pediatric multi-specialty clinic i nursing staff workload

81
I Pediatric Multi-Specialty Clinic Nursing Staff Workload Study Program and Operations Analysis Department Bree Bowersox Kelly Cairns Dennis Michelson April 24, 1998

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I

Pediatric Multi-Specialty ClinicNursing Staff Workload Study

Program and Operations Analysis Department

Bree BowersoxKelly Cairns

Dennis Michelson

April 24, 1998

Executive Summary

This report is a study of the clinical time distribution of the Multi-Specialty ClinicPediatric Nursing Staff in Taubman Center. The study was conducted by a group of TOE481 students. Three teams, consisting of 17 nurses, were studied. The purpose of thisproject is to determine the nursing staff workload. Three areas of interest include:

• Proportion of time spent on clinical activities versus non-clinical activities.• Proportion of time spent performing each separate clinical activity.• Detailed information regarding the phone calls handled by the nursing staff.

Data was collected from February 10, 1998 through March 27, 1998. Workload andphone log studies were conducted for a duration of two weeks each. The project teamconducted interviews of the entire nursing staff and performed the observations of aselect group of nurses throughout the study.

The workload measurement data was analyzed to evaluate the distribution of work withinthe Pediatric Clinic. From this study, it was determined that there exists an imbalance inworkload distribution among divisions within the Pediatric Multi-Specialty Clinic. Keyfindings also include the following:

• The annualized Phone Care nursing minutes per patient visit ranged from 13.0to 58.2 minutes.

• The annualized nursing minutes per patient visit for Clinical Activities rangedfrom 14.5 to 64.6 minutes.

• Phone Care consumes the most Full Time Equivalents (FTE), atapproximately 4.5 FTE’s or 35% of all nurses.

The phone log study was conducted in order to identif,r the distribution of types of phonecalls, length of phone calls, and other relevant phone call information.

• For the Pediatric Clinic, the volume of calls is spread evenly throughout theday at approximately 28 calls per hour.

• 77% of calls are outgoing and 98% are routed appropriately.

• 48°/o of calls are to or from a patient or a patient’s parent.

The interview results were compared with the actual data findings in order to determinethe difference in subjective and objective data. It was found that the estimatedpercentage of Phone Care is higher than the actual percentage in all but one case Also,

— the estimated percent of time spent on Clinical Activities is higher or very close to theactual percentage in most cases Key findings trom the interview include

• 60% of nurses feel they cannot complete their work in a typical workday.

• Several activities which nurses feel they perform outside their job descriptioninclude clerical activities, clinic scheduling, and medical assistant procedures.

• The nurses suggested job improvements including the addition of newcomputers, more time for patient education, and rotation of clinic/ office days.Observations were conducted on 6 nurses for a period of approximately 2 hours each.During these periods, nurses were studied to identify inefficiencies in their normal workpatterns and daily activities. A list of general improvements was obtained from theseobservations. Key findings from the observations include nurses doing the following:

• Performing unnecessary clerical activities.• Calling patients from the waiting area.• Walking unnecessary distances to office equipment they need.• Writing chart summaries prior to seeing patients.

Several data barriers were encountered throughout the study. Two major barriers includemisuse of beepers and discrepancies in interpretations of workload and phone logdefinitions. Further discussion of these barriers can be found in the report.

The recommendations discussed in the report are:

• Reduce dictation time for Gastroenterology.• Reduce phone care time for Nephrology and Neurology.• Reduce non-clinical communication time for Neonatology, CN II’s,and CN Ill’s.• Reduce the amount of scheduling calls handled by nurses.

I

/Table of Contents

/

Introduction and Background

- ... IPurpose

1Scope

Approach and Methodok.gyProject Approach

.• 3Project Methodology

---.3Current SituationFindings/Conclusions

Workload Data Collection Findings

- - 4Phone Log Findings

7Phone! Workload Comparison

14Interview Findings

15Interview! Workload Comparison

17Observation Findings

17Data Barriers

I 8Reconuindatjons

18Appendices

20

1•E\ /

Introduction and Background

A steering committee was formed in July 1997 in order to manage a clinic reorganization

project for the Pediatric Multi-Specialty Outpatient Clinic in Taubman Center. One

phase took place during the Fall semester of 1997, which studied the clinical time

distribution of the Clerical Support Staff The project outlined in this report is another

phase of the clinic reorganization project. This phase, which takes place during the

Winter semester of 1998, studies the clinical time distribution of the Nursing Staff. The

study was conducted by a group of IOE 481 students mentored by the Program and

Operations Analysis department.

Purpose

The purpose of this project is to determine the nursing staff workload. Three areas of

interest include:

• Proportion of time spent on clinical activities versus non-clinical activities.

• Proportion of time spent performing each separate clinical activity.

• Detailed information regarding the phone calls handled by the nursing staff.

Scope

Three teams, consisting of 17 nurses, were studied within the Pediatric Multi-Specialty

Clinic. The breakdown of the nurses who were studied is:

Team Division Number of Nurses Number of FTE’s1 Gastoenterology 2 1.5

Infusion 1 0.3! Nephrology 2 2.0

Team 1 Subtotal 5 3.8

2 NeonatologyNeurology

Team 2 Subtotal

3 EndocrinologyPulmonary

Infusion!MyelodysplasiaTeam 3 Subtotal

I3 2.54 3.1

3

0.6

2.054 3.381 0.88 6.23

Peds Total 17 I 13.13

Note: One nurse from Team 1 and two nurses from Team 3 were not studied dueto unavailability. Therefore, 17 of the original 20 were studied.

The breakdown by nursing level is:

‘FTE = Full Time Equivalent

Note: Two nurses, from Endocrinology and Pulmonary, were not included in thephone log study. One of the nurses was on leave, and the other does notperform any phone care. Seventeen nurses were included in the workloadstudy.

Nursing Level Number of Nurses Total FTE’s1Clinical Nurse I (CN 1) 1 0.5Clinical Nurse II (CN II) 4 2.75Clinical Nurse III (CN III) 3 2.23Clinical Nurse Specialist (CNS) 3 2.35Clinical Care Coordinator (CCC) 3 2.6Pediatric Nurse Practitioner (PNP) 3 2.7

Approach and Methodology

Project Approach

The general approach used for this project include:

• Defining the purpose, scope, approach, methodologies, and project schedule

• Creating and revising data collection tools

• Executing data collection studies (workload and phone)

• Interviewing nursing staff

• Performing nursing observations

• Compiling and analyzing collected data

• Producing a report

• Presenting final results to the Pediatric Multi-Specialty Clinic Steering

Committee

Project Methodology

Data was collected from February 10, 1998 through March 27, 1998. The data collection

involved 17 nurses who recorded workload and phone data. The duration of each study

was two weeks. However, in the case of employee absences, or vacations, partial data

was collected for a minimum of one week. Therefore, data was collected throughout a

six-week period. The project team conducted interviews of each of the 17 nurses studied,

and performed observations of a select group of nurses throughout the study. The

following methods were implemented for data collection:

• In order to determine the workload distribution of the nursing staff, a

workload measurement study was performed. The percent of time each nurse

spends on the defined activities was determined by placing “hash” marks next

to the appropriate activity on the workload data sheet (see Appendix C). The

random time intervals used for placing “hash” marks were determined with

beeper alarms programmed for approximately 4 beeps per hour. The

workload study was conducted for 2 weeks.

3

• A phone log study provided detailed information concerning the phone calls

handled by the nursing staff The phone log identified the types of phone

calls, time at which they occurred, length of calls, and other relevant

information (see Appendix C). The statistics for each call were registered on

the phone log data sheet for a period of 2 weeks.

