding costs. The researchers carried out a time-motion study and performed a regression analysis to identify those variables that are most likely to affect the duration of work elements and productivity. For cost analysis, the COST model was used. The mean productivity of the tower yarder was 10.34 m3/PMH and 8.11 m3/SMH, while for the clambunk skidder, the productivity was 6.23 m3/PMH and 4.93 m3/SMH. The net costs for the combined logging system were calculated as 120.87 €/PMH and 14.93 €/m3. This study adds new data about the correct use of both machines, supporting their application in beech forests.

Impact of Remote Patient Monitoring Systems on Nursing Time, Healthcare Providers, and Patient Satisfaction in General Wards.

Remote patient monitoring systems (RPMS) are increasingly integrated into hospital wards to improve patient safety and reduce the workload on healthcare professionals (HCPs). This study evaluates the efficacy of RPMS in general wards, focusing on their impact on nursing efficiency, patient care, HCPs, and patient satisfaction. A comprehensive time-motion study was conducted along with surveys targeting HCPs and patients in M.S. Ramaiah Memorial Hospital, Bangalore, India, which has implemented RPMS in general wards. The study involved observing and comparing nursing activities in RPMS-equipped wards versus control wards without RPMS across various shifts. In addition, feedback on the system's impact on patient safety, overall care quality, and usability was gathered through a survey form. RPMS decreases the amount of time nurses spend on routine monitoring, communication, and coordination, enabling a 43.11% increase in time available for patient care. More than 89% ofHCPs noted improvements in the level of care and overall patient safety. More than 80% of the HCPs also noted improvement in the patient's experience. More than 50% of HCPs find RPMS easy to use and user-friendly.More than 60% of the patients noted an overall improvement in care quality. RPMS has proven to be a valuable asset in hospital wards, enhancing patient monitoring and safety while reducing the workload on staff. In addition, significant time savings on routine tasks and high satisfaction levels from both staff and patients underscore the system's benefits.

Activities of the oral health teams in primary health care: a time-motion study

BackgroundEfficient planning of the oral health workforce in Primary Health Care (PHC) is paramount to ensure equitable community access to services. This requires a meticulous examination of the population’s needs, strategic distribution of oral health professionals, and effective human resource management. In this context, the average time spent on care to meet the needs of users/families/communities is the central variable in healthcare professional workforce planning methods. However, many time measures are solely based on professional judgment or experience.ObjectiveCalculate the average time parameters for the activities carried out by the oral health team in primary health care.MethodThis is a descriptive observational study using the time-motion method carried out in five Primary Health Care Units in the city of São Paulo, SP, Brazil. Direct and continuous observation of oral health team members occurred for 40 h spread over five days of a typical work week.ResultsA total of 696.05 h of observation were conducted with 12 Dentists, three Oral Health Assistants, and five Oral Health Technicians. The Dentists’ main activity was consultation with an average duration of 24.39 min, which took up 42.36% of their working time, followed by documentation with 12.15%. Oral Health Assistants spent 31.57% of their time on infection control, while Oral Health Technicians spent 22.37% on documentation.ConclusionThe study establishes time standards for the activities performed by the dental care team and provides support for the application of workforce planning methods that allow for review and optimization of the work process and public policies.

Can the Countermovement Jump or Squat Jump predict the kinematic performance of the rear Bandal Chagi kick?

This study aimed to measure the associative and predictive strength of biomechanical variables of the countermovement jump (CMJ) and squat jump (SJ), and performance of the bandal-chagi kick performed with the dominant (D) rear lower limb in elite Taekwondo Athletes. For this, a total of 27 international level athletes (15 males and 12 females) performed the CMJ and SJ on two force platforms. The bandal-chagi was monitored using a motion capture system (VICON). The main results indicated that non-dominant (ND) Stiffness for the CMJ showed predictive power alone (p=0.048) or in combination with eccentric breaking rating of force development (RFD) (p=0.031) for total hip angular speed. Takeoff peak force/BM for the SJ predicted total time (p=0.002). Concentric RFD/BM predicted total linear foot acceleration, either alone (p=0.001) or with vertical speed at takeoff (p=0.042). The total hip angular acceleration predictor was takeoff peak force D alone (p=0.019) or in combination with peak power/BM (p=0.041). In conclusion, CMJ and SJ tests showed specific associations with TKD kick performance. These analyses in this study indicated that they are good predictors for TKD athletes, producing results consistent with the participants’ levels. Keywords: Martial arts, Biomechanical Phenomena, Time-motion studies, Kinanthropometry, Motion Capture.

