Physician Staffing for the VA Volume II, Supplementary Papers (1992) / Chapter Skim
Currently Skimming:
Surgery Panel Report
Surgery Panel Report
Pages 99-160
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 99... ...
Reported here will be the results of these analyses, along with the panel's commentary and recommendations. EXPERT JUDGMENT APPROACHES TO DE1~R~IN~G HIYSICIAN REQUIREMENTS ~ SURGERY AND ANESrllESIOLOGY The DSE Approach Iditial Effort The first meeting of the surgery panel was convened in the early spring of 1990.
|
From page 100... ...
Study staff tested We feasibility of this process in Me first panel meeting, and found Mat it was generally acceptable and that panel members could successfully render reasonable judgments about physician staffing. The panel concluded that study staff should proceed win Me expert judgment process, but mat many of the underlying assumptions within Me initial staffing exercise should be better defined in the next iteration of the instn~ment: .
|
From page 101... ...
This meeting (on May 2-3, 1990) was devoted to a review and critique of the key concepts and modeling assumptions underlying both the empirically based and expert judgment approaches.
|
From page 102... ...
In Section A of each exercise, the basic question was still the same for all patient care areas: How much time must be contributed by physicians in this medical center's surgery and anesthesiology services to meet a specified workload level during an average weekday in each VAMC, under certain assumptions about patient my and support staff availability? In Section B of each exercise, panelists were asked to esh:mP~ the additional surgery and anesthesiology t-1bE associated with night as well as weekend coverage, certain educational and research activities, administration, and other factors.
|
From page 103... ...
The SADI Approach SADI: Overall Rationale At the conclusion of the second round of panel meetings, study staff implemented a sequence of postdating activities designed to assist the eight panels in arriving at consensus positions regarding the appropriate methodology and data for an expert judgment approach to physician staffing. This postmeeting process was formally initiated with the development of a new Staffing Algonthm Development ~stn~ment (SADI)
|
From page 104... ...
. Production Functions A portion of each of the panel's two meetings was devoted to an examination of alternative specifications of PF models for the inpatient surgery patient care area (PCA)
|
From page 105... ...
If the PF or the IPF were to be the primary tool for determining physician requirements, greater attention must be paid to improving Be overall accuracy of the CDR data Id surgery, it nary be particularly important for empirically based models to distinguish between full-time and part-time belle, since a substantial amount of the VA's surgery is performed by physicians whose major appointments are elsewhere. Eight of these surgeons working one-eighth time each in the VA are not likely to be the productivity equivalent of one fill-time VA surgeon.
|
From page 106... ...
There is little systematic difference across all methods in surgeon requirements for patient care and resident education only (though the survey did not probe this issued. Hence, the SADI and DSE estimates are significantly greater than those from the PF and IPF because ninny more t-lEEs were allocated by the panel under these expert judgment approaches to research, continuing education, leaves of absence, purchased coverage for nights and weekends, and non-VA consulting physicians.
|
From page 107... ...
Outpatient staffing is based on a formula of 1.0 t-1~;E per 5000 annual visits. Another external norms application was based on a 1987 survey conducted by the American Medical Association, .1987 AMA Socioeconomic Monitoring System Core Survey, which included only active, nonfederal, patient care physicians.
|
From page 108... ...
· The definition of an FREE is not universal at each institution. For example, the workload expected by one F1BE at some institutions may represent patient care only, while at others a large amount of teaching and/or research is also Plumed in each P-1EE.
|
From page 109... ...
If the PF or the IPF were to be the primary tool for determining physician requirements, then greater attention must be paid to improving the overall accuracy of the CDR data. In surgery, it may be particularly important for the EBPSM to distinguish between full-time and part-time t-lEE, since a substantial amount of the VA's surgery is performed by physicians whose major appointments are elsewhere.
|
From page 110... ...
For anesthesiology, the panel recommends a variant of the Reconciliation Strategy that allows (but does not require) the VA decision maker to place due weight on both expert judgment and empirically based approaches in calculating physician requirements.
|
From page 111... ...
Rather, the fraction of total surgeon FORE requirements to be filled by VA staff physicians should be determined only after careful consideration of the local availability of C&A and WOC surgeons. Extemal Nones Developing non-VA physician staffing standards to which the VA's own staffing could be validly compel proved difficult for several reasons.
|
From page 112... ...