• In addition to the above methodologies, the project team conducted interviews

of all of the nursing staff participating in the study (see Appendix C). The

interviews were used to identify the staffs workload perceptions, which were

compared to the data collected in the workload and phone studies.

• A selected portion of the nursing staff was observed in clinic to identify

activities that were not represented in the workload study. Ineffective

activities in the clinical operations were noted, so suggestions for potential

improvements in the clinic could be made.

Current SituationCurrently, a perceived imbalance of nursing resources among the pediatric divisions

exists. The Steering Committee is interested in creating a more efficient and effective

clinic. This will be accomplished by examining each nurse’s role and determining how

each nurse may be best utilized in the clinic. Limited data has been collected up to now

and there is a lack of tools for on-going measurement. Therefore, a minimal

understanding exists of the actual type of work being performed by nurses. Workload

measurement and phone log studies are necessary to provide initial data for determining

how best to utilize nursing staff resources.

Findin2s/ Conclusions

Workload Data C’ollection Findings

The workload measurement data was analyzed to evaluate the distribution of work within

the pediatric clinic. From this evaluation, it was determined that there exists an

4

imbalance in workload distribution among divisions within the Pediatric Multi-SpecialtyClinic. The following are examples of this imbalance:

• The percentage of Phone Care ranged from 2% in Infusion to 61% in

Nepbrology and Neurology.

• The percentage of time spent on Clinical Coordination! Communication

ranged from 3.5% in Nephrology to 43% in Infusion.

• The percentage of time spent on Patient History! Assessment’ Education

ranged from 3.5% in Neurology to 25% in Infusion.

The Phone Care and Clinical Activities workload results were annualized in order to

examine the average number of nursing minutes each division spends per patient visit.

The breakout of each of the division’s nursing minutes can be seen in Appendix B-4.

• The Phone Care nursing minutes per patient visit ranged from 13.0 to 58.2

minutes. Endocrinology spent the least time at 13.0 minutes per patient visit.

Neurology spent the most time at 58.2 minutes per patient visit.

• The nursing minutes per patient visit for Clinical Activities ranged from 14.5

to 64.6 minutes. Neurology spent the least time at 14.5 minutes per patient

visit. Neonatology spent the most time at 64.6 minutes per patient visit.

Each division was also evaluated in order to compare divisional workload differences.

The clinical nursing level workloads were also compared to locate workload differences

between nursing levels. The results of the workload measurement study were broken

down into the weighted percentage of time spent on each of the activities and the number

of FTh’s spent on each activities (See Appendix A-i, A-2).

5

12

>. 10

0

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LU4

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Figure 1: FTE Breakout by Activity

Figure 1 shows the following results for the overall Pediatric workload distribution:

a,

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• Overall Pediatric Phone Care consumes the most FTE’s with approximately

4.5, and accounts for approximately 35% of total nursing FTh’s.

• Phone Care is followed by Clinic Coordination! Communication and Non-

Clinic Communication which account for 1.9 and 1.4 nursing FTE’s

respectively. These 2 communication categories may also include phone time

that is not directly phone care.

• The remaining categories of activities all consist of tess than I FTE each.

Figure 1 displays the pediatric distribution of Full Time Equivalents (FTE) for each of the

given activities.

FTE Breakout by ActivityI 00.0%90.0%80.0%70.0%60.0%50.0%40.0%30.0%20.0%10.0%0.0%

.P) >,

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6

The following team level findings were obtained (See Appendix A-I, A-2):

• Teams 1 and 2 have a high percentage of time spent on phone care (43.1 °/b and

50.8% respectively). The high percentage in Phone Care for Team I is due to

Nephrology, which spends 61% of their time on this activity. The high

percentage of Team 2’s Phone Care is a result of Neurology’s 61% Phone

Care time.

• Team 3 has a more even spread throughout the activities.

At the nursing level, the following information was gathered (See Appendix A-i, A-2):

• The CN I, CN II, CCC, and PNP nursing levels have phone care percentages

ranging from 43% to 54°/b.

• The CN III, and CNS nursing levels, however, have Phone Care percentages

ranging from 11% to 16%.

• The CCC and PNP nursing levels spend 42.9% and 47.0% respectively on

Phone Care. These nursing levels should have smaller phone care percentages

due to job descriptions entailing more clinical time with patients as opposed to

phone care time.

Phone Log Findings

The phone log data was evaluated in order to identify the distribution of types of phone

calls, length of phone calls, and other relevant phone call information. The data is shown

on the division level, team level, nursing level, and for the overall pediatric clinic (See

Summary Charts in Appendix A). This data is important because the phone call activity

was determined, in the workload study, to consume more FTE’s than any other activity.

This is consistent with the direction of health care. Nurses are handling more patient care

over the phone, as opposed to seeing the patients in clinic.

7

r. The average number of phone calls! day can be found in Appendix A-3. The number of

r calls Ibr each of the possible activities is weighted for each of the divisions by the

number of FTE’s each nurse worked. This means that a nurse with a higher FTE will begiven more weight when determining the divisional average.

• For the pediatric clinic as a whole, the percentage of time spent on each of the

activities is evenly allocated, except for case coordination and symptom type

phone calls (See Figure 2).

Volume of Call per Day by Type

250.0 100.0%90.0% ,nr rto,200.0 °•‘°

. 70.0%C..)f..r1foI150.0 OU.J/O

50.0%ioo.o 40.0%

30.0%Z 50.0 20.0% E

10.0% c30.0 0.0%

(F

Figure 2: Volume of Call per Day by Type

• From Appendix A-3, it can be seen that the Nephrology division has the

highest average volume of phone calls at 72.1 per day. This average is closely

followed by the Pulmonary division at 68.5 calls per day.

• Nephrology has a volume of 35 case coordination calls per day, which

accounts for the majority of this division’s phone calls. Nephrology’s large

Call Type

8

volume of case coordination calls at 35 per day skews the Team I percentage

to 40.8% and the overall pediatric clinic percentage to 27.8%, which is higher

than the other call type categories.

Evaluation at the nursing level displays the following:

• The PNP’s receive the highest volume of phone calls at 81.1 per day followed

by the CCC’s at 69.8 calls per day.

• The CN III’s have the lowest average daily volume of phone calls at 6.7 per

day.

According to job descriptions, the PNP’ s should have the lowest volume of phone calls

because the majority of their time should be spent in the clinic with patients. The

majority of the PNP’s calls are in regard to case coordination, while the majority of CN

l’s calls are in regard to scheduling. This shows a fundamental difference in the type of

phone calls that are handled by the different nursing levels, which is appropriate.

The average length of phone calls handled by the pediatric nurses can be seen in

Appendix A-4. The average length of phone calls is weighted by the volume of calls that

each nurse receives. Therefore, nurses with higher volumes will be weighted more in the

average length calculation. Standard deviations were calculated for call lengths between

each of the divisions in a team, each of the divisions within the clinic, and between the

nurses within each nursing level. Figure 3 depicts the average length of each type of call

for the overall Pediatric Clinic.

9

Figure 3: Length of Call by Type of Call

The length of the phone calls is relatively similar regardless of the type of call.

Test results calls have the longest average length; slightly less than 4 minutes.

Voice mail! paging calls have the shortest length; approximately 1.5 minutes.

• The standard deviation for Team I General Work calls is extremely high with

a value of 6.4 minutes. Gastroenterology causes this high deviation because

its average length of General Work calls is 12.5 minutes compared to 1 and 2-

minute average lengths for the other Team I divisions.

• Among the various nursing levels, the highest standard deviation is 7 minutes,

which occurs for the CNS General Work calls, This corresponds to the

deviation caused by Gastroenterology in the General Work calls.

