How Much Labor Is in a Labor Epidural?

2000 ◽  
Vol 92 (3) ◽  
pp. 851-858 ◽  
Author(s):  
Elizabeth D. Bell ◽  
Donald H. Penning ◽  
Edward F. Cousineau ◽  
William D. White ◽  
Andrew J. Hartle ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Labor Cost ◽  
Full Time ◽  
Full Time Equivalent ◽  
Medicaid Reimbursement ◽  
Tertiary Referral Center ◽  
Time And Motion ◽  
Obstetric Analgesia ◽  
Duke University

Background Some anesthesiologists avoid provision of obstetric analgesia services (OAS) because of low reimbursement rates for the work involved. This study defines the manpower costs of operating an OAS in a tertiary referral center and examines reimbursement for this cost. Methods The time spent providing OAS in a total of 55 parturients was studied prospectively using a modification of classic time and motion studies. Results Mean duration of OAS in our population was 412 +/- 313 min. Mean bedside anesthesia staff time was 90 +/- 40 min, and mean number of visits to each patient's bedside was 6.3 +/- 2.0 visits. Assuming staffing on demand for service (intermittent staffing), a minimum of 2.5 full-time equivalent (FTE) attending anesthesiologists was required to meet demand. With intermittent staffing, labor cost was $325 per patient. Actual practice at Duke University Medical Center is around-the-clock (dedicated) staffing, which requires 4.4 FTEs at a cost of $728 per patient. Neither average indemnity reimbursement ($299) nor Medicaid reimbursement ($204) covered the cost per OAS patient. Breaking even is possible under indemnity reimbursement because operating room reimbursement subsidizes OAS costs. Breaking even cannot occur with Medicaid reimbursement under any circumstances. Conclusions Obstetric analgesia services requires a minimum of 2.5 FTE attending anesthesiologists at Duke University Medical Center. With the current payer mix, positive-margin operating room activities associated with the obstetric service are not sufficient to compensate for the losses incurred by an OAS. Around-the-clock dedicated obstetric staffing (4.4 FTEs) cannot operate profitably under any reasonable circumstances at our institution.

Measurement of Individual Clinical Productivity in an Academic Anesthesiology Department

2000 ◽  
Vol 93 (6) ◽  
pp. 1509-1516 ◽  
Author(s):  
Amr E. Abouleish ◽  
Mark H. Zornow ◽  
Ronald S. Levy ◽  
James Abate ◽  
Donald S. Prough
Keyword(s):  
Medical Center ◽  
Clinical Care ◽  
Obstetric Anesthesia ◽  
Fiscal Year ◽  
Full Time ◽  
Full Time Equivalent ◽  
High Productivity ◽  
Academic Settings ◽  
Individual Productivity ◽  
American Society

Background The ability to measure productivity, work performed, or contributions toward the clinical mission has become an important issue facing anesthesiology departments in private practice and academic settings. Unfortunately, the practice and billing of anesthesia services makes it difficult to quantify individual productivity. This study examines the following methods of measuring individual productivity: normalized clinical days per year (nCD/yr); time units per operating-room day worked (TU/OR day); normalized time units per year (nTU/yr); total American Society of Anesthesiologists (ASA) units per OR day (tASA/OR day); and normalized total ASA units per year (ntASA/yr). Methods Billing and scheduling data for clinical activities of faculty members of an anesthesiology department at a university medical center were collected and analyzed for the 1998 fiscal year. All clinical sites and all clinical faculty anesthesiologists were included unless they spent less than 20% of their time during the fiscal year providing clinical care, i.e., less than 0.2 clinical full-time equivalent. Outliers, defined as faculty who had productivity greater or less than 1 SD from the mean, were examined in detail. Results Mean and median values were reported for each measurement, and different groups of outliers were identified. nCD/yr identified faculty who worked more than their clinical full-time equivalent would have predicted. TU/OR day and tASA/OR day identified apparently low-productivity faculty as those who worked a large portion of their time in obstetric anesthesia or an ambulatory surgicenter. tASA/OR day identified specialty anesthesiologists as apparently high-productivity faculty. nTU/yr and ntASA/yr were products of the per-OR day measurement and nCD/yr. Conclusion Each of the measurements studied values certain types of productivity more than others. By defining what type of service is most important to reward, the most appropriate measure or combination of measures of productivity can be chosen. In the authors' department, nCD/yr is the most useful measure of individual productivity because it measures an individual anesthesiologist's contribution to daily staffing, includes all clinical sites, is independent of nonanesthesia factors, and is easy to collect and determine.