Third, since few private institutions have established explicit staffing standards, and there are no nationally recognized standards, one can question how much policy significance should be given to observed staffing ratios. Overall Adequacy of Physician Staffing in the VA It is evident from Tables 1 and 2 that the panel does not regard surgery and anesthesiology staffing to be adequate (in FY 1989)
|
From page 113... ...
But these affiliates are under increasing pressure to cut costs, and they may become increasingly resistant to such sharing arrangements. Final Remarks For establishing VA staffing standards in surgery and anesthesiology, tibe panel endorses the study committee's Reconciliation Strategy, with the components of Al }iE specified as indicated above.
|
From page 114... ...
level emerging, alternatively, Tom the CDR, Dam both empirically based approaches (as applicable, and Tom both expert judgment approaches.
|
From page 115... ...
B Direct Care and Resident Education ~ l EE Only VAMC CDR IPP DSE!
|
From page 116... ...
(-3.477) where W SUR MD = MElD_MD = with R2 = 0.943 and N= 130 the natural logarithm of total WWUs, plus 1, produced in the inpatient medicine PCA during the fiscal year; VA staff physician Al ~E from surgery allocated to direct care in the inpatient PCA; VA staff physician Al ~E!
|
From page 117... ...
- , neurology, or rehabilitation medicine cost centers; nursin~staff Al HE divided by total Al HE for physicians involved in hands-on delivery of care in He inpatient surgery PCA, defined to include internists, surgeons, psychiatrists, neurologists, and rehabilitation medicine physicians (hereafter, this variable will be labeled more succinctly, Nursing-staff Clue! per total physician Glue in this PCA.)
|
From page 118... ...
118 where P~lYSlCUNSI.HFFING FOR To Vat-VOLUME ~ Ambulatory Surged Patient Care Area W = 12.549 + 0.694 SUR MD + 0.069 SUPPORTtMD (7.261)
|
From page 119... ...
across all PCAs, plus total contract anesthesiologist Al HE! at the VAMC, plus total VA anesthesiologist P-l EE allocated to resident education, plus 1; ANWWU = total surgery WWUs produced during the fiscal year across all inpatient PCAs (divided by 10,000~;
|
From page 120... ...
120 P! IYSI~IAN STHFTl~G FOR ARE Vat-VOLUME RESIDENTS = ALLOWS = total ~1~E!
|
From page 121... ...
SUR:GEORY PA~EL ~ORT TABLE 4 B~al Nonns~urgery 121 Source9 Result9 and Denvation9 if any: VA affi'ia~ VAMC = 1 MD/15 bede; unaffilia~ = 1 MD/l9 beds Indian Health Ser~2 surgeons + 1 addidonal for every 190 cases over 300/yr Amer~can Mediml Assmiation Core Sur~q Disl = 5.3 dis/wk x 47.1 v~c/yr x (40 hr/wk / 58.1 hr/wk)
|
From page 122... ...
122 TABLE 4 External Norms~urgery (continued) PHYSIC MING FOR ~ VA-VOLUME n DoD Standards for the workload per MD per year are specified separately by DoD for each of the large number of specialists, e.g., intend - , neurologists, general surgeons, orthopaedic surgeons, neurosurgeons, etc.
|
From page 123... ...
SURGERY PI REPORT TABLE 5.A Surgery External ~. _ - ~ ~Ce 123 Computed Inpatient Fl~E at Source Statistic W=/MD VAMC I VAMC II VAMC m DoD ADC/MD7.1 9.3 17.1 6.5 HMO ADC/MD7.0 9.4 17.3 6.6 IHS Cases/MD190.0 13.6 26.7 13.6 AMA ADC/MD4.0 16.5 30.3 ll.S Disch/MD36S.0 6.8 13.7 6.8 Disch/MD381.0 6.6 13.1 6.6 NYH&HC ADC/MD5.0 13.2 24.2 9.2 1965 VA Stds BEDS/MD15 or 19 5.1 9.5 2.8 Computed Outpatient Al ~E at Source Sta~ticWkld/MD VAMC I VAMC II VAMC m I DoD vm/MD5,100 S.2 6.3 5.3 HMO vie/MD1,750 15.1 18.3 15.9 IHS vie/MD5,000 5.3 6.4 5.6 AMA vm/MD5,700 4.6 5.6 4.9 NYH&HC vie/MD6,420 5.4 6.5 S.6 GHA~t.Paul vie/MD4,050 6.5 7.9 6.9 1965 VA stds vie/MD3,500 7.6 9.2 7.9 Computed Tota1 Vl ~E at Source VAMC I VAMC II VAMC m DoD 14.5 23.4 11.8 HMO 24.6 35.6 22.4 IHS 18.9 33.1 19.1 AMA 11.5 19.3 11.7 NYH&HC 18.6 30.7 14.8 1965 VA stds 12.6 18.6 10.8
|
From page 124... ...