Length of Call by Type of Call

100.0%90.0%80.0%70.0%60.0%50.0%40.0%30.0%20.0%10.0%0.0%

a)a)Cu

a)h..a)0a,>

EC-)

ece.

Call Type

I0

The phone call volume was broken down into the volume of calls received during each

hour of the day (See Figure 4). The times range from 8:00 a.m. until 6:00 p.m. The

volume of calls was weighted by the number of days each nurse works! week, which

allows for the volume to be weighted more for nurses who work more days. The average

number of calls per day during each hour can be seen in Appendix A-5.

Volume of Calls by Hour of Day

(UE0>

(U0

250.0

200.0

150.0

100.0

50.0

0.0

100.0%

90.0%

80.0%

70.0%

600%

50.0%

40.0%

30.0%

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8-9 9-10 10-11 11-12 12-1 1-2 2-3 3-4 4-5 5-6

Hour

Figure 4: Volume of Calls by Hour of Day

• The volume of calls is spread evenly throughout the day at both the divisional

and overall clinic levels.

• The volume of calls does not dramatically vary by the time of day for the

different nursing levels, either. The first hour and last hour of the day have

the lowest volumes because these are times when not all of the nurses are

typically at work.

Phone calls were also broken down into whom the nurse talked to on the phone. The

results of this breakdown can be found in Appendix A-6. Figure 5 illustrates the spread

II

of phone calls between each of the groups of people with whom nurses frequently are in

contact.

Volume of Calls To/From Whom Each Day

100.0% ,

250.0 90.0%80.0% ‘

200.0 700%60.0%

o 150.0>

0

ioo.o 40.0% .

C) 30.0% .

50.0 20.0%10.0%

0.0 0.0%

FigureS: Volume of Calls To/From Whom Each Day

At the overall Pediatric level, the following was true:

• The majority of phone calls, nearly 50%, were placed to or received from the

patient or the patient’s parent.

• 77% of phone calls are outgoing. The breakout of outgoing calls, correctly

routed calls, and calls requiring follow-up can be seen in Appendix A-7.

• The percentage of calls routed appropriately is 98% for the overall Pediatric

Clinic. Most of the calls that are not routed appropriately are due to the nurses

calling a wrong number when making a phone call.

Whom

12

The team level results are as follows:

• Team I and Team 2 have Patient calls in excess of 50%, while Team 3 has37% of its calls to Patients. Physician and Other phone calls are morefrequent in Team 3 than the other 2 teams, which causes the decrease inpatient calls for Team 3. Phone calls that were not documented to! fromwhom they regarded were placed in the Other category.

• Team 3 has the largest average number of calls per day requiring follow-up at51 calls per day, which is 33% of the calls.

• The percentage of outgoing calls is consistent between teams at approximately77%. The high percentage of outgoing calls is a result of nurses obtaining

most of their calls through voice mail or pages. Therefore, they must return

these calls.

The following are the divisional results:

• At the divisional level, Pulmonary must follow-up on 60% of their calls and

Gastroenterology requires follow-up on 50% of their calls.

• The Infusion division within Team I and the Endocrinology division within

Team 3 have the lowest percentage of outgoing calls at approximately 65%.

• The divisional percentages of calls routed appropriately range from 95% to

100%.

At the nursing level, the following findings were apparent:

• The CCC’s and the CN l’s have the highest percentages of calls requiring

follow-up (60% and 52% respectively). This corresponds to the Pulmonary

13

and Gastroenterology divisions, which have percentages of follow-up at 60%and 50%, respectively.

The nursing level percentages of calls routed appropriately range from 94% to100%.

Phone: Workload Comparison

The number of FTE’s that each division spends on the phone can be seen in Appendix B-3. This table compares the total phone time FTh’s obtained from the phone log study to

the Phone Care FTE’s obtained from the workload study.

• The workload study shows higher FTh’s spent on phone care than the phone

log’s total FTh’s for all divisions except for 1.

• Neurology has the largest variance with a workload phone care FTh of 1.5

and a phone log FTh of 0.6.

The following are reasons for the difference between Phone Log FTh’s and workload

Phone Care FTh’s:

• The workload study includes not only the time spent on the phone, but also

preparation and follow-up for the phone care call. However, the phone log

study indicates only the time spent on the phone.

• The workload study data includes only calls regarding patients, while the

phone log study includes all calls made or received.

• The workload study obtained Phone Care time by random beeper alarms. In

the Phone Log study, however, nurses estimated length of each phone call and

therefore, the total time spent on the phone.

‘4

Interview Findings

Every Pediatric nurse studied was interviewed in order to obtain subjective feedback.This feedback was compared to the objective results obtained through data collection inorder to identify discrepancies between the nurse’s workload perceptions and the actualworkload data. General comments relating to the workplace were also noted. Theinterview template used for personal interviews can be found in Appendix C.

Each nurse was asked to estimate the percentage of time that spent performing clinicalactivities and phone care activities during an average day. Many nurses feel that the

percentage varies depending on the day of the week. Clinical activities include:

• Patient history! assessment! education

• Treatment! medication! procedures

• Independent nurse visits

• Nurse visits with attending

• Clinic coordination! communication

Some nurses may have included Phone care as a clinical activity, which would explain

the large differences between the estimated and calculated values. An obvious instance

of this is notable when a nurse estimates a very high percentage of both clinical activities

and phone care. Instances where the estimated clinical activities and phone care

percentages add up to more than 100% indicate that the nurse included phone care in the

clinical activities.

The following is a list of types of phone calls placed or received by the nursing staff:

• Scheduling • Test Results • Prescription Refills• Medication changes • Referrals • Symptoms• Schools! community • Counseling! behavioral • Assessment! adjustment

outreach issues of regimen• Scheduling non-clinic • Stocking issues • Insurance

appointments

15

A breakout from all nurses on their perceptions of completrng their work within aworkday is:

Fully Complete — 12%

Mostly Complete — 29%

Do Not Complete 59%

Some general comments obtained regarding the ability to complete work in a typical dayinclude:

• Work variation depends on day of week and time of year.

• Many nurses work through their lunch period.

• Some nurses stay beyond the scheduled workday to complete necessary work.

• Minimal time exists for extra projects and program planning.

• Clinic time is demanding.

The following is a list of activities nurses are performing outside of their job descriptions:

• Clerical activities

• Disease management

• Tracking charts

• Clinic scheduling

• Medical Assistant procedures

• Coordinating in-services for fellows

• Cleaning staff rooms

• Covering staff absences

The nursing staff suggested the following job improvements:

• Add new computers! internet access.

• Create time for patient education (internal! external and material

development).

• Rotate clinic and office days intermittently (Friday clinic days make prompt

follow-up difficult).

16

• Add more nursing support.

• Utilize Infusion clinic to full potential.

buerview Workload Comparison

The comparison of interview findings to the actual data collected can be seen inAppendix B-i. The estimated percentage of time spent on phone care is higher than theactual percentage in all cases except for 1. This shows that nurses feel they are spendingmore time on phone care than they actually are. The estimated percentage of time spenton clinical activities is higher or very close to the actual percentage in most cases. Thereare a few cases where the estimated percentage is significantly lower than the actualpercentage.

Observation Findings

Six nurses were observed for a period of approximately 2 hours each. The observations

occurred between March 17 and March 25, 1998. During these periods, nurses were

studied to identify inefficiencies in their normal work patterns and daily activities. The

following is a list of some areas for potential improvements:

• Some nurses call their own patients from the waiting area and obtain patient

vital signs.

• Many nurses are required to walk to other office areas for office equipment

such as photocopiers, printers, etc.