scholarly journals Measuring Clinical Productivity of Anesthesiology Groups

2019 ◽  
Vol 130 (2) ◽  
pp. 336-348 ◽  
Author(s):  
Amr E. Abouleish ◽  
Mark E. Hudson ◽  
Charles W. Whitten
Keyword(s):  
Operating Room ◽  
Data Driven ◽  
Full Time ◽  
Confounding Factors ◽  
Full Time Equivalent ◽  
Group Productivity ◽  
Facility Level ◽  
Large Groups

Abstract Benchmarking and comparing group productivity is an essential activity of data-driven management. For clinical anesthesiology, accomplishing this task is a daunting effort if meaningful conclusions are to be made. For anesthesiology groups, productivity must be done at the facility level in order to reduce some of the confounding factors. When industry or external comparisons are done, then the use of total ASA units per anesthetizing sites allows for overall productivity comparisons. Additional productivity components (total ASA units/h, h/case, h/operating room/d) allow for leaders to develop productivity dashboards. With the emergence of large groups that provide care in multiple facilities, these large groups can choose to invest more effort in collecting data and comparing facility productivity internally with group-defined measurements including total ASA units per full time equivalent.

scholarly journals Extending the Population Health Workforce Through Service Learning Internships During COVID: A Community Case Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Jeffrey Belkora ◽  
Tia Weinberg ◽  
Jasper Murphy ◽  
Sneha Karthikeyan ◽  
Henrietta Tran ◽  
...  
Keyword(s):  
Service Learning ◽  
Population Health ◽  
San Francisco ◽  
Medical Center ◽  
Academic Medical Center ◽  
University Of California ◽  
Full Time ◽  
Learning Program ◽  
Full Time Equivalent ◽  
The University

This report arises from the intersection of service learning and population health at an academic medical center. At the University of California, San Francisco (UCSF), the Office of Population Health and Accountable Care (OPHAC) employs health care navigators to help patients access and benefit from high-value care. In early 2020, facing COVID-19, UCSF leaders asked OPHAC to help patients and employees navigate testing, treatment, tracing, and returning to work protocols. OPHAC established a COVID hotline to route callers to the appropriate resources, but needed to increase the capacity of the navigator workforce. To address this need, OPHAC turned to UCSF's service learning program for undergraduates, the Patient Support Corps (PSC). In this program, UC Berkeley undergraduates earn academic credit in exchange for serving as unpaid patient navigators. In July 2020, OPHAC provided administrative funding for the PSC to recruit and deploy students as COVID hotline navigators. In September 2020, the PSC deployed 20 students collectively representing 2.0 full-time equivalent navigators. After training and observation, and with supervision and escalation pathways, students were able to fill half-day shifts and perform near the level of staff navigators. Key facilitators relevant to success reflected both PSC and OPHAC strengths. The PSC onboards student interns as institutional affiliates, giving them access to key information technology systems, and trains them in privacy and other regulatory requirements so they can work directly with patients. OPHAC strengths included a learning health systems culture that fosters peer mentoring and collaboration. A key challenge was that, even after training, students required around 10 h of supervised practice before being able to take calls independently. As a result, students rolled on to the hotline in waves rather than all at once. Post-COVID, OPHAC is planning to use student navigators for outreach. Meanwhile, the PSC is collaborating with pipeline programs in hopes of offering this internship experience to more students from backgrounds that are under-represented in healthcare. Other campuses in the University of California system are interested in replicating this program. Adopters see the opportunity to increase capacity and diversity while developing the next generation of health and allied health professionals.

scholarly journals Analisis Beban Kerja dan Kebutuhan Karyawan (Direktorat Operasional Kantor Pusat) PT Perkebunan Nusantara VIII

2019 ◽  
Vol 9 (3) ◽  
pp. 182-191
Author(s):  
Puji Lestari ◽  
Erlin Trisyulianti
Keyword(s):  
Labor Cost ◽  
Working Time ◽  
Full Time ◽  
Full Time Equivalent ◽  
Workload Analysis ◽  
Purposive Sampling ◽  
Work Sampling ◽  
Head Office ◽  
Ideal Number ◽  
The Ideal