124 P~IYSICUN SIFTING FOR TRE Vat-VOLUME n TABLE 5.B Anesthesiology External Nomm Applied to VAMCe .
|
From page 125... ...
Section B seelcs responses to a series of questions for the time spent in activities other than direct patient care. Instructions: In Section A, for each cell of each table, please estimate the number of physician hours required from He Surgery Service to deliver good~uality care under the specified circumstances.
|
From page 126... ...
Chart 1 Time per Admission Work-Up without Resident Tilde per Admission Work-up with Resident (Resident Does Work-Up, Staff Physician Reviews Data) High Low Mean Median High Low Mean Median 1.00 0.50 0.70 0.75 0.50 0.20 0.30 0.25
|
From page 127... ...
Abut 2 127 Time per Admission Work-Up without Resident High Low Mean Median Time per Admission Work-up with Resident (Resident Does Work-Up, Staff Physician Reviews Data) High Low Mean Median 2.00 1.25 1.55 1.50 1.50 0.33 0.65 0.50
|
From page 128... ...
caseload, will, of coupe, consist of a moo of highly complicated, moderately complicated, and uncomplicated patients. In responding, assume the proportion of each type of case reflects what one would expect in a typical VAMC with a university-sponsored affiliation in Surgery (and perhaps with other ppecialties3.
|
From page 129... ...
Mean 0.00 0.00 0.00 0.20 0.20 0.20 Median 0.00 0.00 0.00 0.00 0.00 0.00 Any special procedure High 0.50 1.00 1.50 2.00 2.50 3.00 al from those Low 0.00 0.00 0.33 0.00 0.00 0.00 conducted on SICU Mean 0.30 0.60 1.00 1.20 1.40 1.70 (e.g., Starting IVs, Median 0.50 0.75 1.00 1.25 1.25 1.50 Thorac~tesis, Inserting Unnary Catheters, and Suture Removal) Overall Mean Time Overall Median Time 1.40 2.70 3.80 4.80 5.70 6.90 1.60 3.00 4.25 5.50 6.00 7.25
|
From page 130... ...
Integrated win Residents of an Affiliated University Gen Surg Ward Average LOS = 7 ADC ADC ADC ADC ADC ADC 5 10 15 20 25 30 Daily Rounds High 0.50 0.60 0.90 1.20 1.50 1.80 Low 0.25 0.33 0.50 0.67 0.80 1.00 Mean 0.30 0.50 0.70 0.90 1.10 1.10 Median 0.30 0.50 0.75 0.75 1.00 1.00 Charting, Phone, High 0.25 0.33 0.50 0.67 0.80 1.00 and Paperwork Low 0.00 0.00 0.00 0.00 0.00 0.00 Mean 0.30 0.20 0.30 0.40 0.50 0.50 Median 0.10 0.20 0.30 0.40 0.50 0.60 Patient and High 0.70 0.25 0.50 0.50 0.75 0.75 Fenily Contacts Low 0.00 0.00 0.00 0.00 0.00 0.00 and Teaching Mean 0.20 0.10 0.20 0.30 0.40 0.50 Median 0.10 0.15 0.23 0.33 0.40 0.50
|
From page 131... ...