• Some nurses are performing unnecessary clerical activities such as checking

patient status on the computer, filing, etc.

• The scheduling system produces additional work for nurses by randomly

assigning appointments to patients on the waitlist. These patients then call the

nurse if the appointment is unsatisfactory and needs to be rescheduled.

• Some nurses create additional work by reviewing charts and writing a

summary before seeing patients.

• Nurse workload is increased when medical assistants are absent and there are

no substitutes available.

17

Data Barriers

Several barriers to accurate data collection were encountered during the study. Some of

the more prominent barriers include:

• Beepers were not always worn, activated, or heard.

• The interpretation of workload and phone study definitions varied between

nurses.

• Nurse vacations were not identified at the beginning of the study, and

therefore, adjustments could not always be made.

• Communication to nurses regarding the study was sometimes ineffective (i.e.,

email was not always read).

• Due to a short time period for the study, a sense of trust and openness was not

created, which may have hindered some results (i.e. interview data).

• Student schedules prevented the project team from performing extended

observations.

• Some nurses chose not to record data on some days during the study, and

therefore, a smaller sample size was generated.

RecommendationsIn order to utilize the nursing staff to its full potential, the following recommendations

should be considered:

• Alleviate workload imbalance between divisions. The largest imbalance

occurred within Phone Care. Therefore, this area should be focused on first to

identify why the imbalance exists and how the problem could be redistributed.

• Reduce phone care time for Nephrology and Neurology. These divisions have

extremely high phone care percentages relative to the other divisions. The

nurses within Nephrology and Neurology cause the overall PNP and CCC

nursing levels to have high phone care percentages as well. These nurses

- 18

could be better utilized in non-Phone Care activities because of their upper job

levels.

• Reduce non-clinical communication time for Neonatology, CN II, and CN UI.

This type of communication is not directly related to patient care, and

therefore should be minimized.

• Reduce the amount of scheduling calls handled by nurses. Teams I and 2

have a significant percentage of scheduling phone calls each day which should

be filtered through the clerical staff before the nurse becomes involved.

• Reduce dictation time for Gastroenterology. This is the only division that has

a high percentage of dictation. A reduction of dictation would allow these

nurses to spend additional time in areas of higher priority.

Table of Appendices

Appendix A:Workload PercentagesWorkload FTEAverage Volume of Phone Calls! DayAverage Length of Phone CallsAverage Phone Calls/HourAverage Number of Calls To! From WhomCall Routing and Follow-Up

Appendix B:Interview Findings vs ActualGeneral InformationPhone FTE TotalsAnnualized FTE

Appendix C:Workload DefinitionsWorkload Data SheetPhone Log DefinitionsPhone Log Data SheetInterview Template

Appendix D:Workload Raw DataPhone Log Raw Data

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1

nterview Findings vs. Data Findings

Department % Clinical Activities % Phone Care

Estimated Calculated Estimated Calculated

TEAM 1

Gastroenterology

Ronna Fogle 50% 39% 50% 11%Diane Kemp 90% 71% 19% 14%

70% 55% 35% 13%Infusion

Jennifer Steiner 50% 83% 10% 2%50% 83%

Nephroiogy

Cathy Brown 30% 23% 70% 68%Brenda Pontillo 25% 30% 75% 55%

28% 27% 73% 62%TEAM 2 4 - -

Neonatology

Anne latrow 33% 51% 25% 7%33% 51% 25% 7%

Neurology

Sue Armstrong 70% 47% 64% 36%Ann Marker 0% 7% 100% 80%Helen Murrel 100% 4% 88% 71%

57% 19% 84% 62%. .:r . .

TAM3: fEndocrinology

Kathy Clark 65% 66% 15% 7%Margy Fox 33% 39% 56% 21%Denise Garden 24% 27% 45% 27%

41% 44% 39% 18%Pulmonary

Phyllis Askew 19% 8% 29% 64%Julie Konkle 65% 51% 40% 23%Nancy Mcintosh 40% 41% 40% 13%Ermalinda Sakmar 40% 28% 0% 0%

41% 32% 27% 25%Infusion

Patricia Delameilleure 90% 71% 5% 3%nno/ 710/ ‘DO!7’J/O I I/O .J/O

*lnfusion time is included in clinical percentages.

LL

B-i

Pediatric Nursing Staff General Information

ScheduleName Level Clinic FTE Monday Tuesday Wednesday Thursday Friday

TEAM1Brown, Cathy PNP Nephrology 1.00 4 C 4 C 4 0 4 C 4 C

40 40 4C 40 40Fogle, Ronna CN I Gastroenterology 0.50 6 0 4 C ems 4 0 6 0 60

40 4CcmsKemp, Diane CNS Gastroenterology 1.00 8 0 8 C 4 0 4 0 4 0

4C 4C 4CPontillo, Brenda PNP Nephrology 1.00 4 C 4 C 4 C 4 C 4 C

40 40 40 40 40Steiner, Jennifer CN II Infusion 0.30 4 I off 8 I off off

4 off 4/mo._emsTEAM2Armstrong, Sue CCC Neurology 0.85 6 0 8 C 6 0 8 C 4 C

20latrow, Anne CN Ill Neonatology 0.60 off 8 0 4 0 off 8 0

4CMarker, Ann CN II Neurology 0.65 8 0 off 8 0

50 50Murrel, Helen CN II Neurology 1.00 8 0 8 0 8 0 8 0 8 0

••

Askew, Phyllis CCC Pulmonary 1.00 8 0 8 0 4 C 4 0 8040 4C

Clark, Kathy PNP Endocrinology 0.70 4 C 6 0 8 C off 8 C20

Delameilleure, Patricia CN II Infusion 0.80 4 C 8 I off 8 I 8 I41

Fox, Margy CNS Endocrinology 0.60 8 C off 8 diab. off 1 ems0,H 70,H

Garden, Denise CN III Endocrinology 0.75 8 C 8 0 off 8 0 2-3 04 Ed.

Konkle, Julie CCC Pulmonary 0.75 8 0 off 6 C 4 0 4 C20 4C 20

McIntosh, Nancy CNS Pulmonary 0.75 8 0 8 0 4 C 6 0 off40

Sakmar, Ermelinda CN III Pulmonary 0.88 8 Res. 8 Res. 9.2 C 4 Res. 6 C40

KEY: CN I = Clinical Nurse 1 0 = OfficeCN II = Clinical Nurse 2 C = ClinicCN III = Clinical Nurse 3 Res. = ResearchCNS = Clinical Nurse Specialist Ed. = EducationCCC = Clinical Care Coordinator I = InfusionPNP = Pediatric Nurse Practitioner H = Hospital

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B-3

Annualized FTE’s per VisitBased on Projected Visits from July 1997 to June 1998

Phone Care

# Nursing

Division # FTEs Visits/ Year Minutes/ Patient

Gastroenterology 0.41 2816 18.2Nephrology 1.22 2987 51.0Neonatology 0.04 290 17.2Neurology 1.53 3279 58.2Endocrinology 0.38 3642 13.0Pulmonary 0.91 2388 47.6

Clinical Activities (Not including Phone Care)

# Nursing

Division # FTEs Visits! Year Minutes! Patient

Gastroenterology 0.66 2816 29.3Nephrology 0.46 2987 19.2Neonatology 0.15 290 64.6Neurology 0.38 3279 14.5Endocrinology 0.64 3642 21.9Pulmonary 0.44 2388 23.0

*CIinicaI activities include:

Patient History! Assessment! Education

Treatment! Medication/ Procedures

Independent Nurse Visit

Nurse Visit with Attending

* The following divisions were not included:

Biochem Genetics

Infectious Diseases

Ado!escent

Behavioral

Consult

Psychology

Genetics

Myelodysplasia

Rheumatology

B4

Appendix C

irsing Vorlload Data Collection Detinitions

Phone Care: Time spent on the phone, preparation before the call, and documentationfollowing the call. Phone call may be with patient, physician, pharmacist.etc., regarding patient care.

