University of Michigan Health Systems

Validation of Work Processes for Pediatric Respiratory Care

Final Report

Clients:Ron Dechert - Manager, Respiratory Care

Teresa Keppler - MSA, RRT, Clinical Information Analyst Sr., Respiratory CareRenee Uchtorff - Respiratory Therapist Supervisor, Respiratory Care

Project Coordinators:Samuel Clark - Senior Management Engineer, Program and Operations Analysis

Marianne Pilat - Lean Coach, Michigan Quality Systems

Professor:Dr. Mark Van Oyen - IOE 481 Professor

December 10, 2013

Project Team 8 Members:Dan Bracciano

Liang DengMark GrumStephen Lee

Table of Contents

Executive Summary......................................................................................................................2

Introduction...................................................................................................................................5

Background...................................................................................................................................5 Goals and Objectives..............................................................................................................5 Key Issues...............................................................................................................................6 Project Scope..........................................................................................................................6

Data Collection..............................................................................................................................6 Literature Research.................................................................................................................6 Staff Interviews......................................................................................................................6 Shadowing..............................................................................................................................7 Beeper Study..........................................................................................................................7

Data Analysis................................................................................................................................7 Shadowing .............................................................................................................................7 Beeper Study..........................................................................................................................8

Findings and Conclusions.............................................................................................................8 Shadowing..............................................................................................................................8 Beeper Study..........................................................................................................................10

Recommendations.........................................................................................................................10

Expected Impact............................................................................................................................11

Appendix.......................................................................................................................................12

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EXECUTIVE SUMMARYThe Respiratory Care department moved from the Taubman Center to the C.S. Mott Children’s Hospital in December 2011. The much larger facility has resulted in increased travel for therapists and a more dispersed work area. Despite this, respiratory therapists are using the same workload distribution. In addition, there is a current disparity between the current time standards and those recently released by the American Association of Respiratory Care (AARC). Specifically, the contact minutes are 252 minutes per 24 hours of service while the national standard in the AARC are 157 minutes per 24 hours of service. This shows that respiratory therapists are taking a longer time with patients to achieve similar results in the national standards. To address the disparity with the national standards and account new facility factors, Project Team 8 was tasked to validate the current workload and workflow.

Goals and ObjectivesThe primary goal of this project was to inform staffing decisions in the respiratory therapy department by discovering how workflow affects workload and the balance between them. The team achieved this through the following tasks:

Conducted time studies of therapists to validate current time standards Determined the current mean time for separate therapy’s Determined current proportional division of therapists activities

Methodology The team collected data through the following five separate methods:  

Literature ResearchThe team reviewed reports written by previous IOE 481 teams who also worked with the pediatric respiratory unit. Two similar reports on the pediatric respiratory unit in the fall of 2006 and the winter of 2007 were discovered and reviewed. These reports grouped care by whether it was direct patient care or indirect which the team adopted in its analysis.

Staff InterviewsThe team developed a list of interview questions, which were conducted with 16 pediatric respiratory therapists. These interviews were not intended to be statistically relevant but were intended to identify preliminary focus areas for the shadowing phase and help the better team understand the workload of the respiratory therapists.

ShadowingIn the shadowing stage, the team followed pediatric respiratory therapists over the hours of 7 AM - 11 PM for each day of the week.  This spread of times was covered to ensure that the data would not be biased based on high or low workload times.  Over the course of 5 weeks, 89 hours and 30 minutes were observed. The team worked with the clients to develop a compressive list of activities to track as well as a tracking sheet format, which may viewed in Appendix A.  The grouping of concurrent activities was also determined to be a useful method for recording data due to the teams limited observation capabilities and the fact that the A.A.R.C. time standards are structured in a similar manner.  

Beeper Study

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During this stage, the team supplied the respiratory therapy staff with beepers, which randomly alerted the staff at a mean vibration occurrence of two times per hour. Over the two weeks, on both night and day shifts, 8 staff members were participating in the study at any given time. Therefore, in total, data from 192 shifts were collected. The goal of this study was to gather data, which would accurately show the proportional division of labor across units and hours of the day.

Data Analysis The data analysis was done for the shadowing stage and beeper study. Each analysis showed the distribution for direct, indirect, and unscheduled activity, along with time values for each driver.