Integrated with Residents of an Affiliated Universitr Gen Surg Ward Average LOS = 7 ADC ADC ADC ADC ADC ADC 5 10 15 20 25 30 Supervision High 1.00 1.00 1.50 1.60 2.00 2.40 and Teaching Low 0.00 0.00 0.00 0.00 0.00 0.00 (Residents/Staff) Mean 0.40 0.60 0.80 1.00 1.20 1.40 Median 0.40 0.80 1.00 1.25 0.15 1.50 Any special procedures High 0.25 0.25 0.50 0.50 0.80 0.60 apart from those Low 0.00 0.00 0.00 0.00 0.00 0.00 conducted on SICU Mean 0.10 0.10 0.20 0.20 0.30 0.30 (e.g., Starting IVs, Median 0.05 0.10 0.15 0.20 0.25 0.30 Thoracentesis, Inserting Urinary Catheters, "d Suture Removal)
|
From page 132... ...
132 -I ~ Day ~ ~C~ ~S~ F~ ~ ~ Bar ~ ~_= ~ ~ _ ~~ 1 , ~ ~ ~ ~ ~ ~ of age S -- S^~-of~.
|
From page 133... ...
SURGERY PI DEPORT Chart 5 (continued) 133 Assume No Residents Gen Surg Ward Average LOS = 7 ADC ADC ADC ADC ADC ADC S 10 15 20 25 30 Any special procedures apart from Rose conducted on SICU (e.g., Starting IVs, Thoracentesis, Inserting Urinary (catheters, and Suture Removal)
|
From page 134... ...
134 C0t 6 PHYSICIAN STAFFING FOR TO Vet-VOLUME Assume Pull Component of Residents (PGY 1-S) Integrated with Residents of an Affiliated University Gen Surg Ward Average LOS = 7 ADC ADC ADC ADC ADC ADC S 10 IS 20 2S 30 Daily Rounds High 0.06 1.20 1.80 2.40 3.00 3.50 Low 0.S0 0.7S 0.75 1.00 1.2S 1.50 Mean 0.S0 0.90 1.10 1.60 1.90 2.30 Median 0.50 0.80 1.00 1.67 2.00 2.30 Charting, Phone, High 0.25 0.33 0.50 0.67 0.83 1.00 and Paperwork Low 0.00 0.00 0.00 0.00 0.00 0.00 Mean 0.90 0.20 0.30 0.40 0.50 0.60 Median 0.17 0.25 0.40 0.50 0.S0 0.70 Patient and Family High 0.25 0.25 0.05 0.S0 0.7S 0.75 Contacts and ~ Low 0.08 0.17 0.2S 0.33 0.40 0.50 Teaching Mean 0.10 0.20 0.30 0.40 0.50 0.60 Median 0.10 0.20 0.30 0.40 0.50 0.60 Supervision High 2.00 2.00 3.00 3.00 4.00 4.00 and Teaching Low 0.00 0.00 0.00 0.00 0.00 0.00 Residents/Staff Mean 0.70 0.90 1.30 1.50 1.90 1.80 Median 0.50 0.S0 1.00 1.00 1.25 1.25 Any special procedures High 0.20 0.30 0.40 0.50 0.60 0.70 (e.g., Insertion Low 0.00 0.00 0.00 0.00 0.00 0.00 of Monitors and Mean 0.10 0.20 0.20 0.20 0.30 0.40 Nutritional Median 0.00 0.20 0.25 0.25 0.50 0.50 Devices)
|
From page 135... ...
. Gen Surg Ward Average LOS = S .
|
From page 136... ...
136 P! IYSICI ~FPING FOR TRE Vat-VOLUME ~ TIME PER INITIAL CONSULTATION OFF YOUR PCA Fill in the average time in hours required by a staff physician in your service for each initial (new)
|
From page 137... ...
SURGERY PAINED REPORT TIME PER FOLLOW-UP VISIT (POST-CONSULTATION) OPP YOUR PCA 137 Fill in the average time in hours Muir by a staff physician in your service for each follow-up consultation visit (post~onsultation)
|
From page 138... ...
138 P~YSICUN SI~FPI~G FOR ARE Vet-VOLUME OUTPA'liBNT VISITS Please fill in We average time iD holds required by a staff physician in your service for the average ambulatory care clinic visit by a typical patient to one of the clinics run by the surgical/ane~hesiology service, noting the presence or absence of residents and nonphysician practitioners, and whether the visit is by a new or Inning patient. Mart 10 Physician Tine per Visit Type of Visit High Low Mean Median .- ., New Patient Visit No Resident New Patient Visit With Resident New Patient Visit With NP or PA Follow-Up visit No Resident Follow-Up Visit With Resident Follow-Up Visit With NP or PA 0.50 0.33 0.40 0.50 0.33 0.20 0.25 0.25 0.33 0.10 0.25 0.33 0.25 0.10 0.20 0.20 0.20 0.10 0.10 0.10 0.20 0.10 0.10 0.10
|
From page 139... ...