ABSTRACTThe crisis of high labor cost leads companies to evaluate the number of employees in the head office. This study aims to determine the workload and needs of employees in the Directorate of Operations PT Perkebunan Nusantara VIII Head Office. The method used in this research is the analysis of the workload with the calculation of Full Time Equivalent (FTE) and work sampling using purposive sampling techniques. The ideal number of employees at the Directorate of Operations is 40 employees consisting of 21 employees of the Plant Department and 19 employees of the Engineering and Processing Department. Based on teh observation, employee working time in Directorate of Operations shows that the average of employee working time is 87,8 4percent fairly productive because it meets the standard that is above 85 percent.Keywords: workload analysis, job description, work sampling.ABSTRAKKrisis biaya tenaga kerja yang tinggi membuat perusahaan perlu mengevaluasi jumlah karyawan yang ada di kantor pusat. Penelitian ini bertujuan untuk mengetahui beban kerja dan kebutuhan karyawan pada Direktorat Operasional PT Perkebunan Nusantara VIII. Metode yang digunakan dalam penelitian ini adalah analisis beban kerja dengan perhitungan Full Time Equivalent (FTE) dan work sampling dengan penarikan sampel yang menggunakan teknik purposive sampling. Hasil penelitian menunjukkan bahwa jumlah karyawan ideal pada Direktorat Operasional sebanyak 40 karyawan yang terdiri dari 21 karyawan Bagian Tanaman dan 19 karyawan Bagian Teknik dan Pengolahan. Berdasarkan pengamatan penggunaan waktu kerja karyawan pada Direktorat Operasional menunjukkan bahwa rataan persentase waktu produktif karyawan sebesar 87,84 persen. Hal ini menunjukkan bahwa penggunaan waktu kerja karyawan sudah optimal karena sudah memenuhi standar yaitu di atas 85 persen.Kata kunci: analisis beban kerja, uraian pekerjaan, work sampling.

scholarly journals Implementation of a Health-System Wide Antimicrobial Stewardship Program in Omaha, NE

Pharmacy ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 156
Author(s):  
Jennifer Anthone ◽  
Dayla Boldt ◽  
Bryan Alexander ◽  
Cassara Carroll ◽  
Sumaya Ased ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Health System ◽  
Antimicrobial Stewardship ◽  
Program Effectiveness ◽  
Medical Center ◽  
Academic Medical Center ◽  
Full Time ◽  
Critical Access Hospitals ◽  
Full Time Equivalent ◽  
Stewardship Program

The Centers for Medicare and Medicaid Services (CMS) have mandated that acute care and critical access hospitals implement an Antimicrobial stewardship (AMS) program. This manuscript describes the process that was implemented to ensure CMS compliance for AMS, across a 14-member health system (eight community hospitals, five critical access hospitals, and an academic medical center) in the Omaha metro area, and surrounding cities. The addition of the AMS program to the 14-member health system increased personnel, with a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician, and 2.5 FTE infectious diseases trained clinical pharmacists to support daily AMS activities. Clinical decision support software had previously been implemented across the health system, which was also key to the success of the program. Overall, in its first year, the AMS program demonstrated a $1.2 million normalized reduction (21% total reduction in antimicrobial purchases) in antimicrobial expenses. The ability to review charts daily for antimicrobial optimization with ID pharmacist and physician support, identify facility specific needs and opportunities, and to collect available data endpoints to determine program effectiveness helped to ensure the success of the program.

Using pharmacists’ documentation of clinical activities to reclaim employees and reposition the department

1996 ◽  
Vol 53 (3) ◽  
pp. 285-288 ◽  
Author(s):  
Michael R. McDaniel ◽  
Douglas J. DeJong
Keyword(s):  
Total Quality Management ◽  
Task Force ◽  
Medical Center ◽  
Antimicrobial Use ◽  
Full Time ◽  
Clinical Documentation ◽  
Total Quality ◽  
Full Time Equivalent ◽  
Pharmacy Department ◽  
Evening Shift

Abstract The use of documentation on pharmacist clinical activities to encourage greater hospital investment in a department is described. From 1983 through 1988, the number of full-time-equivalent (FTE) positions in the pharmacy department at a 468-bed medical center was reduced from 63 to 39.4. To cope with the challenge of a sharply reduced staff, the department established a permanent pharmacy-nursing task force, developed a pharmacy strategic plan, used total quality management, recruited the best staff possible when openings appeared, and held staff retreats. In addition, measures were taken to begin documenting all pharmacist clinical activities online. As data were accumulated, it became clear that more pharmacist involvement in patient care areas was needed and that more resources would be necessary to achieve that. Presentations were made to hospital administration to demonstrate the existing and potential contributions of the department; the presentations drew heavily on the clinical documentation. Formal reports were also submitted. As a result, the department received approval for a pharmacist career ladder, an increase of 1.6 pharmacist FTEs for the evening shift, a large salary-range adjustment for staff pharmacists, and an increase of 1 pharmacist FTE to focus on antimicrobial use. A pharmacy department successfully used documentation of its clinical activities to make a case to administration for reclaiming some of the pharmacist FTEs lost through downsizing.