Patient History! Assessment! Education: Documentation or discussion regarding thehistory, assessment, and education of the patient. excluding phone care.This may include interaction with the patient. physician, nurses. etc.

Treatment! Medication! Procedures: Administering, documenting, or discussingpatient treatment, medication, and procedures. excluding phone care. Thismay include interaction with the patient. physician, nurses. etc.

Independent Nurse Visit: All activities related to an independent nurse visit. Forexample: preparation, the visit, and post-visit documentation. Thisexcludes phone care.

Nurse Visit with Attending: All activities related to a nurse visit with an attending. Forexample: preparation, the visit, and post-visit documentation. Thisexcludes phone care.

Clinic Coordination! Communication: Activities related to maintaining the flow of theclinic. These activities include: clinic related communication (verbal,email, faxes, written letters), scheduling, rescheduling, physiciancoordination, tracking charts/labs, etc. Excluding dictation.

Non-Clinic Communication: All communication regarding non-clinical activities.Communication may be in the forms of verbal, email, faxes, written letters,etc.

Dictation: Self-explanatory.

Research: All activities related to research projects including related communication.

Tn-Patient: All activities related to in-patient care.

Travel: Time spent traveling from one location to another. For example: traveling

from the office to the Taubrnan Center.

Breaks: Time spent on break excluding lunch.

Other: All activities which are not defined above. Please list the activity in the

appropriate location on the data sheet.

Nursing Workload Data Collection

‘lame:______________________________ Time Begin:_________________

rite: Time End:_____________________

Lunch Begin:__________________

Lunch End:__________________

ease collect this information for 1 week. When the beeper sounds, make a hash mark under the frequency column

oorresponding to the activity you are currently performing. Thank you for your cooperation.

Direct Patient Carehone Care

. atient History! Assessment! Education

reatment! Medication! Procedures

‘9dependent Nurse Visit

Nurse Visit with Attending

nic Coordination/Communication

Jon-CIinic Communication

I Research

in-Patient

rravei

3reaks

Other

13.

Activity Frequency

L7.8.9.

10.

E.[ Length of Call: The approximate number of minutes the phone call lasted.

Route: Whether the phone call was incomingWoroutoin(O.

Call Type: The topic(s) of discussion during the phone conversation. A phone call canr contain more than one code if appropriate. The codes are listed at the

bottom of the data sheet. If Other (0) is used, please note the topic in thenote section.

1. Who Call: The person who is calling the nurse or being called by the nurse. Forexample: patient, physician, pharmacist, etc.

L. Appropriate Routing: Whether or not the call was routed appropriately (YIN).

[ Follow-Up Needed: Place an (x) in the box if additional action is required. Forexample: additional follow-up calls, discussion with physician, etc.

[ Call Type Codes:S=Scheduling-Any calls regarding the scheduling of patient visits.

[ TR=Test Results- Calls regarding obtaining and discussing patient test results.

PR=Pharmacy Refills-Any calls regarding refilling a prescription including follow-up with pharmacy.

SM=Symptom-Any calls regarding symptom inquiries or discussion.

VM=Voice Mail / Paging-Any non-specific checking of voice mail or returning a

[page. .

CCCase Coordination-Any non-symptom calls regarding patient coordination

p with patient or other personnel including consultations.

GW=General Work-Any type call regarding non-patient specific work, i.e.,

p computer problems, clinic forms, etc.

P=Personal-Any personal / non-work calls.

OOther-Any calls not included in the above categories (Please explain nature ofcalls in note column).

[ Note: Any additional information, which is necessa in understanding the nature of thecall.

L(

LL

PHONE TRA CKING DA TA COLLECTION

Please collect this int’ormation [or 2 eeks startin2 March 9, 1998 It is essential tor re\levIn

orkIoad distribution. Thanks t’or your help.

Route: llncomingO=Outgoi ng

Who Call: Patient/Physiciar

Pharmac I st/etc

Codes: S=SchedulingTRTest ResultsPRPharmacy Refills

SM=SvmptomVM=Voice Mail: Pa’n

CC Case Coordination

GWGeneral Work

PPersonal00the r

Name: Date:

Time of Length of Call Route Call Type Appropriate Follow-UpVv ho Call ote

Day (# of Mins) (110) (Codes) Routing? (Y/N) Needed (x)

Notes:

Li

Pediatric Multi-Specialty Clinic Interview Questions

Name___________________________________________ Date________________

I. What percentage of time do you spend performing clinical activities during anaverage day? Office activities? Inpatient activities?

2. What percentage of time do you spend performing phone care during an average day?

3. Does this list reflect the types of phone calls you receive or place?

SchedulingTest ResultsPrescription RefillsSymptomOther___________________

4. Do you feel that you can finish your work within a typical workday? Is there

variation between workdays? Please explain.

5. Do you feel that you are performing work outside of your job description? Please

explain.

6. Is there a specific area of your job that you feel could be improved? Please explain.

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Ann

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3

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3

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Len

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6

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1.6

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8

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3

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Per

Day

Dep

artm

ent

8:00

-9:

009:

00-

10:0

010

:00

-11

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11:0

0-12

:00

12:0

0-

1:00

1:00

-2:

002:0

0-3

:00

3:00

-4:

004:

00-

5:00

5:00

-6:

00

Nep

hro

log

yC

athy

Bro

wn

(2/1

6)P

NP

07

69

67

115

63

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row

n(2

/17)

25

55

65

21

00

Cat

hyB

row

n(2

/18)

104

20

00

44

62

Cat

hyB

row

n(2

/19)

00

10

00

62

76

Cat

hyB

row

n(2

120)

67

99

102

65

65

Cat

hyB

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n(2

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16

00

05

00

32

Cat

hyG

row

n(2

/24)

24

50

30

20

00

Cat

hyB

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n(2

/25)

28

30

43

17

50

Cat

hyB

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n(2

/26)

61

00

04

66

75

Cat

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81

41

86

45

55

Ave

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Num

ber

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3.7

4.3

3.5

2.4

3.7

3.2

4.2

3.5

4.5

2.8

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illo

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NP

34

03

43

52

82

Bre

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25

11

77

66

1

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62

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116

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01

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54

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75

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of

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8.3

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Per

Day

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8:0

0-

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10:0

0-

11:0

011

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12:0

012

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001

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02:

00-

3:00

3:00

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004:0

0-

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5:0

0-6

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M1

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01

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02

14

60

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00

00

76

17

1

Ron

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18

55

36

0

Ron

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(211

9)0

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56

2

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ogle

(2/2

0)0

00

00

51

19

1

Ron

naF

ogle

(2/2

3)0

03

45

74

68

0

Ron

naF

ogle

(2/2

4)0

00

03

23

52

0

Ron

naF

ogle

(2/2

5)0

00

00

62

40

0

Ron

naF

ogle

(2/2

6)0

00

00

42

37

0

Ron

naF

ogle

(2/2

7)0

00

00

39

44

0

Ave

rage

Num

ber

ofC

alls

/Ho

ur

00.

12.

22.

22.

14.

73.

73.

65.

50.