List the time in hours that you would add to each physician's average weekday to allow for Me types of non-patient care work listed below: C:hart 11 Assume the amount of research accomplished et this VAMC is: High' Mediumi Low' Education of Residents High 4.00 1.00 0.80 (didactic, classroom, Low 0.50 0.50 0.00 not on the PCA) Mean 1.80 0.60 0.40 Median 1.50 0.50 0.50 Administration by High 8.00 6.00 4.00 - Chief (time required Low 1.50 0.75 1.50 to manage your whole Mean 3.40 2.60 2.10 service by a Chief Median 2.00 2.00 2.50 and/or Assistant Chief)
|
From page 140... ...
in FY 1988: High: e.g., VAMC I with S8.8 million ~ total fielding; Medium: e.g., VAMC II with S2.75 million in total funding; Low: e.g., VAMC m with about S176,000 in total Finds. 2Assume that Chief does not participate sigmficantly in the Education of Residents and HospitalRelated Activities; SADI users may easily modify this assumption.
|
From page 141... ...
staff (nonresident) member of your service should devote to each of the following categories of non-patient care~related activities?
|
From page 142... ...
The ultimate intention is to develop algorithms which could be applied to estimate staffing requirements at VA medical centers, presumably duplicating the results specialty and clinical program panelists themselves would have derived. Section A of the SADI requests time estimates, in some cases by workload unit.
|
From page 143... ...
This ~average. caseload will, of course, consist of a mix of highly complicated, moderately complicated, and uncomplicated patients.
|
From page 144... ...
1~ ~ ~-~o _ =MISSI~C~C~D Cat Hue ~^~y~ ~- ~ ~ ~ ~ fir ~ aid ~ ~ of _~ ~_of"~ma. Spoof_,_ ~t-~_- "~.
|
From page 145... ...
Keep in mind ~ &e Daily Rounds do not include new admission warmups, since Hey are covered Charts 1. Mart 3 Assume No Residents General Surgery Ward Average LOS = 7 ADC ADC ADC ADC ADC ADC S 10 15 20 25 30 Daily Rounds Low 0.40 0.80 1.20 1.60 2.00 2.40 High 0.S0 1.00 1.51 2.00 2.50 3.00 Median 0.45 0.90 1.35 1.80 2.25 2.70 Charting, Low 0.00 0.00 0.00 0.00 0.00 0.00 Phone, and High 0.50 1.00 1.50 2.00 2.50 3.00 Paperwork Median 0.45 0.50 0.75 1.00 1.25 1.50 Patient and Family Low 0.00 0.00 0.00 0.00 0.00 0.00 Contacts and Ugly 0.00 0.00 0.00 0.00 0.00 0.00 Teaching Median 0.00 0.00 0.00 0.00 0.00 0.00 Supervision Low 0.40 0.40 0.40 0.40 0.40 0.40 and Teaching High 0.50 1.00 1.00 1.00 1.00 1.00 (Residents/Staf ~Median 0.45 0.70 0.70 0.70 0.70 0.70
|
From page 146... ...
. Any Special Procedures Apart Tom those Conducted on SICU (e.g., Starting IVs, Thoracentesis, Inserting Urinary Catheters, and Suture Removal)
|
From page 147... ...