scholarly journals Restructuring the Orthopedic Resident Research Curriculum to Increase Scholarly Activity

2013 ◽  
Vol 5 (4) ◽  
pp. 646-651 ◽  
Author(s):  
Laura Robbins ◽  
Mathias Bostrom ◽  
Robert Marx ◽  
Timothy Roberts ◽  
Thomas P. Sculco
Keyword(s):  
Medical Center ◽  
Academic Research ◽  
Scholarly Activity ◽  
Research Quality ◽  
Full Time ◽  
Full Time Equivalent ◽  
Resident Research ◽  
Protected Time ◽  
Skills Laboratory ◽  
Research Curriculum

Abstract Background Limited time and funding are challenges to meeting the research requirement of the orthopedic residency curriculum. Objective We report a reorganized research curriculum that increases research quality and productivity at our academic orthopedic medical center. Methods Changes made to the curriculum, which began in 2006 and were fully phased in by 2008, included research milestones for each training year, a built-in support structure, use of an accredited bio-skills laboratory, mentoring by National Institutes of Health–funded scientists, and protected time to engage in required research and prepare scholarly peer-reviewed publications. Results Total grant funding of resident research increased substantially, from $15,000 in 2007 (8 graduates) to $380,000 in 2010 (9 graduates), and the number of publications also increased. The 12 residents who graduated in 2005 published 16 papers from 2000 to 2006, compared to 84 papers published by the 9 residents who graduated in 2010. The approximate costs per year included $19,000 (0.3 full-time equivalent) for an academic research coordinator; $16,000 for resident travel to professional meetings; reimbursement for 213 faculty hours; and funding for resident salaries while on the research rotation, paid through the general hospital budget. Conclusions The number of grants and peer-reviewed publications increased considerably after our residency research curriculum was reorganized to allow dedicated research time and improved mentoring and infrastructure.

Multipronged Intervention Strategy to Control an Outbreak of Clostridium difficile Infection (CDI) and Its Impact on the Rates of CDI from 2002 to 2007

2009 ◽  
Vol 30 (2) ◽  
pp. 156-162 ◽  
Author(s):  
Karl Weiss ◽  
Annie Boisvert ◽  
Miguel Chagnon ◽  
Caroline Duchesne ◽  
Sylvie Habash ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Infection Control ◽  
Virulent Strain ◽  
Medical Center ◽  
Intervention Strategy ◽  
Global Strategy ◽  
Full Time ◽  
Surveillance Period ◽  
Full Time Equivalent ◽  
Monthly Basis

Objective.At the end of 2002, a new, more virulent strain of Clostridium difficile, designated BI/NAP1, was the cause of a massive outbreak of infection in the province of Quebec. This particular strain was associated with a dramatic increase in morbidity and mortality among affected patients in 2003–2004. We tested and implemented a multipronged infection control approach to curtail the rate of C. difficile infection (CDI).Design.Five-year observational study.Setting.A 554-bed, acute care tertiary hospital, the largest single medical center in Quebec, Canada.Methods.To curtail the magnitude of the outbreak, we implemented a global strategy consisting of rapid C. difficile testing for all hospitalized patients who had at least 1 occurrence of liquid stool, the rapid isolation of patients infected with C. difficile in a dedicated ward with a specially trained housekeeping team, a global hand hygiene program, and the hiring of infection control practitioners. Antibiotic consumption at the institutional level was also monitored during the 5-year surveillance period. Cases of hospital-acquired CDI per 1,000 admissions were continuously monitored on a monthly basis during the entire surveillance period.Results.The highest recorded CDI rate was 42 cases per 1,000 admissions in January 2004. Once additional infection control resources were put in place, the rate descreased significantly during the period from April 2005 to March 2007. During the 2003–2004 period, there were 762 cases of CDI (mean annual rate, 37.28 cases per 1,000 admissions) recorded in our study, compared with 292 cases of CDI (14.48 cases per 1,000 admissions) during the 2006–2007 period (OR, 0.379 [95% CI, 0.331–0.435]; P < .001 ), a 61% reduction. In March 2007, the equivalent of 4 full-time equivalent infection control practitioners were in place, which gave a ratio of 0.96 infection control practitioners per 133 beds in use, compared with the ratio of 0.24 infection control practitioners per 133 beds in use in 2003, and the total number of hours dedicated to cleaning and housekeeping increased by 26.2%. The total amount of antibiotics used in the hospital did not vary significantly from 2002 to 2007, although there were changes in the classes antibiotic used.Conclusion.The implementation of a multipronged intervention strategy to control the outbreak of CDI significantly improved the overall situation at the hospital and underlined the importance of investing in stringent infection control practices.