4

Dia

neK

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(2/1

0)C

NS

10

01

30

00

01

Dia

neK

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(2/1

1)2

21

00

01

00

0

Dia

neK

emp

(2/1

2)2

30

00

01

00

0

Dia

neK

emp

(2/1

8)0

22

24

00

00

1

Dia

neK

emp

(2/1

9)0

20

20

00

00

7

Dia

neK

emp

(2/2

0)2

51

00

10

05

1

Dia

neK

emp

(2/2

3)1

15

00

10

00

0

Dia

neK

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(2/2

4)1

00

20

51

20

4

Ave

rage

Num

ber

ofC

alls

/Ho

ur

1.1

1.9

1.1

0.9

0.9

0.9

0.4

0.3

0.6

1.8

Wei

ghte

dD

ivis

iona

lA

vera

ge*

1.1

2.0

3.3

3.1

3.0

5.6

4.1

3.9

6.1

2.2

Infu

sion

Jenn

ifer

Ste

iner

(2/1

6)C

NII

03

10

20

00

00

Jenn

ifer

Ste

iner

(2/1

8)4

67

18

10

10

1

Jenn

ifer

Ste

iner

(2/2

3)1

102

11

00

00

0

Jenn

ifer

Ste

iner

(2/2

5)5

43

33

12

10

2

Ave

rage

Num

ber

ofC

alls

/Ho

ur

2.5

5.8

3.3

1.3

3.5

0.5

0.5

0.5

0.0

0.8

Wei

ghte

dD

ivis

iona

lA

vera

ge*

1.0

2.3

1.3

0.5

1.4

0.2

0.2

0.2

0.0

0.3

*Wei

ghte

dby

day

sper

wee

kw

orke

d(o

utof

5day

s)

Dat

aco

llec

ted

2110

/98

thro

ugh

3/27

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Th

Pho

neLo

gR

awD

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She

et4/

9/98

Num

ber

ofC

alls

Eac

hH

our

Per

Day

Dep

artm

ent

8:00

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009

:00

-10

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10:0

0-

11:0

011

:00-

12:0

012

:00

-1:

001:

00-

2:00

2:00

-3:

003:

00-

4:00

4:0

0-

5:00

5:00

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00

-—

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AM

2.

—-

____________________

-

Neo

nat

olo

gy

Ann

eIa

trow

(2/1

8)C

NII

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12

12

10

22

0

Ann

ela

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(2/2

0)0

24

02

20

21

0

Ann

ela

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(2/2

4)2

12

00

72

30

0

Ann

ela

trow

(2/2

5)0

10

00

00

20

0

Ann

ela

trow

(2/2

7)0

00

00

12

00

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Ave

rage

Num

ber

ofC

alls

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2.2

11.

60.

20.

82.

20.

81.

80.

60

Wei

ghte

dD

ivis

iona

lA

vera

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1.3

0.6

1.0

0.1

0.5

1.3

0.5

1.1

0.4

0.0

Neu

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Sue

Arm

stro

ng(2

/17)

CC

C0

15

40

44

65

0

Sue

Arm

stro

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/18)

02

33

62

00

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Sue

Arm

stro

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/19)

00

23

10

03

10

Sue

Arm

stro

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/20)

00

14

51

00

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Sue

Arm

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/23)

02

89

41

00

00

Sue

Arm

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/24)

00

54

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03

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Sue

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/25)

04

74

01

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Arm

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12

55

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00

11

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Arm

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02

36

82

25

00

Ave

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Num

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ofC

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0.1

1.4

4.3

4.7

3.3

1.2

0.7

1.9

0.8

0.1

Ann

Mar

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6)C

NII

00

16

00

00

00

Ann

Mar

ker

(2/1

9)0

23

51

47

24

0

Ann

Mar

ker

(2/2

0)0

00

04

15

20

0

Ann

Mar

ker

(2/2

4)0

23

31

21

34

0

Ann

Mar

ker

(2/2

5)0

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02

92

52

0

Ann

Mar

ker

(2/2

6)0

34

42

34

211

0

Ann

Mar

ker

(2/2

7)0

02

66

15

40

0

Ave

rage

Num

ber

ofC

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0.0

1.0

1.9

3.4

2.3

2.9

3,4

2.6

3.0

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WeI

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dby

day

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erw

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wor

ked

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of5

day

s)

Dat

aco

llec

ted

2110

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ugh

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neL

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Num

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ofC

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Eac

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Per

Day

Dep

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8:0

0-9

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9:0

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12:0

012:0

0-1

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1:0

0-2

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2:0

0-3

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3:0

0-4

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4:0

0-5

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5:0

0-6

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Hel

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63

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0

Hel

enM

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05

22

40

Hel

enM

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/18)

44

24

11

43

30

Hel

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/19)

13

32

41

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Hel

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22

22

31

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24

74

23

31

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Ave

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Num

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ofC

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3.0

3.5

3.5

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1.7

2.8

2.0

1.8

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Wei

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3.1

5.7

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6.8

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2110

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3/27

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neL

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Num

ber

ofC

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Eac

hH

our

Per

Day

Dep

artm

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8:00

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009:

00-

10:0

010

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11:0

0-12

:00

12:0

0-

1:00

1:00

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002:

00-

3:00

3:00

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004:

00-

5:00

5:0

0-

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20

02

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Kat

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(3/1

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10

00

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Kat

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(3/1

6)0

41

60

00

00

0

Kat

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(3/1

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23

95

10

00

0

Kat

hyC

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(3/1

8)0

25

22

01

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0

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0)0

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01

00

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Ave

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Num

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00

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30

00

23

00

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21

93

21

15

0

Ave

rage

Num

ber

ofC

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3.3

4.0

2.0

3.0

1.0

0.7

1.0

1.3

1.7

0.0

Wei

ghte

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lA

vera

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2.2

4.7

2.9

4.1

1.5

1.7

1.3

11.

70

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lmo

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CC

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20

42

96

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0

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98

64

68

69

0

Phyl

lisA

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(3/2

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00

61

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00

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(3/2

7)0

03

50

00

00

0

Ave

rage

Num

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ofC

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!H

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2.5

2.8

2.8

5.3

1.8

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3.5

2.5

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1)C

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05

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00

311

82

42

10

Juli

eK

onkl

e(3

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15

19

90

00

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Juli

eK

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56

25

08

51

00

Juli

eK

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314

96

43

30

00

Juli

eK

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46

24

43

53

00

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26

75

10

Ave

rage

Num

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ofC

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4.4

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4.6

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3.4

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Wei

gh

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utof

5day

s)

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aco

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2110

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Num

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Eac

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Per

Day

Dep

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8:0

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9:00

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10:0

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11:0

011

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12:0

012

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-1:

001:

00-

2:00

2:00

-3:

003:

00-

4:00

4:00

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005:

00-

6:00

Nan

cyM

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08

62

03

00

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Nan

cyM

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(3/1

7)0

67

20

50

06

0

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00

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Ave

rage

Num

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ofC

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5.0

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Wei

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4.6

11.8

10.3

11.8

5.4

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5.1

5.8

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infu

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rici

aD

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(3/2

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11

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Pat

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Num

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Wei

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0.5

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gh

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per

wee

kw

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2110

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3/27

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Num

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Day

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Ron

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Ron

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(2/1

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00

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80

01

Ron

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(211

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60

06

30

00

Ron

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(2/1

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41

12

84

03

Ron

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(2/2

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21

01

00

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Ron

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(2/2

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13

00

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Ron

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Ron

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(212

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10

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Ron

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(212

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11

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Ron

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Ave

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Num

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Dia

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Dia

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Dia

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(2/1

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Dia

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(2/1

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20

00

00

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Dia

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(2/2

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60

10

10

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Dia

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Dia

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Ave

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Num

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0.3

2.3

Infu

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Jenn

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Ste

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(2/1

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01

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21

10

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Jenn

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38

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Jenn

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Jenn

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(2/2

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Ave

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Num

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01.

53.

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03.