Evaluation of Field Performance and Energy Consumption of a Medium-sized Combine Harvester for Harvesting Glutinous Rice in Malaysia

A medium-sized combine harvester has been recently deployed to harvest newly introduced high-value glutinous rice in Malaysia. Thus, efficient utilisation of combine harvesters during harvest is essential to minimise operating costs and grain loss. This study evaluated a medium-sized combine harvester’s performance and energy consumption for harvesting glutinous rice. The experiment was carried out on a one-hectare paddy field with three sub-plots using a central composite design (CCD). A time-motion study was conducted during the harvesting operation to determine the combine harvester’s performance parameters, which included field operating speed (FS), field efficiency (FE), theoretical field capacity (TFC), effective field capacity (EFC), grain throughput capacity (GTC), fuel consumption (FC) and field machine index (MI). The energy expended during the operation, which included machinery energy (ME), fuel energy (FCE), human energy (HE), and total energy (TE) input, were also computed. The average FS, FE, TFC, EFC, FC, and MI values were 2.42 km/h, 59.78%, 0.56 ha/h, 0.33 ha/h, 14.89 l/ha, and 0.30, respectively. The mean values of ME, FCE, HE, and TE were 305.35, 711.69, 3.62, and 1020.66 MJ/ha, respectively. The combine harvester achieved an average grain throughput capacity (GTC) of 1796.91 kg/h, demonstrating its effectiveness in handling glutinous rice harvesting. The average time distribution for the harvesting operation, such as effective harvesting time, turning/reversing time, and unloading time, was 1.85 h/ha, 0.38 h/ha, and 1.05 h/ha, respectively. Based on the results, it is concluded that the medium-sized combine harvester is technically and economically suitable for harvesting glutinous rice.

IJCM_376A: Time motion study in Anti Rabies Vaccination OPD in tertiary care Hospital of Central India

Background: Outpatient department is considered a doorway to health services. The outpatient department thus requires a systematic study of its services for its efficient management and functioning. Time-motion study in ARV OPD provides information on how much time it takes for management of animal bite patients at each step. Such a study could prove useful to improve efficiency of health care services. Objective: To assess the average time spent in different service delivery points in ARV OPD Methodology: A hospital based cross0sectional study was conducted in ARV OPD from July 2022 to June 2023 on Patients coming to ARV OPD. A total of 960 patients were included in the study using Systematic Random sampling technique. Data was collected using a pre-designed and pre-tested questionnaire for socio-demographic details and case history of patients and time required for each step in management of animal bite. Stopwatch of smartphone was used to record time at each step of patient management. All the collected data was entered in SPSS software (version 20.0) and was analyzed accordingly. Results: Study results showed that out of 960 patients 613 (63.85%) were male and 347(36.15%) were female. 509 (53.02%) were from urban and 451(46.98%) were from rural area. Out of 960 patients 816 (85 %) were of category III bite and 144 (15%) of category II bite. The most common site for animal bite was lower limb 556 (57.9%) followed by 288 (30%) on upper limb, on trunk 38 (3.96 %) and 78 (8.14%) on head and neck region. Total time required for management of animal bite was 35.15+/- 17.92 minutes. Conclusion: The time spent in transit could be reduced with proper management of logistics. Also reframing of strategies at various steps could help reduced average time needed to attend a patients at ARV OPD.

A time-motion study and patient satisfaction in the fever clinic of a Government Medical College and Hospital in India

Background: During the recent pandemic, the number of patients with influenza-like symptoms had considerably increased in fever clinics of hospitals leading to queuing and increased patient dissatisfaction. Aims and Objectives: A time-motion study was therefore designed to evaluate the time taken at different service delivery points in the fever clinic and patient satisfaction regarding service delivery time. Materials and Methods: An institutional cross-sectional observational study was conducted at the fever clinic of Midnapore Medical College and Hospital for 1 month. A total of 200 patients were selected by systematic random sampling from the fever clinic outdoors and their movement was recorded and satisfaction assessed. Results: Most patients visited the clinic during the start of the week and in the first half of the day. The total mean time required from entry to exit was 9089 s±143.0. The maximum time was spent waiting time in the fever clinic entry queue followed by that at the pharmacy. The minimum time required was at the nursing table followed by a doctor’s consultation. The maximum meantime for movement between two stations was between station 5 (laboratory investigation station) and station 6 (pharmacy), that is, 1144 s±183.6. The majority of the study population was not satisfied with the time management in the fever clinic whereas only 18.0% of the participants were fully satisfied. Conclusion: Identifying the loopholes and formulating an effective time management strategy can help deliver better patient care as well as boost patient satisfaction.

Human resource implications of expanding latent tuberculosis patient care activities.

The World Health Organization (WHO) declared increasing services for latent tuberculosis infection (LTBI) a priority to eliminate tuberculosis (TB) by 2035. Yet, there is little information about thehuman resource needs required to implement LTBI treatment scale-up. Our study aimed to estimate the change in healthcare workers (HCW) time spent on different patient care activities, following an intervention to strengthen LTBI services. We conducted a time and motion (TAM) study, observing HCW throughout a typical workday before and after the intervention (Evaluation and Strengthening phases, respectively) at 24 health facilities in five countries. The precise time spent on pre-specified categories of work activities was recorded. Time spent on direct patient care was subcategorized as relating to one of three conditions: LTBI, active or suspected TB, and non-TB (i.e., patients with any other medical condition). A linear mixed model (LMM) was fit to estimate the change in HCW time following the intervention. A total of 140 and 143 HCW participated in the TAMs during the Evaluation and Strengthening phases, respectively. Results from intervention facilities showed an increase of 9% (95% CI: 3%, 15%) in the proportion of HCW time spent on LTBI-related services, but with a corresponding change of -11% (95% CI: -21%, -1%) on active TB services. There was no change in the proportion of time spent on LTBI care in control facilities; this remained low in both phases of the study. Our findings suggest that additional HCW personnel will be required for expansion of LTBI services to ensure that this expansion does not reduce the time available for care of active TB patients.