scholarly journals All Hands-On Deck and All Decks on Hand: Surmounting Supply Chain Limitations During the COVID-19 Pandemic

2021 ◽  
Vol 8 ◽  
pp. 237428952110119
Author(s):  
Jill S. Warrington ◽  
Jessica W. Crothers ◽  
Andrew Goodwin ◽  
Linda Coulombe ◽  
Tania Hong ◽  
...  
Keyword(s):  
Supply Chain ◽  
Medical Center ◽  
Clinical Care ◽  
Disease Outbreaks ◽  
Full Time ◽  
Sample Collection ◽  
Full Time Equivalent ◽  
Laboratory Staff ◽  
The University ◽  
University Of Vermont

Testing during the COVID-19 pandemic has been crucial to public health surveillance and clinical care. Supply chain constraints—spanning limitations in testing kits, reagents, pipet tips, and swabs availability—have challenged the ability to scale COVID-19 testing. During the early months, sample collection kits shortages constrained planned testing expansions. In response, the University of Vermont Medical Center, University of Vermont College of Medicine, Vermont Department of Health Laboratory, Aspenti Health, and providers across Vermont including 16 area hospitals partnered to surmount these barriers. The primary objectives were to increase supply availability and manage utilization. Within the first month of Vermont’s stay-at-home order, the University of Vermont Medical Center laboratory partnered with College of Medicine to create in-house collection kits, producing 5000 per week. University of Vermont Medical Center reassigned 4 phlebotomists, laboratory educators, and other laboratory staff, who had reduced workloads, to participate (requiring a total of 5.3-7.6 full-time equivalent (FTE) during the period of study). By August, automation at a local commercial laboratory produced 22,000 vials of media in one week (reducing the required personnel by 1.2 FTE). A multisite, cross-institutional approach was used to manage specimen collection kit utilization across Vermont. Hospital laboratory directors, managers, and providers agreed to order only as needed to avoid supply stockpiles and supported operational constraints through ongoing validations and kit assembly. Throughout this pandemic, Vermont has ranked highly in number of tests per million people, demonstrating the value of local collaboration to surmount obstacles during disease outbreaks and the importance of creative allocation of resources to address statewide needs.

scholarly journals 1069. Implementation and Results of a Health-System Antimicrobial Stewardship (AMS) Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S379-S379
Author(s):  
Dayla Boldt ◽  
Jennifer Anthone ◽  
Bryan Alexander ◽  
Sumaya J Ased ◽  
Cassara Carroll ◽  
...  
Keyword(s):  
Health System ◽  
Program Effectiveness ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Medicine ◽  
Acceptance Rate ◽  
Fiscal Year ◽  
Full Time ◽  
Full Time Equivalent ◽  
Targeting Therapy

Abstract Background AMS expansion initiative was implemented in fiscal year 18 (FY18) across a 14-member health system (~1,000 average daily census combined) consisting of 8 community hospitals, 5 rural critical access hospitals and 1 academic medical center. Methods The expansion initiative included a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician and 2.5 FTE ID-trained clinical pharmacists to support daily AMS activities. Clinical decision support software (Theradoc) had previously been implemented across the health system. Here we report our continuation results for the first 9 months of year 2 (FYTD19) of the expansion initiative. Results AMS personnel documented an average of 319.8 and 313.2 interventions per month in FY18 vs. FYTD19, respectively. Mean acceptance rate of AMS interventions by providers was 87.9% and 89.4% in FY18 vs. FYTD19. Provider groups with the highest acceptance rate were Hospital Medicine, Pulmonary/Critical Care and Infectious Disease. Highest interventions in FYTD19 included recommending other diagnostic testing (17%) followed by de-escalating/targeting therapy based on culture results and recommending alternative therapy (both at 11%). Most common ID disease states AMS intervened included bacteremias (29%), pneumonias (ventilator-associated or community-acquired) 13% each, and UTIs 13%. AMS interventions generated 168 ID consults in FYTD19. The financial impact of AMS across the health system was a cumulative saving in antimicrobial expenditures of $1.29 million and $1.27 million in FY18 and FYTD19, respectively. Conclusion The ability to review offsite electronic medical records daily for antimicrobial optimization with ID pharmacist and physician support, identify facility-specific needs and opportunities, and collect available data endpoints to determine program effectiveness has helped to ensure program success. Disclosures All authors: No reported disclosures.

Sign in / Sign up

Export Citation Format

Share Document