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8

Div

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Wei

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Day

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222

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Cat

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195

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Cat

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127

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00

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3

Cat

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Cat

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131

03

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00

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Cat

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130

21

00

00

0

Cat

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n(2

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235

11

03

00

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Cat

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263

11

00

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4

Cat

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214

37

02

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5

Ave

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Num

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60

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(2/1

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41

50

32

130

6

Bre

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(2/1

8)23

31

00

24

04

Bre

nda

Pont

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(2/1

9)20

42

31

58

04

Bre

nda

Pont

illo

(2/2

3)23

211

30

08

01

Bre

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Pont

illo

(2)2

4)17

31

00

00

01

Bre

nda

Pori

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(2/2

5)19

62

00

07

09

Bre

nda

Pont

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(2/2

6)11

10

50

01

05

Ave

rage

Num

ber

ofC

alls

/D

ay16

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93.

11.

60.

61.

35.

90.

04.

3

Div

isio

nal

Wei

ghte

dA

ver

age

Cal

ls/

Day

*38

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04.

94.

20.

62.

67.

20.

25.

8

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ghte

dby

day

sp

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wor

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(out

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day

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ata

coll

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10/9

8th

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3/27

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Num

ber

ofC

alls

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Fro

mW

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Per

Day

Pag

ingN

oice

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ail

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ther

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AM

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olo

gy

Ann

ela

trow

(2/1

8)C

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03

05

11

04

Ann

ela

trow

(212

0)0

00

03

31

06

Ann

ela

trow

(2/2

4)2

10

03

05

15

Ann

ela

trow

(2/2

5)0

00

02

00

01

Ann

ela

trow

(2/2

7)1

10

00

01

00

Ave

rage

Num

ber

ofC

alls

/D

ay1.

80.

40.

60

2.6

0.8

1.6

0.2

3.2

Div

isio

nal

Wei

ghte

dA

ver

age

Cal

ls!

Day

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10.

20.

40.

01.

60.

51.

00.

11.

9

Neu

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00

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00

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Sue

Arm

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/19)

70

00

02

00

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(2/2

0)6

30

00

00

02

Sue

Arm

stro

ng(2

/23)

161

22

01

00

1S

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(2/2

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01

00

12

01

Sue

Arm

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71

60

00

00

2S

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(2/2

6)14

00

00

20

02

Sue

Arm

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/27)

170

32

01

20

3A

ver

age

Num

ber

ofC

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/D

ay12

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61.

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40.

01.

70.

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01.

4

Ann

Mar

ker

(2/1

6)C

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40

02

00

00

0A

nnM

arke

r(2

119)

180

31

01

01

3A

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arke

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/20)

90

02

00

00

0A

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r(2

/24)

120

21

01

00

0A

nnM

arke

r(2

/25)

80

32

01

00

6A

nnM

arke

r(2

/26)

141

34

00

00

11A

nnM

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/27)

140

52

00

00

3A

ver

age

Num

ber

ofC

alls

/Day

11.3

0.1

2.3

2.0

0.0

0.4

0.0

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awei

gh

ted

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ays

per

wee

kw

ork

ed(o

utof

5day

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ata

coll

ecte

d2/1

0/9

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rough

3/27

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neL

ogR

awD

ata

She

et4/

9/98

Num

ber

ofC

alls

To/

Fro

mW

hom

Per

Day

Dep

artm

ent

Pat

ient/

Par

ent

Ph

ysi

cian

Ph

arm

acis

tL

abora

tory

Pag

ing/

Voi

ceN

urs

eS

ecr:

tary

/S

cho

ol

Oth

er

Hel

enM

urre

l(2

/16)

CN

II16

20

00

00

18

Hel

enM

urre

l(2

/17)

160

00

06

00

9

Hel

enM

urre

l(2

/18)

172

10

00

00

6

Hel

enM

urre

l(2

/19)

90

20

00

00

3

Hel

enM

urre

l(2

/20)

100

00

00

00

2

Hel

enM

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l(2

/23)

201

10

00

00

8

Ave

rage

Num

ber

ofC

alls

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ay14

.70.

80.

70.

00.

01.

00.

00.

26.

0

Div

isio

nal

Wei

ghte

dA

ver

age

Cal

ls!

Day

*35

.91.

53.

82.

00.

03.

00.

60.

310

.1

Wei

ghte

dby

day

spe

rw

eek

wor

ked

(out

of5

days

)D

ata

coll

ecte

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10/9

8th

rough

3/27

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EE

EE

L.J

CE

.—

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CE

.

Pho

neLo

gR

awD

ata

She

et4/

9/98

Num

ber

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alls

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mW

hom

Per

Day

Pag

ing/

Voi

ceS

ecre

tary

/D

epar

tmen

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atie

nt/P

aren

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rmac

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orat

ory

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urse

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ool

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ail

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rk

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do

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80

20

00

00

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/10)

130

00

01

10

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rk(3

/11)

20

20

02

20

3K

athy

Cla

rk(3

/13)

31

00

00

10

0K

athy

Cla

rk(3

/16)

50

50

10

00

0K

athy

Cla

rk(3

/17)

100

10

10

10

7K

athy

Cla

rk(3

/18)

91

31

10

20

1K

athy

Cla

rk(3

/20)

00

00

10

30

0A

ver

age

Num

ber

ofC

alls

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ay6.

30.

31.

60.

10.

50.

41.

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02.

5

Mar

gyFo

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CN

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10

00

03

01

Mar

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/18)

113

00

01

21

1M

argy

Fox

202

30

00

10

0A

vera

geN

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rof

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ls!

Day

11.0

2.0

1.0

0.0

0.0

0.3

2.0

0.3

0.7

Div

isio

nal

Wei

gh

ted

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erag

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ls/D

ay*

11.6

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1.9

0.1

0.4

0.5

2.2

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2.4

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ary

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(3/2

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00

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218

81

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30

10

20

00

2A

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ls!

Day

10.3

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3.3

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0.0

1.8

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Julie

Kon

kle

(3/1

1)C

CC

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20

3Ju

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e(3

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105

00

75

30

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73

00

70

20

6Ju

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e(3

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113

30

40

00

11Ju

lie

Kon

kle

(3/1

8)12

73

213

01

13

Julie

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kle

(3/1

9)17

16

02

00

14

Julie

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(3/2

0)14

55

011

01

09

Avera

geN

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bero

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all

s/D

ay

11.9

3.9

2.9

0.3

8.6

0.9

1.3

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5.3

*wel

ghte

dby

day

sp

erw

eek

work

ed(o

utof

5d

ays)

Dat

aco

llec

ted

2110

198

thro

ugh

3/27

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Pho

neL

ogR

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ata

She

et4/

9/98

Num

ber

ofC

alls

To/

Fro

mW

hom

Per

Day

Dep

artm

ent

Pat

ient/

Par

ent

Physi

cian

Ph

arm

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cho

ol

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er

Nan

cyM

cInt

osh

(3/1

6)C

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17

13

10

20

4

Nan

cyM

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(3/1

7)7

80

20

21

05

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cyM

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osh

(3/1

9)2

40

00

20

02

Ave

rage

Num

ber

ofC

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ay3.

36.

30.

31.

70.

31.

31.

00.

03.

7

Div

isio

nal

Wei

gh

ted

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erag

eCal

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ay*

22.4

12.4

5.8

1.8

11.9

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3.6

0.2

11.2

Infu

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00

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00

00

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20

00

Ave

rage

Num

ber

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01.

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00.

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01.