To properly structure the shadow data, the team developed a template in Excel, seen in Appendix B, in order to ensure the data entry would allow for proper manipulation of the data.  Pivot tables were constructed in order to identify the mean times of major activities when they occurred with and without concurrent activities. Microsoft Access was used in order to create queries to show tables that included the main drivers and the concurrent activities, which went with them.

The team worked with the clients and coordinators to develop a methodology of data input for the beeper study data, which would reflect the proportional division of labor across units and hours of the day. This data was compiled based on the variable, which was being addressed, producing proportional divisions based time of day, type of care, and other factors

FindingsDue to the fact that the team conducted two different types of time studies, which produced different types of data, it is necessary to separate the findings from this data based on the methodology, which was used to obtain it.

Shadowing1575 activity were recorded throughout the shadowing period. While all records were documented, the main activities, also known as the drivers, were furthered analyzed per the clients’ request. Seen in Table 1 is a list of each driver, along with the number of occurrences, total time in minutes, median time per number of occurrences, mean duration, and concurrent activities for each driver. Concurrent activities for each driver are shown in Appendix W – Appendix AB.

Table 1: Time Values and Distribution for Each Main Driver

Beeper study

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In total, 3231 beeps were recorded across the four main units. Displayed in Figure 1 is the proportional division of those beeps as marking direct patient care, indirect patient care, and unscheduled activity.

Figure 1: Distribution of Reported Beeps in Different Units

As seen in the figure, higher levels of unscheduled activity were reported in the NICU and PICU (11-12%) than were in the General Care floors and the PCTU (4-5%). In addition, a higher proportion of direct care was reported as occurring in the General Care floors (59%) than were in the three ICU units (47-53%).

RecommendationsDue to the lack of clinical expertise, Team 8 is not able to give recommendations to upper management for Respiratory Care at C.S. Mott Hospital.

Expected ImpactAs mentioned above, Team 8 lacks the clinical knowledge to make informed decisions about how to change the care provided by respiratory therapists. However, the data that was collected and analyzed by the group can be used by upper management for future work. With their clinical background, upper management will be equipped to make decisions that affect workflow and workload about pediatric respiratory therapists in C.S. Mott Hospital.

INTRODUCTION

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In December 2011, many of the clinics that were located in the Taubman Center moved into its own building, now called the C.S. Mott Children’s and Von Voigtlander Women’s Hospital. The time standards used for procedures in the previous facility are still influencing staffing decisions, even though the current facility is much larger. As a result, the Administrative Director of the department of Respiratory Care in the C.S. Mott Hospital is concerned about the workload distribution and workflow of the respiratory therapists. Using quantitative measures, Mott’s upper management discovered that the current time standards do not match the national standards of the American Association of Respiratory Care (AARC). By comparing this data to the AARC, upper management is concerned because the workflow and workload is not as productive and efficient as the national standards of the AARC. The time standards serve as a specification for determining how many respiratory therapists are scheduled for each shift and task. Subjective measures from both Mott’s upper management and respiratory therapists show that respiratory therapists are forced to walk longer distances resulting in an increase in both non-value added time and physical challenge of the respiratory therapists because of the larger facility. As a result, the Administrative Director asked the Industrial and Operations Engineering (IOE) 481 Project Team 8 at the University of Michigan to develop methods to update the current time standards in order to take into account of the much larger building. The team’s task was using the time standards to recommend how the workload and workflow of the Respiratory Care department could be changed or updated.

BACKGROUNDThe Respiratory Care department was moved to the current C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital in December 2011. The much larger facility results in respiratory therapists walking on average 1.5 miles per 8-hour shift, which is much more than in the previous facility. Even with the increase of space, the workload distribution that was developed in 2005 is still being used. The upper management recognizes this as a potential issue and reason why the current time standards, specifically contact minutes and full-time equivalency (FTE), does not match the national standards of the AARC. The contact minutes are the total time respiratory therapists are in direct contact with the patients. Therefore, this value does not include walking, lunch breaks, etc. Currently, the contact minutes are 252 minutes per 24 hours of service while the national standard in the AARC is 157 minutes per 24 hours of service. This shows that respiratory therapists are taking a longer time with patients to achieve similar results in the national standards. The upper management also expressed concern with the FTE. FTE is a standard unit to incorporate total working hours of part-time and full-time respiratory therapists. Currently, the full-time equivalent (FTE) of respiratory therapists is 0.73 per 10,000 units, and the national standard is approximately 0.5 per 10,000 units. The evidence shows that the Respiratory Care unit has an overall 55 percent inefficiency rate. To address this issue, Project Team 8 was tasked to validate the current workload and workflow and develop recommendations to improve efficiency. The workflow being the chronological order of key tasks the respiratory therapists perform and the workload being how the different tasks are distributed to the respiratory therapists working on a given shift.