Patient Satisfaction with Antiretroviral Therapy Services in Hadiya Zone, Central Ethiopia Using the Donebidean Model: A Time-Motion Study.

A time-motion study is a scientific method for recording time spent on various tasks in a narrow range of specialized work settings, beginning with initial enrollment in ART provision. Therefore, the study aimed to assess the time motion of patient satisfaction with antiretroviral therapy services in Central Ethiopia. A facility-based cross-sectional study was conducted on a sample of 422 patients from June 14 to July 30, 2021. We used a simple random sampling technique to select the participants. Structural input-related qualitative data were collected using an in-depth interview and used for concurrent triangulation with quantitative. Quantitative data were collected using a standardized and pre-tested questionnaire and analyzed using SPSS version 24.0. Bivariate and multivariable logistic regressions were used to identify independent predictors of time motion and patient satisfaction. The degree of association between the outcome and independent variables was assessed by using an odds ratio with a 95% CI. The time motion of patient satisfaction study found that 53.1% (224/422) of the study participants were satisfied. As independent predictors, time spent (time motion) waiting to be seen by a health professional (AOR = 0.228, 95% CI = 0.079-0.661), patient-provider interaction (AOR = 3.72, 95% CI = 2.111-5.771), perceived privacy (AOR = 2.912, 95% CI = 1.76-2.78), sex (AOR = 2.499, 95% CI = 1.556-4.009), and income class (AOR = 0.228, 95% CI = 0.073-0.707) were associated with outcome variable. The study found low patient satisfaction with ART services, indicating the need for further improvement to enhance patient-centered services with the given time motion. Therefore, further research is needed to assess the intensity and reach of the information through an analysis of pre- and post-intervention that provides a complete picture of conceptualizations of time motion studies.

Estimating the number of required nurses in different types of hospitals: An application of the workload indicators of staffing needs (WISNS) method

Background Health system performance depends on the availability, accessibility, acceptability, and quality of health workforces. Policymakers seek whether the number of nurses is optimally matched based on patients’ needs. This study aimed to assess the workforce stock, workload activities, activity standards, and workload pressure to determine the number of required nurses in different types of hospitals in Iran. Methods This study applied the workload indicators of staffing needs (WISNs) method and was conducted in 22 surgical and internal medicine wards at five hospitals in the southwest of Iran during six months. A time-motion study, and several group discussions, interviews were used to extract the required data. Descriptive statistics were used for data analysis. Results All selected hospitals faced nursing shortages. The highest shortage (-47) and workload pressure (WISN ratio 0.45) were observed in the general-educational hospitals. In the specialized hospitals, the workload pressure was high (WISN ratio 0.49). The lowest shortage belonged to the private hospital. Based on our assessment, in all of the hospitals, nurses typically worked overtime due to high workload. The studied hospitals covered an average of 25% of their shortage with nursing overtime working. We noted that nurses were predominantly occupied with health service and supportive activities (≈90% of their time). Conclusions Based on the WISN method, all of the hospitals faced nursing shortages from moderate to high. However, it would be essential to consider current labor market analysis based on accurate data to adopt appropriate policies in HRH planning.

Cost minimization analysis of subcutaneous trastuzumab versus intravenous biosimilar trastuzumab: policy recommendations for breast cancer treatment in Malaysia.

Current clinical practice recommends switching innovator intravenous trastuzumab (IV-TZMi) to subcutaneous trastuzumab (SC-TZM) to save healthcare resources. However, with the availability of biosimilar intravenous trastuzumab (IV-TZMb), there is a need to re-evaluate the recommendation. Hence, this study aims to compare the cost and resource use of SC-TZM and IV-TZMb in a Malaysian public healthcare facility. This activity-based costing study consists of (1) a retrospective medical record abstraction to determine patient details to estimate drug costs and (2) a time-motion study to quantify personnel time, patient time, and consumables used. The total cost of both SC-TZM and IV-TZMb were then compared using a cost-minimization approach, while differences were explored using an independent t-test. A sensitivity analysis was also conducted to determine the impact of uncertainties in the analysis. The mean total cost of SC-TZM and IV-TZMb was USD 13,693 and USD 5,624 per patient respectively. The cost difference was primarily contributed by savings in drug cost of IV-TZMb, a reduction of USD 8,546 (SD = 134), p < 0.001 compared to SC-TZM. Interestingly, SC-TZM had a significantly lower cost than IV-TZMb for both the consumable and personnel cost, a reduction by USD 300 (SD = 17.6); p < 0.001 and USD 176 (SD = 7.3); p < 0.001 respectively. The sensitivity analysis demonstrated that the total cost difference between the formulation was mainly driven by drug costs. The study evidenced that IV-TZMb was a more economically viable option in Malaysian public healthcare currently compared to SC-TZM.