7

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alls

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ay*

3.2

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day

spe

rw

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wor

ked

(out

of5

days

)D

ata

coll

ecte

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10/9

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rough

3/27

198

Pho

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etC

all

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ting

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llow

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4/9/

98

Num

ber

.N

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nt

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uiri

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nt

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cen

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min

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goin

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lyF

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ctly

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astr

oen

tero

logy

Ron

naF

ogle

(2/1

6)C

NI

154

2226

58%

15%

85%

100%

Ron

naF

ogle

(2/1

7)12

121

2255

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100%

Ron

naF

ogle

(2/1

8)19

921

3063

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/19)

2619

3251

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(2/2

0)6

314

1735

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onna

Fog

le(2

/23)

214

3337

57%

11%

89%

100’

/R

onna

Fog

le(2

/24)

84

1115

53%

27%

73%

100%

Ron

ria

Fog

le(2

/25)

41

910

40%

10%

90%

100%

Ror

ina

Fog

le(2

/26)

82

1416

50%

13%

88%

100%

Ron

naF

ogle

(2/2

7)9

119

2045

%5%

95%

100%

Ave

rage

Cal

ls!

Day

12.8

4.8

19.6

24.4

51%

17%

83%

100%

Dia

neK

emp

(2/1

0)C

NS

64

26

100%

67%

33%

100%

Dia

neK

emp

(2/1

1)4

15

667

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0%D

iane

Kem

p(2

/12)

31

56

50%

17°/a

83%

100%

Dia

neK

emp

(211

8)4

110

1136

%9%

91%

100%

Dia

neK

emp

(2/1

9)2

011

718

%0%

100%

64%

Dia

neK

emp

(2/2

0)8

114

1553

%7%

93%

100%

Dia

neK

emp

(2/2

3)2

17

825

%13

%88

%10

0%D

iane

Kem

p(2

/24)

60

1515

40%

0%10

0%100%

Ave

rage

Cal

ls!

Day

4.4

1.1

8.6

9.3

49%

16%

84%

95°/

a

Div

isio

nal

Wei

ghte

dA

vera

geC

alls

!D

ays

17.2

5.9

28.2

33.7

Infu

sion

Jenn

ifer

Ste

iner

(2/1

6)C

NII

22

46

33%

33%

67%

100%

Jenn

ifer

Ste

iner

(2/1

8)1

920

273%

31%

69%

93%

Jenn

ifer

Ste

iner

(2/2

3)5

96

1533

%60

%40

%10

0%Je

nnif

erS

tein

er(2

/25)

47

1722

17%

29%

71%

Av

erag

eCal

ls/D

ay3.

06.

811

.817

.522

%38

%62

%96

°/a

Div

isio

nal

Wei

ghte

dA

vera

geC

alls

!D

ays

1.2

2.7

4.7

7.0

*Wei

ghte

dby

days

per

wee

kw

orke

d(o

utof

5da

ys)

Dat

aco

llec

ted

2/10

/98

thro

ugh

3/27

/98

Pho

neLo

gR

awD

ata

She

et4/

9/98

Cal

lR

outi

ngs

and

Follo

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p

Num

ber

..

Num

ber

Num

ber

Num

ber

Rou

ted

Per

cen

tR

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ring

Per

cen

tP

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nt

Per

cent

Rou

ted

Oep

artm

ent

Req

uiri

ng.

Fol

low

-Up

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min

gC

alls

Out

goin

gC

alls

Cor

rect

lyF

ollo

w-U

pIn

com

ing

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lsO

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ing

Cal

lsC

orre

ctly

Nep

hrol

ogy

Cat

hyB

row

n(2

/16)

PN

P22

1050

6037

%l7

%83

%10

0%

Cat

hyB

row

n(2

)17)

107

2431

32%

23%

77%

100%

Cat

hyB

row

n(2

/18)

82

3032

25%

6%94

%10

0%

Cat

hyB

row

n(2

/19)

63

1922

27%

14%

86%

100%

Cat

hyB

row

n(2

120)

145

6065

22%

8%92

%10

0%

Cat

hyB

row

n(2

/23)

40

1717

24%

0%10

0%10

0%

Cat

hyB

row

n(2

/24)

83

1316

50%

19%

81%

100%

Cat

hyB

row

n(2

/25)

105

2833

30%

15%

85%

100%

Cat

hyB

row

n(2

/26)

98

2735

26%

23%

77%

100%

Cat

hyB

row

n(2

/27)

57

4047

11%

15%

85%

100%

Ave

rage

Cal

ls/D

ay9.

65

30.8

35.8

28%

14%

86%

100%

Bre

nda

Pont

illo

(2/1

7)P

NP

05

2934

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0°/o

Bre

nda

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(2/1

8)8

631

3722

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0%

Bre

nda

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(2/1

9)9

740

4719

%15

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0%

Bre

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Pont

illo

(2/2

3)2

741

484%

15%

85%

100%

Bre

nda

Pont

illo

(2/2

4)6

616

2227

%27

%73

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0%

Bre

nda

Pont

illo

(2/2

5)7

538

4316

%12

%88

%100%

Bre

nda

Pont

illo

(2/2

6)4

716

2317

%30

%70

%10

0%

Ave

rage

Cal

lsI

Day

5.1

6.1

30.1

36.3

15%

19%

81%

100%

Div

isio

nal

Wei

ghte

dA

vera

geC

alls

!D

ay*

14.7

11.1

60.9

72.1

Wei

ghte

dby

days

per

wee

kw

orke

d(o

utof

5da

ys)

Dat

aco

llec

ted

2/10

/98

thro

ugh

3/27

/98

Pho

neLo

gR

awD

ata

She

et4/

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Cal

lR

outi

ngs

and

Follo

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Num

ber

..

Num

ber

Num

ber

Num

ber

Rou

ted

Per

cent

Req

uiri

ngP

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nt

Per

cen

tP

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ntR

oute

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equi

ring

.

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low

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min

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alls

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alls

Cor

rect

lyF

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com

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lsO

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ing

Cal

lsC

orre

ctly

TEA

M2

Neo

nat

olo

gy

Ann

ela

trow

(2/1

8)C

NIII

32

1820

15%

10%

90%

100%

Ann

ela

trow

(2/2

0)1

112

138%

8%92

%10

0%A

nne

latr

ow(2

/24)

34

1317

18%

24%

76%

100%

Ann

ela

trow

(2/2

5)3

12

310

0%33

%67

%10

0%A

nne

latr

ow(2

/27)

00

33

0%0%

100%

100%

Ave

rage

Cal

lsI

Day

21.

69.

611

.228

%15

%85

%10

0%

Div

isio

nal

Wei

ghte

dA

vera

geC

alIs

iD

ay*

1.2

1.0

5.8

6.7

Neu

rolo

gyS

ueA

rmst

rong

(2/1

7)C

CC

1512

1628

54%

43%

57%

100%

Sue

Arm

stro

ng(2

/18)

60

1515

40%

0%10

0%10

0%S

ueA

rmst

rong

(2/1

9)1

19

1010

%10

%90

%10

0%S

ueA

rmst

rong

(212

0)4

38

1136

%27

°/a

73%

100%

Sue

Arm

stro

ng(2

/23)

92

2123

39%

9%91

%10

0%S

ueA

rmst

rong

(2/2

4)5

015

1533

%0%

100%

100%

Sue

Arm

stro

ng(2

/25)

13

1316

6%19

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0%S

ueA

rmst

rong

(2/2

6)9

315

1850

%17

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0%S

ueA

rmst

rong

(2/2

7)6

226

2821

%7%

93%

100%

Ave

rage

Cal

LsI

Day

6.2

2.9

15.3

18.2

32%

15%

85%

100%

Ann

Mar

ker

(2/1

6)C

NII

50

66

83%

0%10

0%10

0%A

nnM

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