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The patient encounter index: a novel method of measuring clinical workload in a paediatric cardiology service

Published online by Cambridge University Press:  07 January 2020

Michael J. Harrison Open the ORCID record for Michael J. Harrison [Opens in a new window] ,
Oliver M. Barry Open the ORCID record for Oliver M. Barry [Opens in a new window] ,
Rachel A. Hounsell  and
Rik De Decker
Michael J. Harrison*
Affiliation:
Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Oliver M. Barry
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, USA
Rachel A. Hounsell
Affiliation:
Nuffield Department of Medicine, University of Oxford, Oxford, UK
Rik De Decker
Affiliation:
Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
*
Author for correspondence: M. J. Harrison, MBChB, Department of Paediatrics and Child Health, Division of Cardiology, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa. Tel: +27 78 120 3604; Fax: +27 21 650 7391. E-mail: michael.john.thomas.harrison@gmail.com
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Abstract

Technological advances have led to better patient outcomes and the expansion of clinical services in paediatric cardiology. This expansion creates an ever-growing workload for clinicians, which has led to workflow and staffing issues that need to be addressed. The objective of this study was the development of a novel tool to measure the clinical workload of a paediatric cardiology service in Cape Town, South Africa: The patient encounter index is a tool designed to quantify clinical workload. It is defined as a ratio of the measured duration of clinical work to the total time available for such work. This index was implemented as part of a prospective cross-sectional study design. Clinical workload data were collected over a 10-day period using time-and-motion sampling. Clinicians were contractually expected to spend 50% of their daily workload on patient care. The median patient encounter index for the Western Cape Paediatric Cardiac Service was 0.81 (range 0.19–1.09), reflecting that 81% of total contractual working time was spent on clinical activities. This study describes the development and implementation of a novel tool for clinical workload quantification and describes its application to a busy paediatric cardiology service in Cape Town, South Africa. This tool prospectively quantifies clinical workload which may directly influence patient outcomes. Implementation of this novel tool in the described setting clearly demonstrated the excessive workload of the clinical service and facilitated effective motivation for improved allocation of resources.

Keywords

Clinical workloadpaediatric cardiologyworkload quantificationlow-resource setting
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 1 , January 2020 , pp. 114 - 118
Copyright
© Cambridge University Press 2020

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