Goals and ObjectivesThe primary goal of this project was to inform staffing decisions in the respiratory therapy department by discovering how workflow affects workload and the balance between them. The team achieved this through the following tasks:

Conducted time studies of therapists to validate current time standards

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Determined the current mean time for separate therapy’s Determined current proportional division of therapists activities

With the information, the team: Provided data on therapists’ workflow and workload distributions Showed proportion of direct care, indirect care and unscheduled activity Updated time standards of pediatric respiratory therapists

Key IssuesThe following key issues drove the need for this project

Respiratory Care department has moved to a larger facility; however, the time standards from the old facility are still being used

Scheduling system was regularly recommending more therapists than are recommended by the AARC standards

There were 252 contact minutes per 24 hours of service compared to 157 contact minutes (AARC Standard)

Project ScopeThis project addressed issues related to the distribution of workload and workflow of the pediatric respiratory therapists and the development of new time standards for the Respiratory Care department. It focused on work activity in units from 7th to 12th floor all days of the week.  

This project did not include recommendations about how the pediatric respiratory therapists provide their care. In addition, this project did not provide a new work schedule and assign specific work to respiratory therapists.

DATA COLLECTIONThe team collected data through the following five separate methods:  

Literature ResearchThe team reviewed reports written by previous IOE 481 teams who also worked with the pediatric respiratory unit. This was done in order to formulate the procedural structure of Team 8’s report.  Two similar reports on the pediatric respiratory unit in the fall of 2006 [cite] and the winter of 2007[cite] were discovered and reviewed.  These reports conducted time studies of the unit in its much smaller previous location.  It was also discovered that these time studies are still being used in the new facility.  These reports grouped care by whether it was direct patient care or indirect which the team adopted in its analysis.

Staff InterviewsThe team developed a list of interview questions, which were conducted with 16 pediatric respiratory therapists.  These questions addressed topics such as the effects of the new facility on their workday and what the therapists view as the greatest inefficiencies in their workplace. These interviews were not intended to be statistically relevant but were intended to identify preliminary focus areas for the shadowing phase and help the better team understand the workload of the respiratory therapists.

Shadowing

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In the shadowing stage, the team followed pediatric respiratory therapists for a series of four-hour blocks.  These shadowing sessions were spread over the hours of 7 AM - 11 PM of each day of the week.  This spread of times was covered to ensure that the data would not be biased based on high or low workload times.  To meet this shadowing goal, each team member shadowed for a minimum of four hours a week with one team member shadowing for 8 hours each week.  Over the course of 5 weeks, 89 hours and 30 minutes were observed.   The team was permitted to follow the therapists around for the entire duration of the shadowing shift but was not permitted to enter patient rooms.  Therefore, the clients and the team determined that, given the teams observation limitations, data on concurrent activities should be grouped as one time block.  For example, if a therapist went into a room and performed an MDI for 10 minutes, patient assessment for 5 minutes, and documentation for another 5 minutes, the team would recorded that occurrence as an MDI for 20 minutes with patient assessment and documentation. The grouping of concurrent activities was also determined to be a useful method for recording data due to the fact that the AARC time standards are structured in a similar manner.  An example of the recording sheet with data may be viewed in Appendix A.

Beeper StudyDuring this stage, the team supplied the respiratory therapy staff with beepers, which randomly alerted the staff at a mean vibration occurrence of two times per hour. Over the two weeks, on both night and day shifts, 8 staff members were participating in the study at any given time. Therefore, in total, data from 192 shifts were collected.  In addition, the participating therapists were evenly distributed amongst the PICU, NICU, PCTU and general care units.  The staff was also supplied with tracking sheets on which they would select their current activity upon alert.  In addition, these tracking sheets were separated by the hour of the shift. The goal of this study was to gather data, which would accurately show case both the proportional division of labor across units and hours of the day.