SURGERY PANEL REPORT Chart 4 147 Assume Pull Component of Resided (PGY1-5) Integrated with Residents of an Af~ia~ University General Surgery Ward ADC ADC ADC ADC ADC ADC Average LOS = 7 S 10 15 20 2S 30 Daily Rounds Low 0.10 0.20 0.30 0.40 0.S0 0.60 High 0.50 0.50 0.75 1.00 1.00 1.00 Median 0.30 3.50 0.53 0.70 0.75 0.80 Charting, Phone, Low 0.10 0.10 0.20 0.20 0.30 0.30 and Paperwork High 0.00 0.00 0.00 0.00 0.00 0.00 Median 0.05 0.05 0.10 0.10 0.15 0.1S Patient and Family Low 0.00 0.00 0.00 0.00 0.00 0.00 Contact and High 0.00 0.00 0.00 0.00 0.00 0.00 Teaching Median 0.00 0.00 0.00 0.00 0.00 0.00 Supervision Low 0.S0 0.50 0.50 0.S0 1.00 1.00 and Teaching High 0.50 0.50 0.50 1.00 1.00 1.00 Residents/Staff Median 0.50 0.50 0.50 0.75 1.00 1.00 Any special Low 0.20 0.20 0.20 0.40 0.40 0.40 procedures apart High 0.00 0.00 0.00 0.00 0.00 0.00 from those Median 0.10 0.10 0.10 0.20 0.20 0.20 conducted on SICU (e.g., Starting IVs, Thoracentesis, Inserting Urinary Catheters, and Suture Removal)
|
From page 148... ...
This atypical. caseload will, of course, present the very difficult and more complex patients characterized as Highly complicated.
|
From page 149... ...
SURGERY PENAL REPORT Chart 5 (continued) 149 Assume No Residents GeneralSurgery Ward ADC ADC ADC ADC ADC ADC Average LOS = 7 S 10 15 20 25 30 Any special Low 0.20 0.40 0.50 0.80 1.00 1.20 procedures apace High 0.00 0.00 0.00 0.00 0.00 0.00 from Dose Median 0.10 0.20 0.30 0.40 0.50 0.60 conducted on SICU (e.g., Starting IVs, Thoracentesis, Inserting Urinary Catheters, and Suture Removal)
|
From page 150... ...
. , General Surgery Ward ADC ADC ADC ADC ADC ADC Average LOS = 7 5 10 15 20 25 30 Daily Rounds Low 0.20 0.40 0.60 0.80 1.00 1.20 High 0.50 1.00 1.50 2.00 2.S0 2.50 Median 0.35 0.70 1.05 1.40 1.75 1.85 Charting, Phone, Low 0.10 0.20 0.30 0.40 0.50 0.60 and Paperwork High 0.00 0.00 0.00 0.00 0.00 0.00 Median 0.50 0.10 0.15 0.20 0.25 0.30 Patient and Low 0.10 0.20 0.30 0.40 0.50 0.60 Family Contacts High 0.00 0.00 0.00 0.00 0.00 0.00 and Teaching Median 0.05 0.10 0.15 0.20 0.25 0.30 Supervision Low 0.50 1.00 1.50 2.00 2.50 3.00 and Teaching High 0.50 1.00 1.50 2.00 2.00 2.00 Residents/Staff Median 0.90 1.00 1.50 2.00 2.25 3.00 Any special Low 0.20 0.20 0.20 0.40 0.40 0.40 procedures apart High 0.00 0.00 0.00 0.00 0.00 0.00 from those Median 0.10 0.10 0.10 0.20 0.20 0.20 conducted on SICU (e.g., Starting IVs, Thoracentesis, Inserting Urinary Catheters, and Suture Removal)
|
From page 151... ...
SURGERY PANEL REPORT Chart 7 151 Assume Pull Component of Residents (PGY1-5) Integral with Residents of an Afghan Unnrersiq SICU UNIT ADC ADC ADC ADC ADC ADC Average LOS = 5 3 5 7 9 11 13 Daily Rounds Low 0.20 0.20 0.30 0.40 0.60 0.80 High 0.30 0.S0 0.70 0.90 1.10 1.30 Median 0.25 0.35 0.50 0.65 0.85 1.15 Charting, Phone, Low 0.10 0.10 0.20 0.20 0.30 0.40 and Paperwork High 0.50 0.70 0.90 1.10 1.30 1.50 Median 0.30 0.40 0.55 0.65 0.80 0.95 Patient and Low 0.10 0.10 0.20 0.20 0.30 0.40 Family Contacts High 0.10 0.20 0.30 0.50 0.70 1.00 and Teaching Median 0.10 0.15 0.25 0.35 0.S0 0.70 Supervision Low 0.50 0.75 1.00 1.25 1.50 2.00 and Teaching High 1.00 1.00 1.00 1.50 2.00 2.00 Residents/Staff Median 0.75 0.88 1.00 1.38 1.75 2.00 Any special Low 0.20 0.20 0.40 0.40 0.40 0.40 procedures High 0.20 0.30 0.50 0.80 1.00 1.20 (e.g., Insertion Median 0.20 0.25 0.45 0.60 0.70 0.80 of Monitors and Nutritional Devices)
|
From page 152... ...
