Patricia Wirth

Comparability of two methods of time and motion study used in a clinical setting: work sampling and continuous observation.

Two methods of time and motion study, continuous observation and work sampling, were used to measure physician behavior in a prepaid group practice. Results of the two methods were compared to determine whether differences occurred because of method. No significant differences appeared in time/unit of patient service for 82 per cent of physicians studied, nor did the presence of the continuous observer affect the number of units of patient service/half day of observation. Nonpatient activities showed a slightly larger number of differences although 74 per cent of comparisons of mean activity times still showed none. Suggested causes for noted discrepancies may be circumstantial dissimilarities in the two study periods or observer proximity. Nonetheless, overall the two methods show a high degree of similarity. Unless there is particular interest in the exact content of the physician-patient encounter, when continuous observation is required, work sampling is preferred because of time, cost, and possible observer influence on nonpatient activities.

The Cost of a Primary Care Teaching Program in a Prepaid Group Practice

Costs were determined for a teaching program in general pediatrics and general internal medicine for advanced residents in a prepaid group practice, the Medical Care Group of Washington University. A time and motion study was conducted to measure the productivity of faculty physicians before and after the establishment of the teaching program. There was a statistically significant loss in productivity for internists and an apparent loss, though not significant, for pediatricians as a result of their teaching effort, but the productivity of the residents more than compensated for the loss. The residual positive value of a full time equivalent (FTE) pediatric resident after reimbursement of all possible lost productivity by faculty pediatricians represented 43.9 per cent of a FTE pediatrician. For a FTE resident in internal medicine the residual positive value was 49.7 per cent of a FTE internist.

An analysis of the fifty graduates of the Washington University Pediatric nurse practitioner program. Part 1: scope of practice and professional responsibility.

With the initiation of increased federal spending on programs to prepare nurses in the expanding role, through program evaluators descriptive data has become available on many program graduates. In much of this research, the number of cases limits the generalizations that can be made from these data. In addition, generalizations are difficult when comparing programs because the data do not “match.” With this issue, we begin a four part series of the program evaluation of the graduates of The Pediatric Nurse Practitioner Program at Washington University. It is hoped that by publishing these and similar articles, models for evaluation can be developed to yield comparable data. Fifty graduates of one PNP program were surveyed to determine their practice settings and patient responsibilities. The PNPs were younger, more highly educated and more likely to work in ambulatory care settings than nurses in general. Seventy-eight percent were actively employed as PNPs. They saw a median of 13 off ice patients per day. The majority independently performed all 19 functions on a list of tasks common to pediatric practice which are within the PNPs scope of practice and independently managed 15 of 18 common pediatric problems. Although the PNPs functioned fairly autonomously, 85% had physicians available for consultation more than 75% of the time.