DATA ANALYSIS

ShadowingTo properly structure the data, the team developed a template seen in appendix B in order to make sure the data entry would allow for proper manipulation of the data.  The team worked with the clients and coordinators to develop a methodology of data input, which would reflect the grouping of data.  As seen in the appendix, records consisted of date and time information, unit, activity being performed, the start and stop times that activity, whether the care was direct or indirect and scheduled or unscheduled.  Also, all activities were assigned a record number and an order number to allow for the pairing of activities, which occurred in the same time block. Concurrent activity records, which occurred in the same time block were assigned the same record number with their order numbers incrementing on the basis of most predominant activity within the time block.

To analyze the shadowing data, the team looked at 5 factors for each driver the clients had specified: Number of Occurrences, Total Time, Median Time, Mean Time and Concurrent Activities. Appendix V shows these data for the desired drivers. To find the concurrent activities for each driver, the team had to import the shadowing data into Microsoft Access. After running queries on unique instances of each driver, the team could then link each unique instance

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to shadowing table whenever the driver had additional concurrent activity. Distributions were then created to show how often a specific activity occurred with a particular driver. This is shown in Appendix W through Appendix AB.

Beeper StudyThe team worked with the clients and coordinators to develop a methodology of data input, which would reflect the proportional division of labor across units, and hours of the day.The beeper study data is comprised of four sheets showing activities in each unit (PICU, NICU, PCTU, and General Care Floors). In each sheet, there were seven tabs showing each day throughout a whole week. In each tab, the team added up the number of a certain activity under a specific period for a specific day based on the beeper study sheets collected from the therapist. Therefore, the number showing in a cell represents the number of an activity in an hour period in a specific day within a unit. The team used the Excel spreadsheets to create the graphs shown in Appendix K – Appendix U.

FINDINGS AND CONCLUSIONSThe following findings were obtained from the analysis the team conducted on the shadowing and beeper study data.

Shadowing Using the Excel template for inputting our shadowing data (Appendix B), our team analyzed all the data from the shadowing stage of our data collection. The main drivers, or activities, we focused on were MDI, SVN, lung conditioning, equipment set-up, CPAP/BiPAP, vent management, and communication and travel with no concurrent activities. The communication driver included communicating with the C.S. Mott Hospital staff as well as the family members of the patients. The reason for grouping both types of communication was because it was determined to be more beneficial to see the time values therapists spent on communicating with anyone.

We found that for CPAP/BiPAP, lung conditioning, and MDI, there were very few data points. However, for the rest of the main drivers, a histogram was created in order to have a visual sense of the main time range that depicted how long the therapists took for each main driver. Although, the total times and average times for each activity were calculated, we were able to see the major outliers with the histograms.

In addition, we used Microsoft Access to find the percent distribution for each concurrent activity within the major drivers.

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0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-5002468

10121416

SVN: Time Range and Corresponding Frequency

Time Range (minutes)

Freq

uenc

y

Figure 1: SVN: Time Range and Corresponding Frequency

0-4 5-8 9-12 13-16 17-20 21-24 25-28 29-32 33-36 37-40 41-44 45-480

5

10

15

20

Vent Mgmt: Time Range and Corresponding Frequency

Time Range (minutes)

Freq

uenc

y

.    Figure 2: Vent Mgmt: Time Range and Corresponding Frequency

The Driver data was compiled to show is a list of each driver, along with the number of occurrences, total time in minutes, median time per number of occurrences, mean duration, and concurrent activities for each driver. Using Microsoft Excel, the team was able to find all fields except for concurrent activities. Shown in Appendix V, each driver has its specific number of occurrences, total time in minutes, median time per number of occurrences, mean duration, and concurrent activities. A table of concurrent activity for the MDI driver is shown below in Figure 3.

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MDI (Sample Size = 11)

Concurrent Activity Frequency

Docum-Billing 64%

Pt. Assessment 64%

Secretion Mgmt 36%

Vent Mgmt 36%

SVN 27%

Comm-MD/RN/RT 18%

Equip Set-up 9%

Figure 3: MDI Concurrent Activity Distribution

Beeper Study The percentage distributions of direct care, indirect care, and unscheduled care in different units are shown in Table X. The total number of reported beeps for General Care Floors, NICU, PCTU, and PICU is 913, 858, 778, and 682 respectively.

Figure 3: Distribution of Reported Beeps in Different Units

As the figure shows, General Care Floors reported the highest percentage for direct care, 59%, whereas PCTU reported the highest percentage for indirect care, 48%. In addition, the percentage for indirect care was slightly higher than the percentage for direct care.