152 P~Y~ICUN STAFFING FOR T7IE Vat-VOLUME ~ TIME PER INITIAL CONSULTATION OFF YOUR PCA Fill in the average tune in hours required by a staff physician in your service for each initial (new) consult on another seance, noting the presence or absence of a resident in your own service.
|
From page 153... ...
SURGERY PAIL REPORT TIME PER FOLLOW-1P VISIT (POST-CONSULTATION) 0~7 YOUR PCA 153 Fill in the average time in hours required by a staff physician ~ your service for each follow-up consultation mat (po4~ |
From page 154... ...
List the time in hours that you would add to each physician's average weekday to allow for Me types of non-patient care work listed below: (:hart 10 .
|
From page 155... ...
in FY 1988 High: e.g., VAMC I with S8.8 million in total funding; Medium: e.g., VAMC II with S2.75 million in total funding; Low: e.g., VAMC m with about S176,000 in total funding. 155 2Assume that Chief does not participate significantly in the Education of Residents and HospitalRelated Activities; SADI users may easily modify this assumption.
|
From page 156... ...
Chart 11 _ Assumes the amount of research accomplished at this VAMC is: Hight Mediumi Lows Continuing Education7 7 7 Research (off the PCA) 30 15 2 Vacation, A~ninist~tive Leave, Sick Leave, Other 10 10 10 Total Percentage of Time 47 32 19 Examples of research level by total amount of funding (VA plus non-VA)
|
From page 157... ...
SURGERY PANEL REPORT ADDITIONAL QUESTIONS FOR ANESTHESIOLOGY 157 For each of the following combinations of operating rooms (in use) , level of resident/CRNA support, and numb" of operative procedures per dry, please estimate He average time (m hours)
|
From page 158... ...
158 Chart 13 P~YSl~lAN SI,JF7FI~& FOR ME Vie-VOLUME Procedures per Day Assume Four Major OR Suites, One Cysto Room, and One Endo Room Major OR Suites 4 8 13 15 16 Cysto Room 1 1 1 0 1 Endo Room 1 1 1 0 1 No Resident Low 15.00 21.00 42.00 45.00 51.00 No CRNA High 16.00 32.00 40.00 45.00 49.00 Median 15.50 26.50 41.00 45.00 50.00 One Resident Low 7.50 10.50 22.50 24.00 25.50 No CRNA High 16.00 32.00 40.00 45.00 49.00 Median 11.50 16.25 31.25 34.50 37.25 No Resident Low 7.50 10.50 22.50 24.00 22.50 High 16.00 32.00 40.00 45.00 49.00 Median 11.50 16.25 31.25 34.50 37.25 l
|
From page 159... ...
SURGERY PI SPORT Cot 14 159 P=c~ures per Day Assume Seven Major OR Suites, Two Cysto Rooms, and Iwo Eye Rooms Major Suites 7 14 20 26 26 Cysto Room 2 2 3 0 3 Eye Room 2 2 3 0 3 No Resident Low 27.00 48.00 78.00 78.00 87.00 No CRNA High 26.00 50.00 63.00 78.00 81.00 Median 26.50 49.00 70.50 78.00 84.00 One Resident Low 15.00 27.00 39.00 45.00 51.00 No CRNA High 26.00 50.00 63.00 78.00 81.00 Median 20.50 38.50 51.00 61.50 66.00 No Resident Low 12.00 27.00 39.00 45.00 51.00 One CRNA High - 26.00 50.00 63.00 78.00 81.00 Median 19.00 38.50 51.00 61.50 66.00 .
|
From page 160... ...
SABISTON, Jr. eclairs, - Professor and Chairman, Department of Surgery, Duke University Medical Center, Durham, North Carolina ELIZABETH BATES, Director, Health Services Research and Development, Ann Arbor VA Medical Center, Ann Arbor, Michigan KIRBY I
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.