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On a daily basis, which is in a 24-hour period, there were some trends for each unit regarding types of care. In General Care Floors, there was a peak two hours after the shift started for direct care and a peak one hour after the shift started for indirect care. In NICU, there were two peaks during each shift for direct care, two hours after the shift started and about three hours before the shift ended. In PCTU, there was also a peak two hours after a shift started for direct care. However, its percentage of reported beeps at the beginning of the morning shift was extremely low. In PICU, a peak happened only one hour after each shift started for direct care.

After comparing four units’ percentages of reported beeps on both weekdays and weekend, General Care Floors reported the highest percentage for direct care on weekdays, 61%, and NICU reported the highest percentage for unscheduled care on the weekend, 18%. In General Care Floors, PCTU, and PICU, the percentages of reported beeps for direct care and unscheduled care on weekdays were higher than weekend, whereas the percentage for indirect care on weekend was higher than weekdays’. In NICU, however, the percentages for direct care and indirect care on weekdays were slightly higher than weekend’s and the percentage for unscheduled care on weekend was much higher than weekdays’.

RECOMMENDATIONSDue to the lack of clinical expertise, Team 8 is not able to give recommendations to upper management for Respiratory Care at C.S. Mott Hospital.

EXPECTED IMPACTAs mentioned above, Team 8 lacks the clinical knowledge to make informed decisions about how to change the care provided by respiratory therapists. However, the data that was collected and analyzed by the group can be used by upper management for future work. With their clinical background, upper management will be equipped to make decisions that affect workflow and workload about pediatric respiratory therapists in C.S. Mott Hospital.

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APPENDIX

Appendix A: Shadowing Data collection sheet

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Appendix B: Shadowing excel template

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Appendix C: Beeper Data collection sheet

Front side

Backside

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Appendix D: Beeper Data Excel Template

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Appendix E: Percentage of Care Type by Unit

Appendix F: Vent Mgmt: Time Range and Corresponding Frequency

0-4 5-8 9-12 13-16 17-20 21-24 25-28 29-32 33-36 37-40 41-44 45-480

5

10

15

20

Vent Mgmt: Time Range and Corresponding Frequency

Time Range (minutes)

Freq

uenc

y

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Appendix G: Equip Set-up: Time Range and Corresponding Frequency

0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-230

2

4

6

8

10

12

Equip Set-up: Time Range and Correspond-ing Frequency

Time Range (minutes)

Freq

uenc

y

Appendix H: SVN: Time Range and Corresponding Frequency

0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-5002468

10121416

SVN: Time Range and Corresponding Frequency

Time Range (minutes)

Freq

uenc

y

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Appendix I: Communication: Time Range and Corresponding Frequency

0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 24-25 26-2705

10152025303540

Communication: Time Range and Correspond-ing Frequency

Time Range (minutes)

Freq

uenc

y

Appendix J: Travel: Time Range and Corresponding Frequency

0-1 2-3 4-5 6-7 8-9 10-110

50

100

150

200

250

300

350

Travel: Time Range and Corresponding Frequency

Time Range (minutes)

Freq

uenc

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Appendix K: General Care Floor Care Type Distribution

1 3 5 7 9 11 13 15 17 19 21 230%

40%

80%

General Care Floors

Percentage direct carePercentage indirect carepercentage unscheduled

HourPerc

enta

ge o

f Rep

orte

d Be

eps*

Appendix L: NICU Care Type Distribution

1 3 5 7 9 11 13 15 17 19 21 230%

20%40%60%80%

100%

NICU

Percentage direct carePercentage indirect carepercentage unscheduled

Hour

Perc

enta

ge o

f Rep

orte

d Be

eps*

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Appendix M: PCTU Care Type Distribution

1 3 5 7 9 11 13 15 17 19 21 230%

20%40%60%80%

100%

PCTU

Percentage direct carePercentage indirect carepercentage unscheduled

HourPerc

enta

ge o

f Rep

orte

d Be

eps*

Appendix N: PICU Care Type Distribution

1 3 5 7 9 11 13 15 17 19 21 230%

20%40%60%80%

100%

PICU

Percentage direct carePercentage indirect carepercentage unscheduled

Hour

Perc

enta

ge o

f Rep

orte

d Be

eps*

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Appendix O: General Care Floor Activity Distribution

Appendix P: PCTU Activity Distribution

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Appendix P: NICU Activity Distribution

Appendix Q: PICU Activity Distribution

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Appendix R: PCTU Weekday vs. Weekend Care Type Distribution

Direct Indirect Unscheduled0%

10%

20%

30%

40%

50%

60%

70%48%

46%

6%

43%

57%

0%

PCTU

Care

Perc

enta

ge o

f Rep

orte

d Be

eps

Appendix S: General Care Floor Weekday vs. Weekend Care Type Distribution

Direct Indirect Unscheduled0%

10%

20%

30%

40%

50%

60%

70%61%

34%

5%

49% 51%

0%

General Care Floors

Care

Perc

enta

ge o

f Rep

orte

d Be

eps

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Appendix T: NICU Weekday vs. Weekend Care Type Distribution

Direct Indirect Unscheduled0%

10%

20%

30%

40%

50%

60%

70%52%

38%

10%

50%

32%

18%

NICU

Care

Perc

enta

ge o

f Rep

orte

d Be

eps

Appendix U: PICU Weekday vs. Weekend Care Type Distribution

Direct Indirect Unscheduled0%

10%

20%

30%

40%

50%

60%

70%54%

35%

12%

48%42%

11%

PICU

Care

Perc

enta

ge o

f Rep

orte

d Be

eps

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Appendix V: Driver Table

Drivers Number of Occurrences

Total Time

(mins)

Median Time

(mins)

Mean Duration

(mins)

Concurrent Activities

MDI 11 205 16 18.64 See Table

SVN 43 603 13 14.02 See Table

Vent Mgmt 69 686 8 9.94 See Table

CPAP/BiPaP 9 86 8 9.56 See Table

Comm-All (Non-Concurrent) 108 378 2 3.50 N/A

Travel (Non-Concurrent) 395 401 1 1.02 N/A

Equip Set-up 45 319 5 7.09 See Table

Lung Cond. 9 111 15 12.33 See Table

Appendix W: CPAP/BiPaP Concurrent Activity Distribution

CPAP/BiPaP (Sample Size = 9)

Concurrent Activity Frequency

Pt. Assessment 67%

Docum-Billing 56%

SVN 22%

Equip Rounds 11%

Order Mgmt 11%

Travel 11%

Appendix X: MDI Concurrent Activity Distribution

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MDI (Sample Size = 11)

Concurrent Activity Frequency

Docum-Billing 64%

Pt. Assessment 64%

Secretion Mgmt 36%

Vent Mgmt 36%

SVN 27%

Comm-MD/RN/RT 18%

Equip Set-up 9%

Appendix Y: SVN Concurrent Activity Distribution

SVN (Sample Size = 43)

Concurrent Activity Frequency

Docum-Billing 67%

Pt. Assessment 58%

Secretion Mgmt 26%

Vent Mgmt 23%

Comm-MD/RN/RT 19%

Comm-Family 14%

Airway Mgmt 7%

MDI 7%

Order Mgmt 7%

CPAP/BiPaP 5%

Equip Rounds 5%

Lung Cond. 5%

Travel 5%

Appendix Z: Equip Set-up Concurrent Activity Distribution

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Equip Set-up (Sample Size = 45)

Concurrent Activity Frequency

Comm-MD/RN/RT 16%

Travel 11%

Vent Mgmt 11%

Airway Mgmt 9%

Docum-Billing 9%

Pt. Assessment 7%

Equip Rounds 4%

Page/Phone 4%

CPAP/BiPaP 2%

MDI 2%

Staff Assist 2%

Appendix AA: Lung Cond. Concurrent Activity Distribution

Lung Cond. (Sample Size = 9)

Concurrent Activity Frequency

Docum-Billing 33%

Pt. Assessment 33%

Vent Mgmt 33%

Airway Mgmt 22%

Comm-Family 22%

Comm-MD/RN/RT 22%

SVN 22%

Order Mgmt 11%

Travel 11%

Appendix AB: Vent Mgmt Concurrent Activity Distribution

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Vent Mgmt (Sample Size = 69)

Concurrent Activity Frequency

Docum-Billing 52%

Pt. Assessment 45%

Comm-MD/RN/RT 23%

Secretion Mgmt 20%

Airway Mgmt 14%

Travel 9%

Comm-Family 7%

Equip Set-up 7%

MDI 6%

Lung Cond. 4%

Order Mgmt 4%

Staff Assist 4%

Alarm/Alert 3%

Equip Rounds 3%

Page/Phone 1%

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